Maria KW Leung 梁堃華

HK Pract 2017;39:65-66

Chronic disease management is a global issue and it is, definitely, one of the major tasks of family physicians. Certainly, with an aging population, our tasks become more challenging as we are not only faced with the rise in volume but also an increase in illness complexity in relation to patients’ multi-morbidities. Many different models¹ have been used to tackle chronic diseases, including the well-known Chronic Care Model, as well as Improving Chronic Illness Care, Innovative Care for Chronic Conditions, Stanford Model and the Community-based Transition Model. Two key elements that many models emphasize are “care coordination” and “self-management”.

Allergic rhinitis, being the commonest allergy disease, is frequently encountered in primary care. It has a prevalence of 15-20%². Its severity varies from mild intermittent runny nose to severe nasal blockage affecting sleep and daily activities. In fact, many more allergic rhinitis patients are still not yet diagnosed. In this article, Dr Yeung Wai Man will go through the management of allergic rhinitis with us. While medical treatment is essential to disease control, one must not neglect the importance of the non-pharmacological aspect. Many patients are still unaware of the correct measures that they could do at home. This paper highlights important information that we can use to educate patients in order to empower them with self-management.

Diabetes mellitus (DM) is another common chronic disease seem in primary care, affecting about one in ten Hong Kong residents. It is well understood that poorly controlled diabetic patients may develop macro and/or microvascular complications; indeed, retinopathy is one of the well-known complications. As the symptoms of diabetic retinopathy do not present until the very late stages, it is important for us, as family physicians, to coordinate timely care and assessment so as to allow early intervention and better disease control. In this issue, Dr Michelle Fu and her team shares with us their study in the prevalence of diabetic retinopathy in a group of Chinese hypertensive patients who have new onset DM.

According to the World Health Organisation (WHO), depression will be ranked 2^nd among the top common diseases by 2020. Patients with chronic illness have a higher risk of depression. Various research studies have shown that depression is particularly associated with certain diseases such as cancer, coronary artery disease, diabetes mellitus, epilepsy, multiple sclerosis, stroke and Parkinson’s disease. Barnett et al³ has found that mental disorders, particularly depression, are more prevalent in people with a high number of physical disorders. Several reasons have been suggested for this phenomena: one could be related to the stress during disease treatment; another reason could be related to the changes in the brain as in the case of stroke and Parkinson’s disease. Both these reasons may contribute towards the higher risk of depression among multiple sclerosis (MS) patients. Further, the use of steroid and interferon in the treatment of MS could also be related to depression. Dr Evelyn Wong will share with us her results from a systematic review on the prevalence of depression among multiple sclerosis. Indeed, as pointed out in the study, making a diagnosis of depression in MS could be difficult as both conditions may have similar symptoms. As family physicians, we have been trained with the bio-psycho-social model when we take history and make diagnoses. This model would be particularly helpful for us in identifying a problem list and making an appropriate management plan when we encounter patients with chronic diseases or patients with multi-morbidities.

As a whole, in order to manage chronic disease effectively, family physicians should be equipped with skills in problems identification and care coordination. In addition, we should involve our patients in their own care management by empowering them with knowledge and skills for self-monitoring and self-management, so that the whole management process can then be handed-over to them. As each patient’s learning process is different, regular follow up is essential to maintain skills transfer. Needless to say, the growth of sophisticated information technology (IT) such as smartphone apps will surely play an important role in information and skills transfer.