Authors (including presenting author) :
Dao MC(1), Fu SN(1), Tsui PT(2), Chan NY(2), Luk W(1)
Affiliation :
(1)Department of Family Medicine and Primary Health Care, Kowloon West Cluster, (2)Department of Medicine, Princess Margaret Hospital
Introduction :
Echocardiogram (Echo) is a rapid and non-invasive diagnostic tool for evaluating cardiac structures and functions. The growing demand of echo service is inevitable due to aging population and increased prevalence of chronic diseases. It is not unusual for family physicians to encounter patients presented to general outpatient clinics (GOPCs) for suspected heart failure, heart murmurs and structural heart diseases. The waiting time for Echo was around 12 months before the project. Since 2016, we have collaborated with cardiologists to provide Echo service in GOPC using a shared-care model, and the average waiting time was reduced to 3 months.
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 at GOPC level
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, our Family Medicine specialists passed the internationally recognized examination (ASCeXAM) for adult echocardiography before independent reporting.
Result & Outcome :
From April 2016 to December 2020, 774 patients had their Echo done in Ha Kwai Chung GOPC. The mean age was 68.9 years and male to female ratio was 1:1.3. The average waiting time was 12 weeks. The most common indications were heart failure symptoms (30.9%), followed by heart murmur (26.2%), suspected structural cardiac abnormality by electrocardiography or chest X-ray (23.1%) and atrial fibrillation (AF) or atrial flutter (13.7%). 103 patients (13.3%) were identified with significant valvular abnormalities, structural abnormalities and heart failure with reduced ejection fraction. 13 of them had severe aortic stenosis which required early surgical intervention. In addition, patients with non-valvular AF were managed in GOPCs by direct-acting oral anticoagulants for thromboembolic stroke prevention. This shared-care model can promote the integration and continuity of care by family physicians and maximize the expertise of our specialists. We could enhance our role as gatekeeper and reduce unnecessary referrals to cardiologists.
