Choices between Chinese and Western medicine in Hong Kong - interactions of institutional environment, health beliefs and treatment outcomes.

BACKGROUND: About 15-20% of the general public in Hong Kong consult TCM practitioners. This study explored the decision making process involved in Hong Kong Chinese's choice between TCM and western medicine. METHODS: Eight focus group interviews (six to eight participants per group) and four individual interviews were conducted. RESULTS: The participants kept an "old fashioned" concept of TCM. Many saw TCM as a non-scientific practice and had stronger trust on the credibility of western medicine. Some participants, however, preferred the more personalized treatment approach of TCM. While western medicine was usually the initial choice, the participants were pragmatic to adopt TCM when they felt western medicine was not working, or to supplement the treatment. They were often referred by members of their social networks. CONCLUSION: The public' perception of TCM lagged behind its actual development. Many TCM users are pragmatic users who learn through trial and error.

Differences in antibiotic use between patients with and without a regular doctor in Hong Kong.

BACKGROUND: Literature shows that continuity of care from a primary care physician is associated with better patient satisfaction and preventive care. This may also have an effect on patients' use of antibiotics. This study investigated the differences in antibiotic use between patients with and without a regular doctor in a pluralistic health care system. METHODS: A cross-sectional telephone questionnaire survey using randomly selected household phone numbers was conducted in Hong Kong. Several key areas about antibiotic use were compared between the respondents with a regular doctor and those without. RESULTS: The response rate was 68.3 %. Of the 2,471 respondents, 1,450 (58.7 %) had a regular doctor, 942 (38.1 %) without, and 79 (3.2 %) did not give a clear answer. The respondents with a regular doctor were more likely to report that they always finished the full course of antibiotics (74.2 % vs 62.4 %), as well as using antibiotics for their last upper respiratory tract infections (17.4 % vs 10.1 %). The association with antibiotic use remained significant in the multivariable logistic regression analysis after adjusting for other confounding factors (P < 0.001, OR = 1.76, 95 % CI:(1.27, 2.48)). CONCLUSIONS: While patients with a regular doctor, compared to those without, were more likely to report finishing the full course of antibiotics, they also had nearly twice the chance of reporting antibiotic use for upper respiratory tract infections. This challenges the common belief of the benefits in having a regular doctor.

How long do the Hong Kong Chinese expect their URTI to last? - effects on antibiotic use.

BACKGROUND: Recent literature shows that there is a large mismatch between the US patients' expected duration of acute cough illness and the actual duration. It has been suggested that this discrepancy may lead to antibiotic misuse. Currently, there is limited relevant information for the Chinese. This study aims to investigate the duration that Hong Kong Chinese expect their upper respiratory tract infection (URTI) to last and its possible association with antibiotic use. METHODS: A cross-sectional telephone questionnaire survey with 2,471 adult respondents was conducted in Hong Kong between November and December of 2010. The expected URTI duration of the respondents and their antibiotic use behaviors were analyzed. Multivariable logistic regression analysis was used to adjust for the effects of demographic factors including age, gender, education and income. RESULTS: Excluding 80 uncertain responses, 544 (23.1%) respondents expected their URTI to last for 1-3 days in general, 613 (25.5%) for 4-6 days, 1168 (48.6%) for 1-2 weeks, and 66 (2.7%) for > 2 weeks. The mean of expected duration was 7.4 (SD:4.2) days. Respondents expecting 1-3 days duration were least likely to ask for and be treated with antibiotics. The proportion of respondents being treated with antibiotics for the last URTI increased from 10% for the 1-3 days group to 23% for the > 2 weeks group (χ(2) = 19.086, P < 0.001). The effect of expected duration remained significant (P = 0.0188) after adjusting for the effects of demographic factors. CONCLUSIONS: The Hong Kong Chinese expect their URTI to last for about 7 days on average. Different from the notion that underestimation of the actual duration would lead to antibiotic misuse, this study shows that patients expecting a longer duration have a doubled chance to be treated with antibiotics.

