DEPT OF MED - FAMILY MEDICINE UNIT

Researcher : Lam CLK

Project Title:

Effectiveness of Traditional Chinese Medicine in Primary Care

Investigator(s):

Lam CLK, Leung KF

Department:

Med - Family Medicine Unit

Source(s) of Funding:

Small Project Funding

Start Date:

12/2005

 

Abstract:

Primary health care has important contributions to the health of the population by managing over 90%of the illnesses of the population. Although Western medicine is the established system of health care in Hong Kong, 50 to 60% of people in Hong Kong have consulted Traditional Chinese medicine (TCM) practitioners and 13.5% of the people consult TCM frequently or occasionally (1). There are 7707 registered TCM practitioners serving a population of 6.8 million in Hong Kong, most of them provide primary care. Despite the popularity of TCM in primary care in Hong Kong, there are not many research data on its effectiveness. Evidence on the effectiveness of TCM is important to inform the public in their choice of primary care . The evaluation of the effectiveness of TCM needs to use appropriate outcome measures. The outcome measures of TCM should be coherent with its underlying philosophy and theory. Health related quality of life (HRQOL) is probably the most suitable outcome measure of TCM because it matches the latter's emphasis on the enhancement of physical, social and psychological well being. HRQOL has been shown to be a reliable and valid outcome measure of health, illness and treatment in Western medicine. It has also been used as an outcome measure in several TCM clinical trials on cancer, geriatrics, and rehabilitation (2-5). Most of the studies were able to show with HRQOL measures that TCM had an effect on patient's psychological well-being. However, many authors have raised the concern that HRQOL measures developed for Western medicine may not evaluate the effectiveness of TCM adequately because they do not capture all the health concept of TCM. A HRQOL measure specific to the concepts of TCM may be more sensitive and responsive to its treatment effects (5-7). The Chinese Quality of Life Instrument (ChQOL) was developed recently in China for assessing HRQOL based on the philosophy and theory of TCM. It is intended for the monitoring the patient's subjective perception during illness and treatment. The ChQOL has been validated and pilot tested on Chinese populations in Guangzhou and Hong Kong (8). Many Chinese medicine interventions have claimed to improve quality of life but few have been substantiated by research studies measuring HRQOL as the primary outcome and with standard validated measures. The aim of the present study is to evaluate the effectiveness of TCM in enhancing patients' quality of life in primary care by the use of a widely used generic and a TCM-specific HRQOL measures. The study would also determine the psychometric properties of these measures for the evaluation of the effectiveness of TCM in the primary care. Research objectives1) To investigate whether TCM can improve HRQOL of patients in primary care. 2) To investigate the correlation between HRQOL evaluations and the clinical assessment by TCM practitioners. 3) To investigate whether a TCM specific HQOL measure is more sensitive and responsive than a generic HRQOL measure to evaluate the effectiveness of TCM.

 

Project Title:

A randomized, double blind, placebo-controlled clinical trial of Chinese herbal medicine in the treatment of acute upper respiratory infections

Investigator(s):

Lam CLK, Wong W, Fong DYT

Department:

Med - Family Medicine Unit

Source(s) of Funding:

Research Fund for the Control of Infectious Diseases - Full Grants

Start Date:

01/2006

 

Abstract:

The aim of this study is to test if Chinese herbal medicine (CHM) guided by Traditional Chinese medicine (TCM) diagnosis will significantly increase recovery rate, and reduce the duration and/or severity of symptoms, and improve the quality of life of patients with URTIs in primary care.

