BackgroundChronic obstructive pulmonary disease (COPD) is a common condition encountered in primary care and presents a substantial burden to the health care system. This study aimed to audit COPD care at all public primary care clinics of Hong Kong and to work out improvement strategies.MethodThe computer record of COPD patients aged 40 or above and had been followed up at any of the 73 public primary care clinics under the Hospital Authority of Hong Kong (HAHK) were reviewed. Evidence-based audit criteria and performance standards were established after thorough literature review. In the first phase from 1st April 2017 to 31st March 2018, deficiencies of care were identified. It was followed by a one-year implementation phase through which a series of improvement strategies were executed. Outcome of the service enhancement was assessed in the second phase from 1st April 2019 to 31st March 2020. Student’s t test and Chi-square test were used to identify any statistically significant changes between the two.ResultsTotally 10,385 COPD cases were identified in Phase 1, among whom 3,102 (29.9%) were active smokers. Most of the patients were male (87.7%) and the mean age was 75.3±9.9 years old. Of those smokers, 1,788 (57.6%) had been referred to Smoking Counselling and Cessation Service (SCCS) and 1,578 (50.9%) actually attended it. 4,866 cases (46.9%) received Seasonal Influenza Vaccine (SIV) and 4,227 cases (40.7%) received Pneumococcal Vaccine (PCV). 1,983 patients (19.1%) had spirometry done before and 1,327 patients (12.8%) had been admitted to hospital due to acute exacerbation of COPD (AECOPD). With the concerted effort taken during the implementation phase, Phase 2 data showed a significant improvement in all criteria. There was a marked increase in the SIV and PCV uptake rate, spirometry performance rate and most importantly, a significant reduction in AECOPD rate leading to hospital admission (9.6%, P<0.00001).ConclusionCOPD care at all public primary care clinics of HAHK had been significantly improved for all audit criteria via the systematic team approach, which in turn reduced the hospital admission rate and helped relieve the burden of the healthcare system.
Background:Poor drug adherence is one of the leading causes of uncontrolled hypertension. Little is known about the barriers to attaining good drug adherence among Chinese patients in primary care setting.Methods: Cross-sectional questionnaire survey of patients with uncontrolled hypertension was performed in five primary care clinics in Hong Kong in 2016. Patients who attended regularly for hypertension follow-up, with office systolic blood pressure (SBP) > 140 mmHg &/or diastolic BP > 90 mmHg in recent 2 clinic visits were invited to participate. Structured questionnaire was designed to collect personal and clinical parameters. Drug adherence was assessed by the validated 8-item Morisky's Medication Adherence Scale (MMAS-8). Health literacy was assessed by the Chinese Health Literacy Scale for Chronic Care (CHLSCC). Prescriptions, medical history and biochemical results were collected from electronic record system. Multi-variate logistic regression using low drug adherence as dependent variable was performed.Results: Two hundred and ninety one (291) participants were successfully interviewed. The male to female ratio was 0.65. The mean age was 67.0 (S.D. 9.9). More than 80% of them reported good to moderate drug adherence while 13.7% of them had low drug adherence. More than half of them had inadequate health literacy. The mean number of years since hypertension diagnosed was 9.65 (S.D. 8.73). Almost 40% of them had hypertension less than 5 years. The most popular prescription was once-daily regimen, with 2 or more type of anti-hypertensive drugs. Calcium channel blockers were most commonly prescribed. In the logistic regression model predicting low drug adherence, only diagnosis of HT less than 5 years was statistically significant (adjusted OR = 2.32, 95% C.I. 1.12-4.80, p = 0.02). There was no statistical significance in sex, older age, educational level, health literacy, occupation, number of types of antihypertensive drugs and daily frequency of drugs. Conclusion:In primary care setting, patients with uncontrolled hypertension reported satisfactory drug adherence. They would have lower drug adherence if their hypertension were diagnosed less than 5 years.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.