Are There Differences in Antibiotic Use Between the Recent-Immigrants from Mainland China and the Local-Born in Hong Kong?

Immigrants, especially the first-generation, were thought to have different knowledge, attitudes and practice (KAP) with antibiotics. Doctors often perceived extra pressure from them to prescribe antibiotics. To test these perceptions, we studied the difference in KAP with antibiotics between the recent-immigrants from mainland China and the local-born of Hong Kong-places with significantly different healthcare and socio-economic systems. Focus groups (including one specific group of recent-immigrants) with 56 participants and territory-wide telephone questionnaire survey with 2,471 randomly selected respondents. Recent-immigrants shared similar KAP with the local-born. After adjustment for age, sex and education, the main significant difference was the new-immigrants' behaviour of acquiring antibiotics without prescription and keeping the leftover. They, like the local-born, preferred doctors who prescribed antibiotics cautiously. Immigration status could be the surrogate for age, sex and education in the KAP with antibiotics. For antibiotic use, health education and patient care could be similar between the recent-immigrants and the local-born.

Comparison of the knowledge, attitudes and practice with antibiotic use between traditional Chinese medicine and western medicine usual attenders in Hong Kong.

BACKGROUND: Patients who usually attend Traditional Chinese Medicine (TCM) need to go to western medicine (WM) doctors for antibiotics in Hong Kong. They might have different knowledge, attitude and practice (KAP) with antibiotics from the WM-attenders. OBJECTIVE: This study compares TCM attenders with the WM-attenders in Hong Kong about their KAP with antibiotics. The comparison could help future campaigns/education on appropriate antibiotic use. DESIGN AND SETTING: A questionnaire on KAP with antibiotics was designed after eight focus groups of purposively selected participants. A territory-wide telephone survey then interviewed randomly selected residents who were aged 18 years or above and spoke the local dialect. RESULT: Of 2471 respondents, 270 and 2092 usually attended TCM and WM, respectively. Majority of both the TCM- and WM-attenders preferred doctors who were judicious in prescribing antibiotics and seldom asked for them. The TCM-attenders were significantly more likely to be female and with lower household income. They were also more likely to agree that antibiotics were not useful for upper respiratory tract infections and that antibiotic resistance was a serious local problem. They were less likely to accept or be treated with antibiotics. The TCM-attenders were also more concerned about the side-effects of antibiotics. However, they were also less likely than the WM-attenders to always finish a full course of antibiotic. CONCLUSION: Apart from non-compliance, the TCM-attenders' KAP with antibiotics favour the appropriate use of antibiotics.

Menopausal symptoms and the menopausal rating scale among midlife chinese women in Macau, China.

Studies on menopause-related quality of life (QoL), especially using the Menopausal Rating Scale (MRS), in Asian women are scarce. This study surveyed menopausal symptoms in a convenience sample of 442 Chinese women aged 40-60 years who attended the Well-Women Clinic, Macau, China, in a public health center. The questionnaire included sociodemographic data, the MRS, and a novel question on which area of QoL was affected. The average age of the participants was 49.2±5.08 years, and 98.9% of them reported experiencing menopausal symptoms. The four most prevalent menopausal symptoms were physical and mental exhaustion (90.3%), joint and muscle discomfort (88.5%), irritability (78.1%), and sleep problems (77.1%). The average MRS score was 14.2±8.80. A severe MRS score (≥17) was found in 35.5% of participants. Severe scores in the psychological, somatic, and urogenital MRS subscales were found in 17.9%, 42.8%, and 34.8%, of women, respectively. Menopausal symptoms affected QoL in 57.2% of women: daily life in 36.7%, work in 29.2%, sexual life in 17.0%, and relationship with husband in 13.8%. Daily life was significantly affected by hot flushes and joint/muscular discomfort; work was reportedly affected by irritability and exhaustion; sexual life was reported to be affected by hot flushes, sexual problems, and vaginal dryness, and relationship with husband was affected by sexual problems. We concluded that menopausal symptoms were highly prevalent among midlife Chinese women and often affected their QoL. The MRS, however, did not have a high sensitivity in detecting impaired QoL.