 

Project Title:

Translation and Validation of the Chronic Liver Disease Questionnaire (CLDQ) for Chinese patients with Chronic Hepatitis B Infection in Hong Kong

Investigator(s):

Lam CLK, Lai CL, Yuen RMF

Department:

Med - Family Medicine Unit

Source(s) of Funding:

Small Project Funding

Start Date:

10/2006

 

Abstract:

Introduction More than 2 billion people have been infected with hepatitis B in the world[1], with an estimated 350 million being chronic carriers and approximately 250-300 million of whom are Chinese. Without treatment, infected individuals may progress through the different stages of liver disease from uncomplicated HB carriers, to chronic hepatitis, to cirrhosis, liver failure and/ or hepatocellular carcinoma (HCC). Chronic hepatitis infection can adversely affect mental and physical health leading to impairment of quality of life (QOL)[2-4]. Younossi et al found an association between scores in HRQOL and the severity of the liver disease[4]. HRQOL has become an important outcome indicator in clinical services and health policies in the last two decades. HRQOL measures can be categorized broadly into two types: generic and disease-specific. Generic measures are applicable to people of all health status and allow comparison between different types of diseases. However, they may not be able to detect small but clinically important differences in HRQOL that are specific to certain diseases, such as fatigue in chronic liver disease. Therefore, a disease-specific measure may be needed to supplement a generic measure to assess the HRQOL of patients with a particular disease. Several HRQOL measures have been developed specific for chronic liver disease patients, such as the Chronic Liver Disease Questionnaire (CLDQ)[5], the Hepatitis Quality of Life (HQLQ)[6], and the Liver Disease Quality of Life (LDQOL)[7]. The Chronic Live Disease Quality of Life (CLDQ) is the first available disease specific HRQOL measure for chronic liver disease (CLD) developed by Younossi et al. It is applicable to patients with different types of chronic liver diseases. It has been shown to have good reliability, validity and sensitivity, and has been validated in different cultures including Italian, German, Chinese (Simplified format) and Thai [8-12]. Therefore, the CLDQ has been shown to be suitable for cross-cultural adaptation. It captures important areas and problems relating to HBV infection, such as, fatigue. The CLDQ has only 29 items and can be completed in less than 15 minutes. The other two liver disease specific HRQOL measures are less widely used because they are much longer, have less validation data and have been tested only on patients with specific types of chronic liver diseases. In Hong Kong, no disease-specific HRQOL measure is available for hepatitis B patients because all existing disease-specific instruments were developed in Western countries and none have been validated for the local Chinese population. The CLDQ has been translated and tested in mainland China, this Chinese version may not be applicable to people in Hong Kong because there are significant differences in the usage of words and terms between Hong Kong and Mainland China. Therefore, it is necessary to develop a Chinese translation that is linguistically appropriate and psychometrically valid for people in Hong Kong. The aim of this study is to translate and validate the CLDQ for the Chinese population in Hong Kong so that we can have a disease specific HRQOL measure applicable to our patients with different stages of chronic HB infection. This will enable the evaluation of the impact of CHB infection on our Chinese population, and assess the effect of treatment on quality of life of these patients.Study objectives1. To develop a Chinese (Hong Kong) version of the CLDQ that is semantically equivalent to the original.2. To test the scaling assumptions of the Chinese (HK) CLDQ.3. To test the internal and test-retest reliability of the Chinese (HK) CLDQ.4. To test the construct validity of the Chinese (Hong Kong) CLDQ by comparing its scores to those of the Chinese (Hong Kong) Short-Form 36 (SF-36).5. To test the construct validity and sensitivity of the Chinese (HK) CLDQ by comparing the scores of patients with different stages of chronic HB infections.6. To test the responsiveness of the Chinese (Hong Kong) CLDQ in detecting the changes in HRQOL of CHB patients over time.

