The family medicine moment has arrived

William CW Wong 黃志威

HK Pract 2023;45:87-88

In 2012, I wrote an editorial for the Hong Kong Practitioners, entitled “Strengthening evidence-based family medicine in Hong Kong” in which I had argued that “the practice of high quality, evidence-based clinical care must form the uncompromised foundation of Family Medicine”.¹ Eleven years on, it is welcoming to see primary care research is at the core and forefront of our everyday practice. Not only family doctors are actively searching for the evidence on improving patient care, but also incorporating these new practices tackling common conditions in primary care in Hong Kong.

In the issue, we saw the introduction of the non-vitamin K antagonist oral anticoagulant (NOAC) such as dabigatran and apixaban in general outpatient clinics (GOPCs) of the Hospital Authority (HA) since 2019. Despite the clear advantages of their efficacy and the side effect profiles in stroke prevention amongst the atrial fibrillation patients, Chen et al found that the utilisation rate was unsatisfactory at only 54% in two GOPCs in Hong Kong.² The authors speculated that the cost and availability of these new drugs in the public sector may deter some patients from using them but even with sponsorship, nearly one-in-five patients not on NOAC would still refuse it.

Health behaviour and treatment choices are complex matters. It involves a high degree of contextual complexity i.e. a broad range of evolving signs and symptoms as well as perceived harms and benefits presented within the patient’s own value and cultural systems. Hence, family doctors need to take into consideration of biomedical and psycho-social evidence before making effective clinical decisions and to provide appropriate care within the healthcare system. A thorough understanding of these processes employed in this setting and successful models of health care delivery will support better and more cost-effective practices.

Professor Jackson and her team were engaged in promoting the use of integrated care approaches by family doctors to provide primary care services to the community. They found a model of integrated care for managing patients with complex type 2 diabetes delivered by family doctors in the community would achieve similar (if not better) clinical outcomes to usual care in outpatient clinics, with higher satisfaction and lower costs.^3-4 It is believed that family doctor-led community health services can provide similar quality of care, reduce cost and, increase access and convenience of health services.⁴

This is particularly relevant with the primary care reform outlined in the Primary Care Blueprint in 2022.⁵ It lies down the future primary healthcare direction in Hong Kong with an emphasis on health promotion and disease prevention. A case report by Yan et al presented the potential difficulties and challenges in identifying and managing familial hyperlipidaemia as an example of territory prevention of premature cardiovascular event.⁶ The district-based community health system based on the district health centre model through protocol-driven care pathway for specified chronic disease screening and co-care with family doctors will hopefully leads to the concept of “family doctor for all” advocated by the Hong Kong College of Family Physicians to cultivate a long-term family doctor-patient relationship and shifting the focus from treatment-oriented to prevention-oriented care.

In response to the changes in the external environment as well as in line with international development, both medical schools in Hong Kong have made a number of strategic moves to strengthen the undergraduate teaching and research on family medicine and primary care. A 7-week rotation was introduced in the specialty clerkship in the undergraduate medical curriculum at the University of Hong Kong (HKU) in 2017. The HKU Primary Healthcare Academy was set up in 2023 serving as a facilitating platform to foster collaboration, training and research across a number of disciplines and schools concerned with the development of primary healthcare in Hong Kong. The Chinese University of Hong Kong (CUHK) introduced more integrated learning with other specialties and the new CUHK Medical Centre allows family medicine students to see patients in the private sector. Both universities have contributed significantly to the developments of evidence-based reference frameworks for common diseases and primary care models.

Family doctors, from the grassroot to higher institutions, must ride on this unique opportunity to work together with the government to deliver the primary care reform that will work for the people of Hong Kong. Participating in the family doctor-patient pairing and chronic disease co-care scheme is a vote of confidence in our discipline and universal health coverage. There may be many hurdles on the way, but I firmly believe family medicine and primary care will have a bright, brilliant future ahead.

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