Hong Kong chronic patients consulting specialists more likely to be admitted to hospital, study finds
Authors say it is vital to encourage the development of primary health care by getting people to have a single family doctor
Chronic patients who opt for specialists rather than general practitioners for regular care were found to be two times more likely to be admitted to hospital, according to a study led by the Chinese University.
Roger Chung Yat-nork, the study’s lead author and a public health professor from the university, told the Post that residents, who often prefer going to specialists, should embrace the concept of family doctors, who provide comprehensive care to people of all ages.
The study, which also involved former health minister Professor Yeoh Eng-kiong, now director of the university’s School of Public Health and Primary Care, looked at data from 25,780 people obtained from the government’s thematic household survey on health carried out between October 2011 and January 2012.
It examined the number of chronic diseases individuals were suffering from, the number of hospital admissions and whether they had regular care from general practitioners or specialists. From this data, it concluded that chronic patients were two times more likely to be sent to hospital if they saw specialists.
However, the study found that patients with two or more chronic diseases, such as cancer, diabetes or heart disease, were less likely to go to hospital if they first visited a general practitioner when they felt unwell.
People under constant primary care, regardless of how many diseases they had, were also less likely to be admitted to hospital.
But more than 65 per cent of the sampled population did not have a regular doctor, indicating a possibility that they shopped around for one. Only 30.6 per cent saw the same general practitioner regularly.
“There is a misconception in the medical sector that specialists appear to be more noble, but I don’t think we should look at it that way,” Chung said.
Family doctors, who are mostly general practitioners, play a central role in primary care – the first level of health care for handling diseases and offering preventive care.
The concept of sticking to one family doctor has not been widely adopted given the convenience of seeing a private practitioner near a person’s home or workplace
The study, which was published in Nature’s Scientific Reports last month, explained that general practitioners provide better continuity in care, meaning doctors could have better knowledge of a patient’s medical history and make more appropriate decisions on treatment – and this might reduce hospital admissions.
That is in contrast to people who visit specialists regularly who are observed to have a significantly higher admission rate.
“Specialists might not be trained in how to treat patients in a primary care setting, which emphasises continuity of care,” Chung said.
Chung added that patients visiting specialists might also have more severe conditions, leading to a higher chance of being admitted to hospital.
Among about 13,000 doctors in the city, around half are general practitioners. But the city does not have an established family doctor system encouraging people to visit the same doctor regularly.
Chung said people should start learning about the concept of family doctors in primary school.
“In Britain, having a family doctor is common sense, People don’t do much doctor-shopping and often discuss medical plans with their doctor,” he said.
Tim Pang Hung-cheong of the Patients’ Rights Association agreed that the notion of seeking specialists first remains deeply rooted in Hong Kong.
“People might feel family doctors are for lower-level people,” Pang said.
He said the work of the Primary Care Office, which was set up in 2010 under the Health Department, had been limited despite efforts to create a doctors’ directory for patients and primary care operational frameworks for doctors. He said the office should operate directly under the Food and Health Bureau to boost its influence.