 

Researcher : Lam TP

Project Title:

Use of antibiotics by primary care doctors in Hong Kong

Investigator(s):

Lam TP, Ho PL, Lam KF

Department:

Med - Family Medicine Unit

Source(s) of Funding:

Small Project Funding

Start Date:

11/2005

Completion Date:

11/2006

 

Abstract:

Overuse of antibiotics is a worldwide phenomenon (1, 2) and it contributes to the emergence of antimicrobial resistance (3, 4, 5). Unnecessary use of antibiotics also leads to an increased risk of side effects (6), high costs (7) and medicalising effects (8). In the Fifty-eighth World Health Assembly held in May 2005, it was resolved and agreed by more than 60 countries (including Hong Kong and China) that the containment of antimicrobial resistance is one of the internationally agreed health-related goals but the strategy for it has not been widely implemented. It urges Member States (a) to enhance rational use of antimicrobial agents, including through development and enforcement of national standard practice guidelines for common infections, in public and private health sectors, (b) to monitor regularly the use of antimicrobial agents and the level of antimicrobial resistance in all relevant sectors, and (c) to share actively knowledge andexperience on best practices in promoting the rational use of antimicrobial agents. Primary care doctors prescribe most of all antibiotics and many of these are for infections of the respiratory tract (9) despite research studies demonstrating little or no clinical benefits (10-17). Surveys done by Lam & Lam revealed that antibiotics are frequently used in patients with respiratory tract infections in Hong Kong (18) and many doctors also acknowledged that they might be prescribing antibiotics too often for upper respiratory tract infections (URTI) (19). There are many possible reasons why primary care doctors in Hong Kong are prescribing antibiotics for URTI, for example, their misconceptions about the significance of fever, discoloured sputum or nasal discharge, exudates and lymphadenopathy (18), as well as patients' expectations (19). These findings were based on the primary care doctors' report of their clinical behaviours. They may therefore under estimate or even over estimate their use of antibiotics in these previous studies. There is otherwise no current information available on the actual usage of antibiotics by primary care doctors in Hong Kong. The proposed study represents a step forward in the understanding of the use of antibiotics by primary care doctors in Hong Kong. It aims to examine the primary care doctors' clinical behaviour in the use of antibiotics by detailing the type of antibiotics they use, including the dosage and duration, and the illnesses that they use the antibiotics. Similar study provided useful information to help reduce antibiotics use in Scadinavia (20). Objectives of the proposed study: 1. To document the level of use of antibiotics by primary care doctors in Hong Kong, including the types of antibiotics, dosage and duration. 2. To examine the primary care doctors' use of antibitocs and its relation to common infections in the community. 3. To examine the relationship between patients' expectation of antibiotics and the prescription of antibiotics by primary care doctors. 4. To identify the characteristics of primary care doctors e.g. age, gender, vocational training in general practice/family medicine and the use of antibiotics in the community. Hypotheses It is hypothesized that: 1. Antibiotics are too frequently used for common infections in primary care setting in Hong Kong. 2. Patients' expectation of antibiotics are associated with higher level of use of antibiotics by primary care doctors. 