Authors (including presenting author) :
Luk CW (1)(2), Wu CY (1)(2), Yiu MP (1)(2), Wan KY (1), Chan CW (1)(2), Yiu YK (1), Luk W (1)
Affiliation :
(1) Department of Family Medicine and Primary Health Care (FM&PHC), Kowloon West Cluster, (2) Dermatology Interest Group, FM&PHC, KWC
Introduction :
With only 115 registered dermatologists in Hong Kong and an even smaller number of dermatologists serving in the Department of Health (DH), the routine waiting time for DH dermatology clinic in KWC is 2-3 years. Previous study revealed that general practitioners with special interest in dermatology can provide skin consultations that are more accessible than dermatologists while achieving similar clinical outcomes. Designated skin service was therefore set up in Lady Trench (LT) GOPC in 7/2020 to meet the dermatology service demand.
Objectives :
1. To evaluate the clinical outcome of designated skin service in a GOPC
2. To determine if designated skin service can reduce referral rate to DH Dermatology Clinic
Methodology :
All doctors of LT GOPC could refer patients to the service. Consultations were provided by a Family Medicine Specialist with post-graduate diploma in dermatology. Wood’s lamp was incorporated to improve diagnostic accuracy. The application of dermoscopy helped differentiate look-alike skin diseases, e.g. eczema vs psoriasis, rosacea vs acne. Clinical photos were taken for progress comparison with iPad provided by HA. Apart from conventional pharmacological treatment, cryotherapy was provided for suitable patients. Dermatology Life Quality Index (DLQI) was performed on the first visit and the fourth or last visit upon discharge, whichever was earlier.
Result & Outcome :
53 patients were seen in 5 months. The longest waiting time was 10 weeks. 20 patients completed the DLQI evaluation, including 19 patients being discharged from the service. Among the 20 patients (F: 13, M: 7), the mean age was 60.9. The discharged cases included recalcitrant tinea infection (35%), eczema (20%), contact dermatitis (15%), wart (15%), chronic urticaria (10%), psoriasis, macular amyloidosis, seborrheoic dermatitis, scalp folliculitis, lichen simplex chronicus, dermatofibroma, skin tag and seborrheoic keratosis. The mean DLQI dropped from 6.6 to 2.6 (p = 0.01), indicating that the effect of skin disease on patient’s life improved from moderate to small. Patients also reported improvement in the degree of itchy, sore, painful and stinging sensation from 1.5 to 0.7 (p = 0.01). Patients were less embarrassed, improving from 1.15 to 0.35 (p = 0.01). Patients had less difficulty with sports, with a reduction from 0.55 to 0.15 (p = 0.04). Only 3 patients were referred from the service to DH Dermatology Clinic eventually, resulting in an 85% reduction of referral to secondary care.
To conclude, designated skin service in GOPC can improve patients’ skin condition, reduce waiting time and referral to DH Dermatology Clinic.