Stress urinary incontinence in younger women in primary care: prevalence and opportunistic intervention.

BACKGROUND: Stress urinary incontinence (SUI) is prevalent in females, even among young adults. Though their quality of life (QOL) is impaired and pelvic floor exercise is an effective treatment, not many affected women seek medical help. This study aimed to evaluate the feasibility of case finding and opportunistic intervention of SUI at a public Well Women Clinic in Macau, China. METHOD: A convenience sample of 408 consecutive female patients aged 30-50 years filled in the Urogenital Distress Inventory Short Form and the Incontinence Impact Questionnaire Short Form. They were also asked reasons for not seeking for medical help. The patients with incontinence were educated on pelvic floor muscle exercise during the gynecological examination. RESULTS: SUI was reported by 153 (37.5%) women, of whom 47 (30.7%) had impaired quality of life despite mild symptoms. Of the SUI patients, 52.9% thought that incontinence was inevitable with age, 22.2% believed that they should cope with the problem themselves, 13.7% thought that no useful treatment was available, and 3.9% had sought medical advice before. After learning pelvic floor muscle exercise for 4 to 6 months, 9.8% of SUI patients had complete relief of the symptoms, 47% partial improvement, and 17.6% no significant change. CONCLUSIONS: SUI with impaired quality of life was common before menopause. Very few affected women sought medical help. Opportunistic case finding and education about pelvic floor exercise in a Well Women Clinic were effective in the detection and treatment of the silent SUI.

Chinese men's knowledge and risk factors of osteoporosis: compared with women's.

Male osteoporosis is underappreciated. Little is known about men's knowledge of osteoporosis and how much men are at risk. This study surveyed men's knowledge of osteoporosis and their risk factors with reference to women in the primary care setting in Macau, China. A convenience sample of 302 men and 635 women aged 18 to 90 years completed questionnaires comprising the Osteoporosis Knowledge Assessment Tool and the One-Minute Osteoporosis Risk Test. Their risks of osteoporosis were assessed with the Osteoporosis Self-Assessment Screening Test. Men and women, who were aged 55 years or below, had similarly limited knowledge of osteoporosis. People aged above 55 years had significantly less knowledge; men had less knowledge than women only in this age-group. If questions specific to women or menopause were excluded, men had similar knowledge as women. A higher proportion of men than women had risk factors as more men consumed alcohol or smoked tobacco. Similar proportions of men and women reported a loss of 1 inch in body height after age 40. After age 55, 29.2% men were at medium to high risk of osteoporosis. This study concludes that health education and primary prevention of osteoporosis should be promoted to men starting in middle-age.

The public's perspectives on antibiotic resistance and abuse among Chinese in Hong Kong.

PURPOSE: Antibiotic abuse and resistance impose a continuing threat to the world. The awareness of antibiotic resistance is said to be inversely associated with the prevalence of abuse. We examined the public's perspectives on antibiotic resistance in our study of the public's knowledge, attitude and practice with antibiotics. METHODS: The study adopted a combined qualitative and quantitative approach. Eight focus groups were conducted with 56 participants purposively selected from community centres and of different socio-economic strata. The qualitative data collected were used to construct a questionnaire for the telephone survey which surveyed 2471 adults from randomly selected residential numbers. RESULTS: The focus-group participants were unclear about the nature and causes of antibiotic resistance; they also attributed antibiotic abuse to the doctors' responsibility. Of the questionnaire respondents, 9.0% had not heard of the term, 7.8% had ever acquired non-prescribed antibiotics, 6.6% had ever kept the leftover and only 69.8% had always finished the full course of antibiotics. Furthermore, 77.3 % and 75.1%, respectively, agreed that the purchase of antibiotics without prescription and incomplete courses of antibiotics would lead to undesirable consequences. Of the respondents who had heard about antibiotic resistance, 38.7% agreed that they could help the prevention of resistance. They were more likely to complete the full course of antibiotics and less likely to keep the leftovers. CONCLUSIONS: The public in general was not aware of the causes of, nor their role and capability in preventing, antibiotic resistance. Future campaigns and health education should empower everyone to restrain antibiotic resistance.