3. There is a close association between the level of use of antibiotics and certain characteristics of primary care doctors e.g. age, gender and vocational training experience. 1. Arroll B, Goodyear-Smith F. General practitioner management of upper respiratory tract infections: when are antibiotics prescribed? New Zealand Medical Journal 2000;113(1122):493-496. 2. Wang EE, Einarson TR, Kellner JD, Conly JM. Antibiotics prescribing for Canadian preschool children: evidence of overprescribing for viral respiratory infections. Clinical Infectious Disease 1999;29(1):155-160. 3. Schwartz B, Bell DM, Hughes JM, et al. Preventing the emergence of antimicrobial resistance. JAMA 1997;278:944-945. 4. Belongia EA, Schwartz B. Strategies for promoting judicious use of antibiotics by doctors and patients. BMJ 1998;317:668-671. 5. Seppala H, Klaukka T, Vuopio-Varkula J, Muotiala A, Helenius H, Lager K, et al. The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. N Eng J Med 1997;337:441-6. 6. Arroll B, Kenealy T. Antibiotics for the common cold. Cochrane Database Syst Rev 2000;(2):CD000247. 7. Mainous III G, Hueston WJ. The cost of antibiotics in treating upper respiratory tract infections in a Medicaid population. Arch Fam Med 1999;7:45-9. 8. Little P, Gould C, Williamsen I, Warner G, Gantly M, Kinmonth AL. Reattendance and complications in a randomised trial of prescribing strategies for sore throat: the medicalising effect of prescribing antibiotics. BMJ 1997;315:350-2. 9. De Melker RA, Kuyvenhoven MM. Management of upper respiratory tract infections in Dutch family practice. J Fam Pract. 1994;38:353-7. 10. Little P, Williamson I, Warner G, et al. Open randomised trial of prescribing strategies in managing sore thoat. BMJ 1997;314:722-727. 11. Orr PH, Scherer K, MacDonald A, et al. Randomized placebo-controlled trials of antibiotics for acute bronchitis: a critical review of the Literature. J Fam Pract. 1993;36:507-512. 12. Gonzales R, Sande M. What will it take to stop physicians from prescribing antibiotics in acute bronchitis? Lancet 1995;345:665-666. 13. Verjeij TJM, Hermans J, Mulder JD. Effects of doxycycline in patients with acute cough and purulent sputum: a double-blind, placebo-controlled trial. Br J Gen Pract 1994;44:400-404. 14. Dunlay J, Reinhardt R, Roy LD. A placebo-controlled, double-blind trial of erythromycin in adults with acute bronchitis. J Fam Pract 1987;25:137-141. 15. King DE, Williams WC, Bishop L, et al. Effectiveness of erythromycin in the treatment of acute bronchitis. J Fam Pract 1996;42:601-605. 16. Heikkinen T, Ruuskanen O, Ziegler T, et al. Short-term use of amoxicillin-clavulanate during upper respiratory tract infection for prevention of acute otitis media. J Paediatr 1995;126:313-316. 17. Kaiser L, Lew D, Hirschel B, et al. Effects of antibiotic treatment in the subset of common-cold patients who have bacteria in nasopharyngeal secretions. Lancet 1996;347:1507-1510. 18. Lam TP, Lam KF. Why do family doctors prescribe antibiotics for upper respiratory tract infection? International Journal of Clinical Practice 2003:57(3):167-169 19. Lam TP, Lam KF. What are the non-biomedical reasons which make family doctors over-prescribe antibiotics for upper respiratory tract infection in a mixed private/public Asian setting? Journal of Clinical Pharmacy and Therapeutics. 2003;28:197-201. 20. Mikstra Programme - antimicrobial treatment strategies (Accessed in June 2005 http://www.stakes.fi/mikstra/e/)

