Background Chronic obstructive pulmonary disease (COPD) is a progressive lung disease commonly encountered in primary care. This study aimed to audit COPD care at primary care clinics of Hong Kong and to work out improvement strategies. Method All COPD patients aged 40 or above who had been followed up at 13 public primary care clinics of Kowloon Central Cluster (KCC) under the Hospital Authority of Hong Kong (HAHK) were included in this clinic audit. Evidence-based audit criteria and performance standards were established after thorough literature review. Phase 1 was from 1st April 2016 to 31st March 2017, with deficiencies of care identified. It was followed by a one-year implementation phase through which a series of improvement strategies were executed. Outcome of the enhancement was reviewed during Phase 2 from 1st April 2018 to 31st March 2019. Chi-square test and student’s t test were used to detect statistically significant changes between Phase 1 and Phase 2. Results A total of 2358 COPD cases were identified in Phase 1 where 658 of them were smokers. Of those smokers, 332 (50.5%) had been referred to Smoking Counselling and Cessation Service (SCCS) and 289 (43.9%) actually attended it. 991 cases (42%) received Seasonal Influenza Vaccine (SIV) and 938 cases (39.8%) received Pneumococcal Vaccine (PCV). 698 patients (29.6%) had spirometry done before and 423 patients (17.9%) had been admitted to hospital due to acute exacerbation of COPD (AECOPD). With the concerted effort taken during the implementation phase, Phase 2 data showed significant improvement in nearly all criteria. There was a marked increase in the SIV and PCV uptake rate, spirometry performance rate and most importantly, a significant reduction in AECOPD rate leading to hospital admission (13.5%, P = 0.000043). However, the referral rate and attendance rate of SCCS among smokers remained stagnant (P > 0.05). Conclusion Via a systematic team approach, COPD care at primary care clinics of KCC under HAHK had been significantly improved for most of the audit criteria, which in turn reduced the burden of the healthcare system.

Background Service gaps exist in oral anticoagulant (OAC) use among patients with atrial fibrillation (AF) in primary care. The purpose of this study was to explore the clinical effectiveness of a community dwelling Atrial Fibrillation Special Clinic (AFSC) run by primary care physicians by evaluating its impact on OAC use and the control of modifiable cardiovascular disease (CVD) risk factors in high risk AF patients. Method Quasi-experimental study was conducted in AFSC run by public primary care physicians in Hong Kong. Study subjects were high risk AF patients with CHA2DS2-VASc scores ≥ 2, who had been followed up (FU) at AFSC for at least one year from 01 August, 2019 to 31 October, 2020. OAC usage and modifiable CVD risk factor control were compared before and after one year of FU at AFSC. Drug-related adverse events, emergency attendance or hospitalisation episodes, survival and mortality rates after one year FU at AFSC were also reviewed. Results Among the 299 high risk AF patients included in the study, significant increase in OAC use was observed from 58.5% at baseline to 82.6% after one year FU in AFSC (P < 0.001). Concerning CVD risk factor control, the average diastolic blood pressure level was significantly reduced (P = 0.009) and the satisfactory blood pressure control rate in non-diabetic patients was markedly improved after one year FU (P = 0.049). However, the average HbA1c and LDL-c levels remained static. The annual incidence rate of ischaemic stroke/systemic embolism was 0.4%, intra-cranial haemorrhage was 0.4%, major bleeding episode was 3.2% and all-cause mortality was 4.3%, all of which were comparable to reports in the literature. Conclusion AFSC is effective in enhancing OAC use and maintaining optimal modifiable CVD risk factor control among high risk AF patients managed in primary care setting, and therefore may reduce AF-associated morbidity and mortality in the long run.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive lung disease commonly encountered in the primary care. This study aimed to audit COPD care at primary care clinics of Hong Kong and to work out improvement strategies. Method: All COPD patients aged 40 or above and had been followed up at 13 public primary care clinics of Kowloon Central Cluster (KCC), the Hospital Authority of Hong Kong, were included in this clinic audit. Evidence-based audit criteria and performance standards were established after thorough literature review. Phase 1 was from 01/04/2016 to 31/03/2017, with deficiencies identified, followed by one-year implementation phase with improvement strategies being executed. Phase 2 was from 01/04/2018 to 31/03/2019 with outcome of enhancement reviewed. Chi-square test and student’s t test were used to compare the significance of relevant changes noted. Results: 2,358 COPD cases were identified in phase 1. Among the 658 smokers, 332 (50.5%) had been referred to Smoking Counselling and Cessation and Service (SCCS) and 289 (43.9%) actually attended it. 991 cases (42%) received Seasonal Influenza Vaccine (SIV) and 938 (39.8%) received Pneumococcal Vaccine (PCV). 