Authors (including presenting author) :
Chen XR Catherine, Hui LC, Choy PS, Li YC.
Affiliation :
Dept. of Family Medicine and General Outpatient Clinics (GOPCs), Kowloon Central Cluster (KCC)
Introduction :
Cardiovascular disease (CVD) is a major cause of morbidity and mortality both locally and internationally. It ranked third among the 10 leading causes of death in Hong Kong in 2020 and has imposed a significant disease burden to the public health care system.
Objectives :
To meet this challenge, we reviewed the control of 4 major modifiable CVD risk factors (diabetes, hypertension, hyperlipidemia and smoking) among patients with chronic diseases (CD) managed in all GOPCs in KCC over the past 12 years and shared the improvement strategies.
Methodology :
Design: retrospective clinical service review
Subject: Patient with CD and had been FU regularly at GOPCs of KCC from 01/10/2009 to 30/09/2021 were included. CD is defined as the presence of diabetes (DM) or hypertension (HT) or both.
Mail outcome measures: blood pressure (BP) control rate among HT patients, HbA1c capture rate and control rate among DM patients, lipid control rate among DM patients and the smoking cessation rate among smokers with CD. Student’s t test and analysis of variance were used to evaluate continuous variables and Chi squared test for categorical data.
Result & Outcome :
Totally there were 30,694 HT patients and 13,076 DM patients being regularly FU at KCC GOPCs in 2008-2009. Among them, BP control rate was only 52.3% among HT cases, HbA1c capture rate was 69% and HbA1c control rate was 33% for DM patients. Lipid control rate among DM cases was 48.2% in 2013. All these Key performance index (KPI) parameters were the lowest among HA seven clusters. A series of improvement strategies were established to improve the chronic disease control in KCC from year 2009. The introduction of Risk Assessment and Management Program (RAMP) for DM & HT in 2009 and smoking cessation program in 2012 have standardized the management workflow and risk stratification for patients with CD. Staff education and Quarterly clinical audit on CD control both at departmental level and clinic level had been performed to all frontline medical staff. Continuous Quality Improvement projects with studies exploring the therapeutic inertia among CD control had been performed, with gaps identified and filled in. Special clinics addressing the service need of patients with very poor control has been set up both at daytime and night time. Latest KPI reports up to 3Q2021 revealed that BP control rate reached up to 83.7%, HbA1c capture rate 95%, HbA1c control rate 69.3% and lipid control rate 79.3%, all were significantly improved (P<0.001) and ranked first among 7 clusters in HA. The smoking cessation rate among smokers with CDs (56-63%) has been above HA average level throughout the past 5 years.
Conclusion: Primary health care team has played an important role in the comprehensive management of CVD in HA. Through standardized programs, team approach with staff engagement, regular clinical audit and a series of CQI initiatives, the quality of care for CD patients had been significantly improved in primary care clinics of KCC over the past decade. These positive outcomes will help HA face the CVD pandemic and to reduce its mortality and morbidity in the long run.
