DOI: 10.12809/hkmj175067
© Hong Kong Academy of Medicine. CC BY-NC-ND 4.0
EDITORIAL
The Hong Kong Reference Frameworks—for our
doctors and our community
Monica MH Wong, FHKAM (Community Medicine)
Primary Care Office, Department of Health, Hong Kong
Corresponding author: Dr Monica MH Wong (headpco@dh.gov.hk)
Introduction
I remember that as a student, when I wanted to
find papers about new developments in disease
management, I needed to consult what looked like
a set of encyclopaedias—the MEDLINE / Index
Medicus. There followed a search in the medical
library for hard copies of overseas medical journals.
What a tedious job it was! Thanks to the invention of
computers and evolvement of this cyber world, I can
now sit comfortably anywhere and access all sorts of
updated guidelines and recommendations with one
click. Wait a minute, there are so many international
guidelines available for any particular subject! I have
been asking myself, “How best can we choose which
one is most suitable for patients in Hong Kong? Can
we have local protocols that address the needs of
Hong Kong?”
The Hong Kong Reference Frameworks
The answer lies in a series of Hong Kong Reference
Frameworks, or RFs for short, released after 2010
to cover the preventive care of children and older
adults, as well as the prevention and treatment
of two common chronic conditions (diabetes and
hypertension) in the primary care setting.1 2 3 4 The
development of RFs was one of the initiatives
recommended by the then Working Group on
Primary Care, chaired by the Secretary for Food
and Health, and produced by the Task Force on
Conceptual Model and Preventive Protocols under
this Working Group. These frameworks are based
on evidence from international literature with input
from primary care physicians, as well as specialists
from relevant Colleges of the Hong Kong Academy
of Medicine, academic experts from the universities,
doctors from the public and private sectors, and
representatives from professional associations and
patient groups.
It is hoped that these RFs will serve as a handy
local source of information about evidence-based
practice and a reference for doctors in their day-to-day
work in a primary care setting.
Our platform
Being mindful of environmental conservation, these
RFs are available primarily on a web-based platform,
on the website of the Primary Care Office at <www.pco.gov.hk>. Various aides mémoire are available to provide doctors with a quick reference during
patient consultations. For example, A4 size cards
that summarise the major recommendations, and
cue cards for immunisation and health assessment.
We also have a mobile application ‘Framework@PC’
that can be accessed from mobile devices to enable
prompt retrieval of the major recommendations in
the RFs.
You may ask, how have we ‘advertised’ these
RFs to end users? How can we encourage more
primary care doctors to adopt these RFs?
There is no surprise or magic answer. We have
used various CME platforms. We are co-organising
CME seminars with professional organisations (such
as the Hong Kong Medical Association and Hong
Kong Doctors Union). We run training programmes
in collaboration with the Hong Kong College of
Family Physicians to elaborate on the contents of the
RFs. We have also submitted articles to the Hong Kong
Medical Journal5 6 7 8 and other journals9 to facilitate a broad readership, at any time and in any place. This
also enables RF-related articles to be indexed and
searched on online medical publication databases,
and hence further broadens our readership. Doctors
listed in the Primary Care Directory will also be
notified of any release of new modules and major
updates of the existing RFs.
We believe that increasing the understanding
of the general public about prevention and
management of diseases is an effective means to
create an environment that is conducive for doctors
to implement RF recommendations for their patients.
Over the years, we have produced information
booklets or leaflets for the general public that will
empower them by providing information about the
recommendations of the RFs.
Although online viewing of the RFs does
not necessarily imply a reader’s adoption of the
recommendations, viewing figures nevertheless
provide an indication of readers’ awareness of these
documents. Since their publication on our website,
we have recorded over 600 000 downloads of the
core documents and the various modules under the
four RFs, with a consistent number of downloads
every month. We know promulgation activities must
continue so that these RFs reach as many doctors as
possible. We will not stop.
Future development
New modules will continue to be produced,
particularly for RFs relative to specific population
groups, such as the module on development in
children and another on cognitive impairment in
older adults. Hopefully, the in-depth discussions and
problem-solving algorithms in the modules will help
professionals manage such issues in a primary care
setting.
May I take this opportunity to call upon all
doctors to support enhancement of primary care
through the provision of high quality care that
is comprehensive, continuing, co-ordinated, and
person-centred. Although there are many ways to
achieve this, applying the recommendations of the
RFs in your patient care is certainly one of your best
options. The contribution of each individual doctor
contributes to the overall health of Hong Kong
people. I know I can count on you.
References
1. Hong Kong Reference Framework for Preventive Care for
Children in Primary Care Settings. Available from: http://www.pco.gov.hk/english/resource/files/ref_framework_children.pdf. Accessed 26 Apr 2017.
2. Hong Kong Reference Framework for Preventive Care
for Older Adults in Primary Care Settings. Available
from: http://www.pco.gov.hk/english/resource/files/ref_framework_adults.pdf. Accessed 26 Apr 2017.
3. Hong Kong Reference Framework for Diabetes Care for
Adults in Primary Care Settings. Available from: http://www.pco.gov.hk/english/resource/files/RF_DM_full.pdf. Accessed 26 Apr 2017.
4. Hong Kong Reference Framework for Hypertension Care
for Adults in Primary Care Settings. Available from: http://www.pco.gov.hk/english/resource/files/RF_HT_full.pdf. Accessed 26 Apr 2017.
5. Wong MC, Sin CK, Lee JP. The reference framework for
diabetes care in primary care settings. Hong Kong Med J
2012;18:238-46.
6. Griffiths SM, Lee JP. Developing primary care in Hong
Kong: evidence into practice and the development of
reference frameworks. Hong Kong Med J 2012;18:429-34.
7. Siu NP, Too LC, Tsang CS, Young BW. Translating evidence
into practice: Hong Kong Reference Framework for
Preventive Care for Children in Primary Care Settings.
Hong Kong Med J 2015;21:261-8. Crossref
8. Sin CK, Fu SN, Tsang CS, Tsui WW, Chan FH. Prevention
in primary care is better than cure: The Hong Kong
Reference Framework for Preventive Care for Older
Adults—translating evidence into practice. Hong Kong
Med J 2015;21:353-9. Crossref
9. Cindy LK Lam, KH Ngai, Jeff PM Lee. The Hong Kong
Reference Framework for Hypertension Care for Adults in
Primary Care Settings—translating evidence into practice.
Hong Kong Pract 2012;34:76-83.