 

Project Title:

What are the stigmatizing opinions about people with mental health problems among Hong Kong residents

Investigator(s):

Lam TP

Department:

Med - Family Medicine Unit

Source(s) of Funding:

Small Project Funding

Start Date:

01/2007

 

Abstract:

Objectives of the proposed study:1. To investigate the stigmatizing opinions towards patients of different common mental illnesses e.g. anxiety related conditions, depression, schizophrenia, drug and alcohol abuse, and dementia.2. To investigate if health care attendance by family physicians with special training in mental health instead of specialist psychiatrists for minor mental illnesses e.g. anxiety, depression, would affect the readiness of some Hong Kong patients to seek treatment and to continue follow up for their illnesses.According to the US Surgeon General, stigma is the number one barrier to mental health care and this has been supported by recent studies (1). There is also evidence that stigmatizing opinions about people with psychiatric disorders are widely held in the UK. (2) These stigmatizing opinions vary in nature and frequency for different mental disorders. Li et al investigated the barriers to meeting the mental health needs of the Chinese community in UK. (3) They found that stigma associated with mental illness and limited knowledge in the community were the main causes for the widespread discrimination experienced by their participants. It is likely that such stigmatizing opinions exist in Hong Kong, however, little is known about its level of intensity and the specific mental health conditions that they are associated with. This knowledge is of vital importance if we are to aim to reduce such stigmatizing opinions since studies have shown that people's attitudes towards psychiatric patients are susceptible to change. (4) Interventions have been shown to have positive impact on participants' attitudes towards people with mental health problems. (5)Crisp (6) has said that it is general practitioners and their teams who are confronted endlessly by the challenge of mental disorder and related mental health problems in their patients. The primary care team often has the potentially precious advantage, diagnostically speaking, of knowing the ongoing psychological and social dynamics of the family background. Li et al also found that general practitioners were pivotal in the management of their patients' mental health conditions. In Hong Kong, many patients with minor mental health problems e.g. anxiety related illness, depression, are attending specialist psychiatrists, either private or public. Phongsavan et al reported that 64% of Australian general practitioners had found patient feeling uncomfortable being referred to psychiatrists. (7) It is uncertain if attending psychiatrists carries sufficient stigma that would affect the readiness of some Hong Kong patients to seek care and to continue follow up for their mental health conditions. It is therefore of importance to investigate if care by family physicians with special training in mental health would help to reduce such stigma, hence, affect the readiness of some Hong Kong patients to seek care and to continue follow up for their mental illnesses.The Family Medicine Unit of the Department of Medicine, the University of Hong Kong launched a one-year part-time Postgraduate Diploma in Community Psychological Medicine for primary care physicians in September 2002. (8) The objectives of the Course are to improve the knowledge, skills and confidence of primary care physicians in the care of the patients with psychological problems. It also emphasises the aspects of care that are different for these patients. Graduates of the Course have also been recognized by the Hospital Authority as suitable receiving doctors for accepting discharged patients with certain minor mental illnesses from the Specialist Psychiatry Clinics in various public hospitals. References:1. Lewis L. Mood disorders: diagnosis, treatment, and support from a patient perspective. Psychopharmacol Bull 2001 Autumn; 35(4):186-196.2. Crisp AH, Gelder MG, Rix S, Meltzer HI, Rowlands OJ. Sigmatisation of people with mental illnesses. The British Journal of Psychiatry 2000; 177:4-7.3. Li P, Logan S, Yee L, Ng S. Barriers to meeting the mental health needs of the Chinese community. Journal of Public Health Medicine 1999; 21 (1):74-80.4. Schulze B, Richter-Werling M, Matschinger H, Angermeyer MC. Crazy? So what! Effects of a school project on students' attitudes towards people with schizophrenia. Acta Psychiatr Scand 2003 Feb; 107(2):142-150.5. Pinfold V, Toulmin H, Thornicroft G, Huxley P, Farmer P, Graham T. Reducing psychiatric stigma and discrimination: evaluation of educational interventions in UK secondary schools. The British Journal of Psychiatry 2003; 182:342-346.6. Crisp AH. The stigmatization of sufferers with mental disorders. British Journal of General Practice 1999; 49:3-4.7. Phongsavan P, Ward JE, Oldenburg BF, Gordon JJ. Medical Journal of Australia 1995; 162(3):139-142.8. Lam TP, Tse EYY. The setting up of a diploma course in community psychological medicine for primary care doctors. Wonca Asia Pacific Regional Conference in Beijing. 2003 October.

 

Project Title:

Is there a need to promote family medicine concept in Hong Kong? – Meeting the need for recognition and treatment of depression as a model

Investigator(s):

Lam TP, Li DKT, Lam KF

Department:

Med - Family Medicine Unit

Source(s) of Funding:

Public Policy Research

Start Date:

04/2007

 

Abstract:

1) To collect in-depth views of some members of the public towards family medicine through focus group interviews. 2) To describe the general public views towards family medicine through a territory wide cross-sectional study, with specific reference to treatment of depression. 3) To describe the relationship between the demographic factors of the public and their views towards family medicine. 4) To describe the doctors' views towards family medicine concept. 5) To describe the relationship between the demographic factors of the doctors and their views towards family medicine.




-- End of Listing --