In a free healthcare system, why do men not consult for lower urinary tract symptoms (LUTS)?

BACKGROUND: The prevalence of lower urinary tract symptoms (LUTS) varies among different populations but the rate of seeking medical advice is consistently low. Little is known about the reasons for this low rate. In the city of Macau, China, primary healthcare is free and easily accessible to all citizens. We aim to study the patients' rate of consulting for LUTS and their reasons for not consulting under a free healthcare system. METHOD: A convenience sample of 549 male patients aged 40-85 years in a government health centre filled in the International Prostate Symptoms Scale (IPSS) questionnaire. They were also asked if they had consulted doctors for LUTS, and if not, why not. RESULT: Of the whole sample, 64 men (11.7%) had ever consulted doctors for LUTS. Of 145 with moderate to severe LUTS, 35 (24.1%) consulted. Of 73 who were dissatisfied with their quality of life, 22 (30.1%) consulted. Regarding the symptoms as normal or not problematic was the main reason for not consulting. Advancing age and duration of symptoms were the significant factors for consulting. CONCLUSION: Primary care doctors could help many of LUTS patients by sensitively initiating the discussion when these patients consult for other problems.

Reasons for preferring a primary care physician for care if depressed.

BACKGROUND: Most studies showed that patients would first go to their primary care physicians (PCPs) when depressed. This choice is probably due to PCP being the entry point into the health care system. We studied the general population's initial choice of mental care in Hong Kong, where patients were unclear about family medicine and free to choose doctors of any specialty. METHODS: A combined qualitative and quantitative approach was adopted. We held focus groups with participants recruited from community centers and a telephone survey with adults ages 18 or above randomly selected from the domestic telephone directory. RESULTS: Of 1,647 adults successfully interviewed, 49.0% would seek help from their regular PCP, 19.3% from psychiatrists, 4.8% from any doctors, 16.5% from non-medical resources; 6.9% would not seek any help, and 3.5% were uncertain of what to do. Those who did not seek any help were more likely to be male or without regular doctors. The focus group participants highlighted the stigmatizing effect of consulting psychiatrists and expressed strong expectation of empathic relationship, time, and communication skills from their care providers. Some participants were not aware that PCP could manage mental illness. CONCLUSIONS: Given free choice of health care service, most people would first consult their regular doctors for treatment of depression specifically because of better relationship and no stigmatization. To draw depressed patients to seek help, especially from primary care, public education of the PCPs role in mental health should be promoted, and the PCPs could demonstrate their empathy and listening skills to patients.

How do patients choose their doctors for primary care in a free market?

AIMS: A recent trend in health care system is to provide more choices to the patients. This study surveyed the general public's choices for primary care in Hong Kong which has the setting of free choices for private or public service and also direct access to specialists. METHODS: We used a combined qualitative and quantitative approach. We held five focus group interviews with participants of different socio-economic categories. Information from the focus groups helped to design a questionnaire for random telephone interviews with members of the public aged 18 or above. RESULTS: There were 37 participants in the focus groups and 1647 respondents in the telephone survey. The most important factor for choosing a doctor was proximity to home or workplace, followed by quick relief from the illness. Once continuity of care had been established, distance was of less importance but comprehensive care was valued. Nearly 70% of the public had regular doctors. About 93% of the public would consult specialists directly when they thought they needed a specialist's opinion. Nearly 30% chose specialists for any medical care and 38% preferred specialists to also look after their primary care problems. CONCLUSION: Convenient accessibility was the most important factor for the initial choice of primary care doctors by the general public. The perceived clinical proficiency of the doctor determined future continuity of care. Patients liked to have direct access to specialists. Though some chose to see the specialists even for primary care problems, most people had regular doctors who were likely to have the attributes of family doctors.