Authors (including presenting author) :
Dao MC(1), Fu SN(1), Tsui PT(2), Luk W(1)
Affiliation :
(1) Department of Family Medicine and Primary Health Care, Kowloon West Cluster, (2) Department of Medicine and Geriatrics, Princess Margaret Hospital
Introduction :
Echocardiography (echo) is a rapid and non-invasive diagnostic tool for evaluating cardiac structures and functions. We often encountered patients presented to GOPCs with suspected heart failure, heart murmurs and structural heart diseases, which are all common indications for echo. Currently, the waiting time for echo is around 10-12 months, which made early diagnosis of significant structural or valvular abnormalities impractical. A pilot model of family physician-led bedside echo service was established in 2016 to provide consultations with bedside echo as an adjunct to increase diagnostic accuracy for guiding treatment.
Objectives :
(1) To reduce referral for echo to hospital and unnecessary referral to cardiologists (2) To make prompt referral for cardiologists in case of severe valvular or structural abnormalities (3) To provide more appropriate and timely management
Methodology :
Our department has collaborated with the Department of Medicine, Princess Margaret Hospital for echo training and supervised scanning regularly since February 2016. Training content and structure was adopted from the framework by the American Society of Echocardiography. For quality assurance, two doctors passed the examination by the National Board of Echocardiography for the special competency in adult echocardiography and obtained the testamur status. The images and video clips scanned by family physicians in GOPCs were also randomly checked by the cardiologists to ensure the quality of images and correct interpretation of findings.
Result & Outcome :
From April 2016 to December 2018, 254 patients had their echo done in Ha Kwai Chung GOPC, which was equivalent a total of 85-week hospital echo sessions. The mean age was 68.3 years and male to female ratio was 0.7. The average waiting time was 4.6 weeks. The common indications were heart failure symptoms (34%), followed by suspected structural cardiac abnormality by electrocardiography or chest X-ray (25%), heart murmur (19%) and newly diagnosed atrial fibrillation/atrial flutter (19%). 19 patients (7.5%) were referred to cardiologist for early assessment for significant valvular heart disease or dilated cardiomyopathy, 7 of them had severe aortic stenosis which required early surgical intervention. Patients with non-valvular AF was managed in GOPC by novel anticoagulant for thromboembolic stroke preventions. Conclusion: This pilot model can promote the integration and continuity of care by family physicians and maximize the expertise of family medicine specialists. It can also reduce unnecessary referrals to cardiologists. Further evaluations could be done to assess the long-term sustainability of this model.
Co-location with:
