Authors (including presenting author) :
F Tsui(1), YY Chan(1), YH Chan(1), TK Chu(1), J Liang(1), YS Ng(1)
Affiliation :
(1)Department of Family Medicine & Primary Health Care, New Territories West Cluster(NTWC)
Introduction :
Trigger finger causes significant functional impairment to affected individuals. Surgical procedures, such as corticosteroid injection, should be considered when conservative treatment fails. However, these are usually performed in secondary care setting after prolonged waiting time. Since about 250 patients per year are referred to Orthopedic Specialist Outpatient Clinic (SOPC) for management of trigger finger in NTWC General Outpatient Clinics (GOPCs), empowering GOPC doctors in performing corticosteroid injection of trigger finger may have significant impact on reducing referrals to secondary care.
Objectives :
- Reduce unnecessary referral to SOPC.
- Enhance quality of care for patients with trigger fingers in GOPCs.
- Train up family doctors in performing the outpatient minor surgical procedure safely.
Methodology :
A structured program of corticosteroid injection for trigger finger treatment has been started since July 2021 in the NTWC for adult patients who attended two GOPCs in Tin Shui Wai district for trigger finger and had considered corticosteroid injection as treatment. Patients would be arranged for a scheduled appointment of this pilot program. They would be assessed and managed in an integrated approach by family doctors. Corticosteroid injections were performed by them under the supervision by clinic doctor in-charge or deputy who had acquired skills and experience in Orthopedic SOPC. All patients who had undergone the procedure would be followed up 4 weeks afterwards for outcome evaluation.
Result & Outcome :
From July to December 2021, 23 patients were recruited and more than half of them (n=13) had corticosteroid injection. No complications have been reported in those who had received corticosteroid injection, while all of them showed symptoms improvement. 70% of them having symptoms completely resolved. Patients who did not had injection were either clinically unsuitable (n=5), for example, having prior repeated corticosteroid injection to the same digit, or preferred to continue conservative treatment after explanation (n=5).
This pilot program demonstrated that corticosteroid injection for trigger finger treatment is feasible in the local primary care setting. Family doctors could be empowered to perform minor surgical procedures safely when adequate training and resources are available. This could significantly reduce the number of referrals to secondary care and contribute to sustainability of the public healthcare service.
