Research in primary care : A means to an end

William CW Wong

HK Pract 2019;41:25-26

In response to research capacity building in Hong Kong, The Hong Kong College of Family Physicians introduced the Research Fellowship as early as 2005 and included research projects as an option for HKAM fellowship exit examination in 2012. Thus far, two-third of the candidates have chosen to do research in their exit examination since 2014 with an overall pass rate of >90%. Not only the number had increased over the past few years, we also witnessed the quality of these research improved significantly, some of which were published in international peer-reviewed journals, joining in the scholarly discussion of the issues close to the heart of family doctors and influencing other co-workers in the area of practice.

One good example of how research can change practice was demonstrated in the manuscript, “Palliative care in Hong Kong - past, present and future”¹ when Dr Lam reviewed the local research on the needs of terminally ill patients and highlighted spirituality “gives strength and relates to meaning of life” and how health professionals such as nurses can provide them interpersonal care and support spiritually. Research further tells us what distress and hardship their caregivers had to face in order to provide them appropriate skill training and emotional support.

Based on these work and retrospective reviews of 494 cancer patients in four hospitals and comparison of cancer and non-cancer deaths, the Hospital Authority established new palliative service for non-cancer patients in 2010 and the End-of-Life Care program in residential care homes for the elderly in 2015. The continual cycle of service improvement on palliative care and subsequently the Strategic Service Framework for Hospital Authority in 2017 allow patients to plan their own care and involving family physicians sharing care with palliative care specialists and other healthcare workers. Naturally we are eagerly awaiting outcomes of the evaluation of these changes.

On the other end of the spectrum shoulder pain is extremely common in primary care and we are very pleased to see the update article by Dr Chung on the overview and approach in shoulder pain in this issue.² Use of investigations such as Magnetic Resonance Imaging (MRI) or point-of-care ultrasound in primary care may help delineate shoulder pathology and help family physicians to refer more appropriately while others could be treated with lignocaine and steroid injections by the family physicians.

Nonetheless, our journey of exploration into better quality and standard of care is far from straightforward and complete, and it is perfect time to re-examine our needs and plan our next stages of development.³ It is very encouraging to see many family physicians in Hong Kong intrinsically motivated and willing to participate in research. Research, like clinical practice, can never be learned in classroom setting alone. The idea of fostering research network and collaboration to facilitate further research should be considered seriously. Perhaps it is also time for the College to rethink its research capacity building strategies.