Authors (including presenting author) :
Luk MH(1), Wong SN(1), Chan PF(1), Chao DVK(1), Lam KHE(2), HC Cheng(2), WS Tam(3)
Affiliation :
(1)Department of Family Medicine and Primary Health Care, Kowloon East Cluster (KEC)
(2)Department of Orthopaedics and Traumatology, United Christian Hospital
(3)Specialist Out-patient Department, United Christian Hospital
Introduction :
With an aim to enhance the gatekeeping role of Family Physicians, a pilot Family Medicine Triage Clinic (FMTC) was established in KEC in August 2017 to manage stable patients with predefined orthopaedics conditions referred to Orthopaedics Specialist Outpatient Clinic (SOPC). Comprehensive assessment and pharmacological treatment by FM specialists according to evidence-based clinical guidelines, early non-pharmacological interventions by physiotherapists and occupational therapists are provided.
Objectives :
To evaluate the diagnoses and outcomes of patients with chronic knee pain referred to FMTC
Methodology :
Relevant data of all patients with chronic knee pain referred to FMTC from 18 August 2017 to 17 October 2017 were reviewed in Clinical Management System.
Result & Outcome :
Results:
134 patients were referred to FMTC for chronic knee pain. Mean age was 62.6 years old. 67.9% of these patients were female. 120 patients (89.6%) were referred from GOPC and 14 patients (10.4%) were triaged from Orthopaedics SOPC. Mean waiting time was 11.8 days. The median presenting knee pain duration was 52 weeks (1st quartile = 24 weeks, 3rd quartile = 247 weeks). 36 patients (26.9%) had multiple underlying pathologies accounted for their knee pain. The three most common diagnoses were osteoarthritis (79.9%), patellofemoral pain syndrome (13.4%) and tendinopathy (6.7%). Other diagnoses included bursitis, meniscal injury, medial plica syndrome, iliotibial band syndrome, Parkinsonism and Hoffa’s disease. 68.3% patients had improvement in symptoms during subsequent follow-up. 59 patients (44.0%) had already been discharged to GOPC and majority of them (86.4%) did not need further regular follow-up. The mean number of consultation attendances before discharge was 3.42 visits and the mean follow-up duration was 145.6 days. Only 25 (18.7%) patients required referrals to the Orthopaedics SOPC. The referral indications were intra-articular loose bodies on knee X-ray, severe osteoarthritis and intramedullary bony infarct of the knee. Conclusion:
Family physicians led Triage Clinic can make accurate diagnosis and can provide appropriate and effective management to patients with chronic knee pain. Patients with severe conditions can also be detected and referred timely to SOPC. The clinic helped reduce the workload in secondary care by performing a gatekeeper role successfully.
Co-location with:
