Authors (including presenting author) :
LEUNG WL(1)
Affiliation :
(1)Department of Family Medicine and Primary Health Care, Kowloon West Cluster
Introduction :
It is the role of primary care doctors in the public sector to act as gatekeepers in health care system for effective patient management and better allocation of secondary healthcare resources. As family physicians, we often encounter patients with acute conditions of variable severity and urgency. Appropriate and judicious AED referral could reduce the burden of the AED, allowing the AED to focus on managing patients with urgent needs.
Objectives :
1. To review the epidemiology of AED referral pattern in our General Practice Clinic (GPC);
2. To demonstrate any changes in referral patterns when compared with a similar review conducted by our clinic in 2007;
3. To promulgate the results to our team members for awareness of our AED referral pattern and outcome of the patients;
4. To evaluate our role in gatekeeping to allow effective utilization of healthcare resources.
Methodology :
Patients referred to the AED from Yan Chai Hospital GPC during the period from 2nd to 26th Jan 2021 were sampled and analyzed to find out: (1) patient demographics, (2) the spectrum of referring diagnoses, (3) patient outcome, and (4) the appropriateness of referrals. In this review, a referral is deemed appropriate if either: (1) hospital admission was required (including specialty ward and emergency medical ward), (2) observation and reassessment in an observation ward were required, or (3) patient was provided urgent investigation and/or treatment in the AED that was not readily available within GPC setting.
Result & Outcome :
Among the 44 AED referrals reviewed, the age of patients ranged from 25 to 106 years old. Male-to-female ratio is 21:23. The top referring diagnoses were congestive heart failure (14%), acute surgical abdominal conditions (14%) and trauma (11%), followed by chest pain (9%), abscess or soft tissue infections (9%) and acute chest conditions (9%). 93.2% of the referral is deemed appropriate (in which 80.5% with hospital admissions or stayed in observation ward). In 84% of the referrals, our referring diagnosis matched with the final diagnosis.
This review showed the relative complexity of referring diagnoses, as compared to poor blood pressure or diabetic control which had been the commonest causes of AED referral in the previous review in 2007. This reflects our better competency in making prudent referral of selected cases to the AED. The findings were shared with colleagues in our clinic meeting to promote awareness of our performance as gatekeepers. This review also forms a basis for our future review and clinic audit.
