Publications (6)2.62 Total impact

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    ABSTRACT: OBJECTIVES. To assess primary care patients for their awareness, knowledge, and attitude towards colorectal cancer and screening, to report on the uptake of faecal occult blood test screening and the results of screening, and explore predictors of screening uptake. DESIGN. Cross-sectional study. SETTING. Four primary care clinics in Hong Kong. PATIENTS. A total of 1664 patients aged 50 to 74 years attending the clinics in the period July 2006 to July 2007. MAIN OUTCOME MEASURES. Percentage of subjects who were aware that colorectal cancer is common and curable at an early stage, and who knew that faecal occult blood test or colonoscopy is useful for screening; relevant knowledge score; uptake rate of faecal occult blood testing; rate of testing positive; and factors predicting uptake. RESULTS. A total of 1645 questionnaires were collected. In all, 89% (95% confidence interval, 88-91%) were aware that colorectal cancer is common, 95% (94-96%) believed faecal occult blood test and colonoscopy are useful for screening, and 58% (56-61%) achieved a knowledge score of 50% or above. The uptake rate of the faecal occult blood test was 35%. Uptake was higher among those with a positive family history (odds ratio=1.57; 95% confidence interval, 1.08-2.27; P=0.02), those who were more aware that colorectal cancer is common (1.86; 1.29-2.69; P=0.001), and that colorectal cancer is potentially curable at an early stage (1.76; 1.32-2.36; P=0.0001). Rate of testing positive was 2.1% (95% confidence interval, 0.9-3.3%); no colorectal cancer was detected and the neoplasia detection rate (for cancers and adenomas) was 5.1 per 1000 subjects screened. CONCLUSIONS. Patients were aware that colorectal cancer is common in our community, and faecal occult blood test or colonoscopy is useful for screening. The uptake of screening was low, though relatively higher for those with a positive family history and greater awareness of the high frequency and potential for cure of colorectal cancer. Faecal occult blood test positivity rate was 2.1%, and neoplasia detection rate 5.1 per 1000 screened.
    No preview · Article · Oct 2011 · Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine
  • T.K.W. Tam · K.-K. Ng · C.-M. Lau
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    ABSTRACT: Objective: To investigate the risk factors associated with white-coat hypertension (WCH) in Chinese adults and to predict the possibility of WCH in patients with elevated blood pressure in clinic but normal blood pressure at home in clinical practice. Design: Retrospective case series. Subjects: From three primary care clinics. They had 24-hour ambulatory blood pressure monitor (ABPM) performed from January 2001 to October 2006. Main outcome measures: Percentage of subjects having WCH, relationship between WCH and variables including age, gender, smoking, office systolic blood pressure (SBP), office diastolic blood pressure (DBP), body mass index (BMI), diabetes, anxiety, occupation, education level, and family history of cardiovascular diseases. Results: The percentage of WCH in the study population was 28.2%. The mean age of the 617 patients was 52.9±9.5 years, mean BMI 24.0±3.2 kg/m2, mean office SBP 153.0±11.8 mmHg, and DBP 89.8±7.6 mmHg. Advanced age and lower BMI characterized subjects with the development of WCH as opposed to those with sustained hypertension. Conclusion: WCH is a common and important phenomenon. In selecting patients for ABPM, use of home BP monitor, supplemented with identification of features including advanced age and lower BMI would enable the practicing physicians to determine more accurately which subjects were likely to benefit from ABPM.
    No preview · Article · Nov 2007 · Hong Kong Practitioner
  • W.-K. Lam · K.-Y. Ho · K.-K. Ng · K.-H. Kwok · L.C.Y. Tsang
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    ABSTRACT: Objective: (1) To investigate the morbidity pattern of patients attending 4 government general practice (GP) clinics, (2) to generate information for strategic planning of health care services to assist decision on priority for development of quality improvement, and (3) to understand occurrence of common diseases in general practice. Design: A cross-sectional survey from 1st, September 2004 to 31st August 2005 of health problems/diagnoses of clinical encounters of all subjects attending 4 government GP clinics during the one year study period, coded using the International Classification of Primary Care (Revised Edition) (ICPC-2) by attending family physicians. The diagnoses or problems identified by the attending family physicians in each patient encounter were recorded. Training and clinical audits on the coding practice were organized to ensure the validity of the codes. Microsoft Visual FoxPro based programmes were used in the analysis of the data retrospectively. Subjects: All subjects attended 4 government GP clinics during the one year study period. The four GP clinics were all Family Medicine training centres. Three of the clinics served patients who were government servants, pensioners and their dependents. The remaining one clinic served the general public of Hong Kong by referral. Main outcome measures: The diagnoses or problems identified by the attending family physicians in each patient encounter. Results: In the first year of implementation of ICPC-2 in 4 GP clinics, 53 314 individual patients (24 953 male and 28 361 female patients) were identified among the 166 957 clinical encounters. Each patient had an average of 1.7 problems per encounter. On average, each individual patient used the service 3.13 times per year. There was a bimodal age distribution of the patient population, with one peak at age 40-99 and another peak at age 10-14. The top ten diagnoses in the four government GP clinics, in descending order, were upper respiratory tract infection (16.2%), uncomplicated hypertension (12.9%), non-insulin dependent diabetes mellitus (4.8%), lipid disorder (4.1%), atopic eczema (2.6%), allergic rhinitis (2.5%), dermatophytosis (1.7%), elevated blood pressure (1.7%) contact dermatitis (1.7%) and obesity (1.5%). If important cardiovascular risk factors including hypertension, diabetes, lipid disorders, smoking abuse, overweight and obesity were combined, these factors were the most common health problem among the four GP clinics and outnumbered the burden of URTI. The frequency was 72 260, which was 25.47% of all the health problems treated in the clinics, (or 43.28 per 100 patient encounters). Conclusion: ICPC-2 is useful for our understanding of patient characteristics and morbidity pattern in the clinics. The data leads to an epidemiological understanding of the patients that utilizes the services of the four clinics. Cardiovascular risk factors are the most common health problems among the patients. This has the implication for the need to develop evidence based guidelines and clinical audit, and re-allocation of health care resources for better management of these risk factors to prevent future cardiovascular diseases. Strategic planning in health promotion of healthy eating, exercise and prevention of cardiovascular diseases may also be the priority area in health care planninq.
