Interfacing between primary and secondary care is needed
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《英国医生杂志》
EDITOR—Straus et al highlighted the impact of severe acute respiratory syndrome (SARS) on professionalism and gave several examples of strained professional behaviour.1 Research in Hong Kong showed anxiety among general practitioners who, despite worries, demonstrated willingness to do their duty as was expected from a highly professional workforce.2 Altogether 82.3% of general practitioners in the study wanted more involvement in the management of SARS: 74.6% as educators and 68.4% as gatekeepers.3 However, the primary care system in Hong Kong is less well developed and most general practitioners work in the private sector, whereas most hospital care is given in the public sector, with little interfacing and collaboration.4
Primary care is the gatekeeper to hospital care. The fear and panic caused by SARS made it difficult for patients with symptoms to be managed in primary care without a close working relationship with and support system from hospitals. If general practitioners had direct access to basic diagnostic procedures and communicated with the hospital team directly, they would have more confidence in screening out suspected cases. They can also be useful health educators to minimise panic, which would also decrease unnecessary admission.
Measures must be taken to avoid overloading the hospital system and putting further strain on frontline doctors in a public health crisis. This would ensure that professionalism was not eroded. General practitioners are useful partners but not fully used. In facing new public health challenges, governments should take the SARS crisis opportunity to strengthen the primary care system and ensure appropriate mechanisms for partnership and interfacing with secondary care.5
Albert Lee, professor
alee@cuhk.edu.hk, Department of Community and Family Medicine, Chinese University of Hong Kong, 4th Floor, School of Public Health, Prince of Wales Hospital, Shatin, Hong Kong
William Wong, assistant professor, Samuel Yeung Shan Wong, assistant professor
Department of Community and Family Medicine, Chinese University of Hong Kong, 4th Floor, School of Public Health, Prince of Wales Hospital, Shatin, Hong Kong
Kwong Ka Tsang, health promotion officer
Centre for Health Education and Health Promotion, School of Public Health, Chinese University of Hong Kong
Competing interests: None declared.
References
Straus SE, Wilson K, Rambaldini G, Rath D, Lin Y, Gold WL. Severe acute respiratory syndrome and its impact on professionalism: qualitative study of physicians' behaviour during an emerging healthcare crisis. BMJ 2004;329: 83-5. (10 July.)
Wong W, Lee A, Tsang KK, Wong S. How did general practitioners protect themselves, their staff and their families during the severe acute respiratory syndrome epidemic in Hong Kong? J Epidemiol Community Health 2004;58: 180-5.
Lee A., Wong W. Primary care during the SARS outbreak. Br J Gen Pract 2003;September: 733.
Lee A. Seamless health care for chronic diseases in dual health care system: managed care and role of family physicians. J Manag Med 1998;12: 398-405.
Lee A, Abdullah ASM. Severe acute respiratory syndrome: challenge for public health practice in Hong Kong. J Epidemiol Community Health 2003;57: 655-8.
Primary care is the gatekeeper to hospital care. The fear and panic caused by SARS made it difficult for patients with symptoms to be managed in primary care without a close working relationship with and support system from hospitals. If general practitioners had direct access to basic diagnostic procedures and communicated with the hospital team directly, they would have more confidence in screening out suspected cases. They can also be useful health educators to minimise panic, which would also decrease unnecessary admission.
Measures must be taken to avoid overloading the hospital system and putting further strain on frontline doctors in a public health crisis. This would ensure that professionalism was not eroded. General practitioners are useful partners but not fully used. In facing new public health challenges, governments should take the SARS crisis opportunity to strengthen the primary care system and ensure appropriate mechanisms for partnership and interfacing with secondary care.5
Albert Lee, professor
alee@cuhk.edu.hk, Department of Community and Family Medicine, Chinese University of Hong Kong, 4th Floor, School of Public Health, Prince of Wales Hospital, Shatin, Hong Kong
William Wong, assistant professor, Samuel Yeung Shan Wong, assistant professor
Department of Community and Family Medicine, Chinese University of Hong Kong, 4th Floor, School of Public Health, Prince of Wales Hospital, Shatin, Hong Kong
Kwong Ka Tsang, health promotion officer
Centre for Health Education and Health Promotion, School of Public Health, Chinese University of Hong Kong
Competing interests: None declared.
References
Straus SE, Wilson K, Rambaldini G, Rath D, Lin Y, Gold WL. Severe acute respiratory syndrome and its impact on professionalism: qualitative study of physicians' behaviour during an emerging healthcare crisis. BMJ 2004;329: 83-5. (10 July.)
Wong W, Lee A, Tsang KK, Wong S. How did general practitioners protect themselves, their staff and their families during the severe acute respiratory syndrome epidemic in Hong Kong? J Epidemiol Community Health 2004;58: 180-5.
Lee A., Wong W. Primary care during the SARS outbreak. Br J Gen Pract 2003;September: 733.
Lee A. Seamless health care for chronic diseases in dual health care system: managed care and role of family physicians. J Manag Med 1998;12: 398-405.
Lee A, Abdullah ASM. Severe acute respiratory syndrome: challenge for public health practice in Hong Kong. J Epidemiol Community Health 2003;57: 655-8.