698 (29.6%) patients had spirometry done before and 423 cases (17.9%) had been admitted to hospital due to acute exacerbation of COPD (AECOPD). With the concerted effort taken during the implementation phase, phase 2 data showed significance improvement in almost all criteria. There was a marked improvement in SIV and PCV coverage, spirometry performance rate and most important of all, a reduction in the AECOPD (n=294, 13.5%, P=0.000043). However, the SCCS referral rate and attendance rate among smokers remained stagnant (both P>0.05). Conclusion: COPD care at primary care clinics of KCC has been tremendously improved in most of the audit criteria via a systematic team approach, therefore reducing the burden to specialist and hospital.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive lung disease commonly encountered in the primary care. This study aimed to audit COPD care at 13 public primary care clinics of Hong Kong and to work out improvement strategies. Method: All COPD patients who were aged 40 or above and had been followed up at 13 public primary care clinics of Kowloon Central Cluster (KCC), Hong Kong were included in this clinic audit. Evidence-based audit criteria and performance standards were established after thorough literature review. Phase 1 was from 01/04/2016 to 31/032017, with deficiencies identified, followed by one-year implementation phase with improvement strategies being executed. Phase 2 was from 01/04/2018 to 31/03/2019 with outcome of enhancement reviewed. Chi-square test and student’s t test were used to compare the significance of relevant changes noted. Results: 2,358 COPD cases were identified in phase 1. Among the 658 smokers, 332 (50.5%) had been referred to Smoking Counselling and Cessation and Service (SCCS) and 289 (43.9%) actually attended it. 991 cases (42%) received Seasonal Influenza Vaccine (SIV) and 938 (39.8%) received Pneumococcal Vaccine (PCV). 698 (29.6%) patients had spirometry done before and 423 cases (17.9%) had been admitted to hospital due to acute exacerbation of COPD (AECOPD). With the concerted effort taken during the implementation phase, phase 2 data showed significance improvement in almost all criteria. There was a marked improvement in SIV and PCV coverage, spirometry performance rate and most important of all, a reduction in the AECOPD (n=294, 13.5%, P=0.000043). However, the SCCS referral rate and attendance rate among smokers remained stagnant (both P>0.05). Conclusion: COPD care at primary care clinics of KCC has been tremendously improved in most of the audit criteria via a systematic team approach, therefore reducing the burden to specialist and hospital.

Background: There are service gaps existed in atrial fibrillation (AF) management in Hong Kong with relatively low utilization of oral anticoagulants. The purpose of this study was to explore the clinical effectiveness of Atrial Fibrillation Special Clinic (AFSC) by evaluating its impact on the oral anticoagulants use and the control of modifiable cardiovascular disease (CVD) risk factors in high risk AF patients.Method: This was a quasi-experimental, pre-test/post-test study in public primary care clinics. Participants included high risk AF patients with CHA2DS2-VASc score ≥2, had been followed up (FU) for one year at 5 AFSCs of Kowloon Central Cluster (KCC) of the Hospital Authority of Hong Kong from 01 August, 2019 to 31 October, 2020. Our primary outcomes were 1) total number of patients agreed for novel oral anticoagulant (NOAC) treatment after recruitment at AFSC, and 2) modifiable CVD risk factors control including blood pressure (BP), Haemoglobin A1c (HbA1c) if diabetic and low-density lipoprotein-c (LDL-c) level, compared at baseline and after one year FU. Our secondary outcomes were drug-related adverse events, major bleeding and non-major bleeding episodes, stroke or systemic embolism events, Accident and Emergency Department attendance or hospitalisation episodes, survival and mortality rates after one year FU.Results: Among the 299 high risk AF patients included in the study, significant increase in NOAC utilization was observed from 58.5% to 82.6% after FU in AFSC (P <0.001). Concerning the CVD risk factors control, the average diastolic BP level was significantly reduced (P=0.009) and the satisfactory BP control rate in non-DM patients was significantly improved after one year FU (P=0.049). However, the average HbA1c and LDL-c level remained static. The annual incidence rate of ischaemic stroke/systemic embolism was 0.4%, intra-cranial haemorrhage was 0.4%, major bleeding episode was 3.2% and all-cause mortality was 4.3%, all of which were comparable to the literatures. Conclusion: AFSC is effective in enhancing NOAC use and maintaining optimal modifiable CVD risk factors control among high risk AF patients managed in primary care setting, therefore may reduce AF-associated morbidity and mortality in the long run.