    No preview · Article · Sep 2006
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    T K W Tam · C M Lau · L C Y Tsang · K K Ng · K S Ho · T C Lai
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    ABSTRACT: To estimate the prevalence and risk factors of diabetic retinopathy in type 2 diabetic patients, and to investigate the difference in retinopathy progression in patients with normal fundi or established retinopathy at baseline and the risk factors implicated in the progression. Retrospective community-based study. Ten primary care clinics in Hong Kong. Type 2 diabetic patients; subsidiary analysis included subjects with more than one screening event. Patient demographics, baseline prevalence, and risk factors of diabetic retinopathy; progression of retinopathy in patients with normal fundi and established retinopathy at baseline, and the associated risk factors. A total of 6165 patients were recruited from January 1998 to May 2004. Primary analysis included 4423 patients with good-quality retinal photographs. The mean age of the patients was 60.36 years (standard deviation, 10.80 years; range, 28-94 years), the mean duration of diabetes was 4.71 years (standard deviation, 4.67 years; range, 0.1-40.6 years), and the mean level of glycated haemoglobin was 7.47% (standard deviation, 1.44%). The prevalence of retinopathy at baseline was 28.4%. Subsidiary analysis showed progression to sight-threatening retinopathy was more common in the group with baseline retinopathy than that without (7.9% vs 0.7%), and occurred at a faster rate (mean, 1.5 [range, 0.5-3.0] vs 2.0 [1.0-4.2] years). Logistic regression revealed that the level of glycated haemoglobin was positively associated with both the onset (P<0.001) and progression of retinopathy (P=0.03). Optimal glycaemic control is important for reducing sight-threatening retinopathy. Close observation is required for patients with established retinopathy as progression occurs more rapidly.
    Preview · Article · Jan 2006 · Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine
  • W.-K. Lam · K.-Y. Ho · K.-K. Ng · K.-H. Kwok · L.C.Y. Tsang
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    ABSTRACT: The International Classification of Primary Care - (revised version) (ICPC-2) is a useful classification system, which allows classification of the patient's reason for encounter (RFE), the problems/diagnoses managed, interventions, and the ordering of these data in an episode of care structure. In this clinical audit, we identified deficiencies in the correctness and completeness of coding of diagnosis and health problems in our clinics and noted common errors in coding ICPC-2. We implemented changes to improve our coding practice. In this project, we found that clinical audit can be useful in improving the correctness and completeness of coding.
    No preview · Article · Sep 2005
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    ABSTRACT: To determine the prevalence of microalbuminuria among patients with type II diabetes mellitus in a primary care setting, and to study the association between various risk factors and the presence of microalbuminuria. Cross-sectional community-based study. Four primary care clinics, Hong Kong. All patients with type II diabetes mellitus who regularly attended the clinics between May 2002 and March 2003. Patients' demographic data, the proportion with microalbuminuria (measured using a spot urine test), and the association between this condition and risk factors for diabetic nephropathy (via correlation and multivariable logistic regression analysis). The mean age of the 1161 patients in the sample population was 58.0 years. The mean duration of diabetes mellitus was 5.7 years, and the mean level of glycated haemoglobin was 7.4%. A total of 13.4% of the patients had microalbuminuria. Having the condition was significantly associated with advanced age, female sex, poor glycaemic control, and coexisting hypertension in both correlation and regression analyses. No significant association with ever smoking was found. Early screening for incipient diabetic nephropathy and aggressive management of modifiable risk factors in a primary care setting may be important in optimising the renal outcome of patients with type II diabetes mellitus.
    Preview · Article · Nov 2004 · Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine