Authors (including presenting author) :
Luk MH, Wong SN, Chan PF, Too LC, Kwan Y, Pun LY, Fung HT, Yeung SW, Chao DVK
Affiliation :
Department of Family Medicine and Primary Health Care, Kowloon East Cluster (KEC)
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 which would otherwise require referral 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 outcomes of patients with stenosing tenosynovitis (trigger fingers) referred to FMTC.
Methodology :
Relevant clinical information of all patients with trigger fingers referred to FMTC from 1 August 2018 to 28 February 2019 were reviewed in Clinical Management System.
Result & Outcome :
Results:
179 patients were referred to FMTC for trigger fingers. Mean age was 62.2 years old. 67.6% were female. Mean waiting time was 72 days.
The median presenting finger pain duration was 24 weeks (1st quartile: 12 weeks, 3rd quartile: 48 weeks). 21.3% patients had two or more fingers involvement. 174 patients were diagnosed of trigger fingers (97.2%). Other diagnoses included hand osteoarthritis (1.7%), suspected chronic osteomyelitis (0.6%) and non-specific hand pain (0.6%).
110 patients (61.5%) received local steroid injection. One of them was complicated with infection which was subsided with antibiotics. No patients had other serious complications. 86 patients (48.0%) received splintage from occupational therapist. 85.5% patients had symptoms improvement. 48.0% patients had already been discharged. The median consultation attendances and follow-up duration before discharge were 3 visits and 113 days respectively.
Only 10 patients (5.5%) required referrals to the Orthopaedics SOPC as 8 of them needed surgery for trigger fingers. One patient was referred as a finger lump was noted after local steroid injection, which was later subsided on subsequent SOPC visits. Another patient was referred due to suspected chronic osteomyelitis. Computer tomography was done by SOPC and suggested of osteoid osteoma.
Conclusion:
Family physicians led Triage Clinic can provide appropriate and effective management to patients with trigger fingers. Patients with severe conditions and unusual clinical features can also be detected and referred timely to SOPC. The clinic helped reduce the workload in secondary care by performing a gatekeeper role successfully.
