OBJECTIVE Cardiovascular diseases (CVD) are a long-term sequela of diabetes. Better individual-based continuity of care has been reported to reduce the risk of chronic complications among patients with diabetes. Maintaining a one-to-one patient–physician relationship is often challenging, especially in public health care settings. This study aimed to evaluate the relationship between higher team-based continuity of care, defined as consultations provided by the same physician team, and CVD risks in patients with diabetes from public primary care clinics. RESEARCH DESIGN AND METHODS This was a retrospective cohort study in Hong Kong of 312,068 patients with type 2 diabetes and without any history of CVD at baseline (defined as the earliest attendance at a doctor’s consultation in a public-sector clinic between 2008 and 2018). Team-based continuity of care was measured using the usual provider continuity index (UPCI), calculated by the proportion of consultations provided by the most visited physician team in the 2 years before baseline. Patients were divided into quartiles based on their UPCI, and the characteristics of the quartiles were balanced using propensity score fine stratification weights. Multivariable Cox regression was applied to assess the effect of team-based continuity of care on CVD incidence. Patient demographics, smoking status, physiological measurements, number of attendances, comorbidities, and medications were adjusted for in the propensity weightings and regression analyses. RESULTS After an average follow-up of 6.5 years, the total number of new CVD events was 52,428. Compared with patients in the 1st quartile, patients in the 2nd, 3rd, and 4th quartiles of the UCPI had a CVD hazard ratio (95% CIs) of 0.95 (0.92–0.97), 0.92 (0.89–0.94), and 0.87 (0.84–0.89), respectively, indicating that higher continuity of care was associated with lower CVD risks. The subtypes of CVD, including coronary heart disease and stroke, also showed a similar pattern. Subgroup analyses suggested that patients <65 years of age had greater benefits from higher team-based continuity of care. CONCLUSIONS Team-based continuity of care was associated with lower CVD risk among individuals with type 2 diabetes, especially those who were younger. This suggests a potential flexible alternative implementation of continuity of care in public clinics.

Purpose: To determine whether enablement was a moderator of the effect of chronic back and knee pain on health-related quality of life (HRQOL). Methods: This was a cross-sectional study of 1319 Chinese primary care patients with chronic back and knee problems who completed the Chinese Patient Enablement Instrument-2 (PEI-2), the Chinese Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the Pain Rating Scale (PRS). Multivariable regression examined the effect of disease characteristics, PRS score and PEI-2 score on WOMAC total score. Moderation was evaluated by whether the interaction between enablement (PEI-2 score) and pain (PRS score) had a significant effect on HRQOL (WOMAC total score) in the moderation regression model and by simple slope analysis. Results: Valid data from 1306 participants were analyzed. PRS score was associated with WOMAC total score (β = 0.326, p<0.001), while PEI-2 score was associated inversely (β = -0.260, p<0.001). There was an inverse relationship between PRS and PEI-2 scores. The effect of the interaction between PRS and PEI-2 (PRS*PEI-2) scores on the WOMAC total score was significant (β = -0.191, p<0.001) suggesting PEI-2 was a moderator. Simple slope analyses showed the relationship between PRS and WOMAC was stronger for participants with a low level of PEI-2 (gradient=3.056) than for those with a high level of PEI-2 (gradient =1.746) Conclusions: Patient enablement moderated the impact of pain on HRQOL. A higher level of enablement can lessen impairment in HRQOL associated with chronic back and knee pain.

<b>Background</b> <p>Cardiovascular diseases (CVD) are a long-term sequela of diabetes mellitus. Better individual-based continuity of care has been reported to reduce the risk of chronic complications among patients with diabetes mellitus. Maintaining a one-to-one patient-physician relationship is often challenging, especially in public healthcare settings. This study aimed to evaluate the relationship between higher team-based continuity of care, defined as consultations provided by the same physician team, and CVD risks in patients with diabetes mellitus from public primary care clinics.</p> <p><b>Study design</b></p> <p>This was a retrospective cohort study in Hong Kong of 312,068 patients with type 2 diabetes mellitus and without any history of CVD at baseline (defined as the earliest attendance at a doctor’s consultation in a public-sector clinic between 2008-2018). Team-based continuity of care was measured using the usual provider continuity index (UPCI), calculated by the proportion of consultations provided by the most visited physician team in the two years before baseline. Patients were divided into quartiles based on their UPCI, and the characteristics of the quartiles were balanced using propensity fine stratification weightings. Multivariable Cox regression was applied to assess the effect of team-based continuity of care on CVD incidence. Patient demographics, smoking status, physiological measurements, number of attendances, comorbidities, and medications were adjusted for in the propensity weightings and regression analyses. </p> <p><b>Result</b></p> <p>After an average follow-up of 6.5 years, the total number of new CVD events was 52,428. Compared to patients in the 1^st quartile, patients in the 2^nd, 3^rd and 4^th quartiles of the UCPI had a CVD hazard ratio (HR) (95% confidence intervals) of 0.95 (0.92-0.97); 0.92 (0.89-0.94) and 0.87 (0.84-0.89) respectively, indicating that higher continuity of care was associated with lower CVD risks. The subtypes of CVD, including coronary heart disease and stroke, also showed a similar pattern. Subgroup analyses suggested that patients younger than 65 years had greater benefits from higher team-based continuity of care.</p> <p><b>Conclusion</b></p> <p>Team-based continuity of care was associated with lower CVD risk among individuals with type 2 diabetes mellitus, especially those that were younger. This suggests a potential flexible alternative implementation of continuity of care in public clinics. </p>

Background Benefits of intercalation during an undergraduate medical degree are well-recognized. The University of Hong Kong implemented a compulsory Enrichment Year (EY) in its Bachelor of Medicine and Bachelor of Surgery degree programme (MBBS) in 2016. In their third year of study, students could work on an area of interest in any of three programme categories (i) intercalation/ university exchange (IC); (ii) research (RA); (iii) service/ humanitarian work (SH). This study aimed to explore the barriers, enablers, and overall student learning experiences from the first cohort of EY students in order to inform future development of the EY. Methods An exploratory sequential mixed-method study in 2019-20. Twenty students were purposively selected to attend three semi-structured focus group interviews. Conventional thematic analysis was employed and results assisted the design of a cross-sectional questionnaire. Sixty-three students completed the questionnaire. ANOVA or chi-square test was used to compare the difference in student’s characteristics, barriers, enablers and perspectives on EY between programme categories. Adjusting student’s characteristics, logistic regressions were conducted to identify the effect of programme categories on the EY experience. Results Most students (95% in the questionnaire) agreed that EY was worthwhile and more rewarding than expected. EY was positively regarded for enhancing personal growth and interpersonal relationships. The main barriers were financial difficulties, scholarship issues and insufficient information beforehand. A few students had practical (i.e. accommodation, cultural adaptation) problems. Potential enablers included better financial support, more efficient information exchange and fewer assignments and preparation tasks. Similar barriers were encountered by students across all three categories of EY activities. Conclusions Personal growth was the most important benefit of the EY. Barriers were consistent with those identified in the literature except for cultural adaptation, which could be related to Hong Kong’s unique historical context. Financial limitation was the most concerning barrier, as it could result in unequal access to educational opportunities. Better and timely access to scholarships and other funding sources need to be considered. Trial registration Ethics approval was obtained from the local Institutional Review Board of The University of Hong Kong/Hospital Authority Hong Kong West Cluster (UW 19-585).