Authors (including presenting author) :
Luk MH, Lai KPL, Yeung SW, Chan PF
Affiliation :
Department of Family Medicine and Primary Health Care, Kowloon East Cluster
Introduction :
With an aim to enhance the gatekeeping role of family physicians, a Family Medicine Triage Clinic (FMTC) was established in Tseung Kwan O Hospital (TKOH) in August 2019 to manage stable patients with predefined orthopaedics conditions which would otherwise require referral to Orthopaedics Specialist Outpatient Clinic (SOPC). Comprehensive assessment and pharmacological treatment by FM specialists according to evidence-based clinical guidelines, early interventions by physiotherapists and occupational therapists were provided.
Objectives :
To evaluate the outcomes of patients with chronic shoulder pain referred to TKOH FMTC.
Methodology :
Relevant clinical information of all patients with chronic shoulder pain referred to TKOH FMTC from 12 August 2019 to 29 February 2020 in Clinical Management System were reviewed.
Result & Outcome :
Results: 175 patients were referred to FMTC for chronic shoulder pain. Mean age was 61.6 years old (standard deviation: 11.0 years old). 55.4% were female. Median waiting time was 7 days (Interquartile range: 4 – 10.5 days). The median presenting shoulder pain duration was 24 weeks (Interquartile range: 8 – 44 weeks). 12.6% patients had bilateral shoulders involvement. The most common diagnosis was rotator cuff tendinopathy (69.7%), which were followed by adhesive capsulitis (14.3%) and biceps tendinitis (4.6%). Sinister pathologies were also diagnosed, which included rotator cuff tear (3.4%), humeral head fracture (0.6%) and polymyalgia rheumatica (0.6%). The patients attended FMTC were managed with shoulder care advice and analgesics. They were also referred for physiotherapy (82.3%) and occupational therapy for lifestyle and occupational advice and training by occupational therapists (4.6%). For patients who attended FMTC for subsequent visits, 75.3% of them showed symptoms improvement. 33.7% patients had already been discharged from FMTC without need of further follow-up. Only 17.1% patients were referred to the Orthopaedics SOPC for further evaluation and consideration of surgical intervention. There were 46.9% patients defaulted FMTC follow-up, which might be due to COVID-19 outbreak in 2020. Conclusion: Family physicians led Triage Clinic could provide appropriate and effective management to patients with chronic shoulder pain. Patients with severe conditions could also be detected and referred timely to Orthopaedics SOPC. The clinic helped reduce the workload in secondary care by performing a gatekeeper role successfully.
