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香港醫學會對「慢性疾病共同治理先導計劃」的建議

政府於去年十二月公布《基層醫療健康藍圖》，提出一系列基層醫療措施，為應對本港人口老化及慢性疾病人數上升帶來的挑戰。醫務衞生局於七月向立法會提交「慢性疾病共同治理先導計劃」(下稱先導計劃)文件，指先導計劃將為四十五歲或以上、沒有已知高血壓或糖尿病的市民，提供篩查和疾病管理服務。計劃透過定額資助參加者參與篩查診症和治療診症，而參加者或需要為治療診症支付共付金額。

香港醫學會一直關注本港基層醫療發展，因應政府推出的《基層醫療健康藍圖》進行了一連串的工作。會長鄭志文醫生表示：「我們對香港發展基層醫療的方向抱有支持及開放的態度，為此特別建立了香港醫學會健康網絡，與十八區的地區康健中心、相關團體及醫院管理局聯網會面，收集了不少意見。我們又成立『慢性疾病共同治理先導計劃支援工作小組』及進行了一連串研究、討論，希望以不同的角度為政策作出建議。」香港醫學會會董會召開了特别會議，檢視了小組的研究和討論。整合意見後，本會對公眾、會員及基層醫療健康辦事處作出以下建議：

香港醫學會給公眾的建議：

1. 香港醫學會建議符合條件的市民參加先導計劃。
2. 糖尿病和高血壓為常見的慢性疾病，可導致心血管疾病，包括缺血性心臟病和中風。糖尿病能引發嚴重併發症，包括慢性腎衰竭和失明。如果能夠在早期識別出症狀，可及早進行治療，從而預防慢性疾病所引致的併發症。
3. 本會不建議市民進行頻繁及重覆的篩查。市民或會有機會接受其他篩查計劃，例如由保險公司或僱主提供的年度體檢，以及家庭醫生因診治其他疾病時進行的伺機性篩查。就相同情況進行的重覆篩查對及早發現病情並沒有幫助。
4. 現時有很多其他重要的篩查計劃，例如血脂篩查、癌症篩查和心理健康篩查等。先導計劃只是早期篩查計劃的一部分，其他篩查計劃同樣重要。
5. 疾病預防固然重要，例如控制前期糖尿病、糖尿病和高血壓、戒煙、減重等，但奉行健康的生活模式，例如積極實踐健康飲食和定期進行體能活動，同樣重要。
6. 香港醫學會呼籲未符合資格參加先導計劃的市民，特別是四十五歲以下的人士，應注意不同的健康風險因素，如家族病史、吸煙、過重、併發症和使用藥物情況等，有機會要進行篩查。市民應諮詢家庭醫生，就其個人情況制定身體檢查方案。
7. 參加者應注意先導計劃的細節，特別是計劃範圍，以及不同醫生的共付金額。

香港醫學會給會員和醫生的建議：

1. 香港醫學會建議各會員及醫生參加是次先導計劃。
2. 在參加前，本會建議醫生仔細研究計劃細節，並考慮個人因素，包括工作量、人力資源、診所服務時間和電腦配套。
3. 建議醫生根據個人診所條件訂明合理的共付金額。
4. 香港醫學會不會評論資助金額或個別醫生訂明的共付金額。
5. 本會建議醫生清楚列明診所服務時間，以及計劃範圍以外的附加費用。
6. 香港醫學會因應計劃成立了「慢性疾病共同治理先導計劃支援工作小組」，為會員提供支援。任何有關先導計劃的求助、意見和投訴，會員均可透過電郵 (cdcc@hkma.org) 向本會提交。工作小組由專責的會董和職員支援跟進，亦會與基層醫療健康辦事處進行高層溝通。
7. 香港醫學會早前成立「香港醫學會健康網絡」，連繫十八個地區康健中心和康健站，支援在十八區內提供基層醫療服務的會員，並作兩者的主要溝通橋樑。
8. 參加先導計劃的醫生必須使用電子健康紀錄互通系統(醫健通)。有見及此，香港醫學會研發了升級版香港醫學會診所管理系統0，以供參與計劃的醫生使用。
9. 本會建議醫生繼續為病人提供先導計劃以外的其他篩查計劃，亦應為未有參加先導計劃的市民提供常規篩查或伺機性篩查。
10. 本會建議醫生注意那些不符合參加資格的市民，特別是四十五歲以下，有前期糖尿病、糖尿病及高血壓高風險因素人士。

香港醫學會給基層醫療健康辦事處的建議：

1. 香港醫學會致力就「慢性疾病共同治理先導計劃」與基層醫療健康辦事處緊密合作。
2. 本會建議基層醫療健康辦事處向參加者和服務提供者清楚說明計劃範圍，尤其是醫生不會在先導計劃內提供範圍以外的服務，及會向參加者就計劃範圍外的服務收取額外費用。
3. 不同醫生的診所服務時間、會診的時間長短和共付金額或會有所不同。本會建議基層醫療健康辦事處公開發放這些資訊予參加者，讓他們自己選擇服務提供者。另外，本會認為基層醫療健康辦事處不應對個別醫生訂立的共付金額作評論。
4. 基層醫療健康辦事處適宜為先導計劃作定期檢討。
5. 基層醫療健康辦事處應為醫生提供技術和病人管理支援。香港醫學會成立了「慢性疾病共同治理先導計劃支援小組」，為參加計劃的會員提供支援。香港醫學會亦成立「香港醫學會健康網絡」，連繫十八個地區康健中心和康健站，並為會員統籌有關先導計劃的事情。

二零二三年八月十九日

傳媒聯絡：   

葛樂詩女士 - 高級經理(服務)

電話：2527 8941　     電郵：media@hkma.org

網址：www.hkma.org          

編輯備忘：

香港醫學會成立於一九二零年，旨在聯繫政府、各公立醫療機構、大學及私人執業的醫務工作者，交流意見，團結一心。   醫學會致力將最新的醫療資訊及醫務發展傳遞與會員，提倡會員遵行專業操守，進而服務社會，維護民康。

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19 August 2023

The HKMA’s Recommendations on the Chronic Disease Co-Care Pilot Scheme

The Government announced the “Primary Healthcare Blueprint” (Blueprint) last December, setting out strategies for strengthening primary healthcare in Hong Kong.  In July, the Government submitted documents of “Chronic Disease Co-Care Pilot Scheme” (CDCC) to the Legislative Council.  Under the scheme, health screening and diseases management to population at/over the age of 45 without known diabetes mellitus and/or hypertension will be provided.  A fixed subsidy on both screening and follow-up consultations would be offered to the participants, in which co-paying for consultations may be involved. 

The Hong Kong Medical Association (HKMA) highly concerns primary healthcare development in Hong Kong, in response to the launch of the “Primary Healthcare Blueprint”, various tasks have been carried out.  Dr CHENG, Chi Man, President of the HKMA said, “We are positive and open about the long-term development of Primary Healthcare in Hong Kong.  Thus, the HKMA District Health Network was specially established, meetings were held with the 18 district health centres/expresses, related organisations and the hospital clusters of the Hospital Authority, a lot of feedback was collected.  The HKMA Support Group for the CDCC has also been set up, a series of research work and discussions were done.  We hope to make recommendations in different perspectives.”  The HKMA Council had convened a special meeting to look into the research and discussions of the Support Group for the CDCC, we then came up with a list of recommendations to the public, our members/doctors, and the Primary Healthcare Office.  The recommendations are as follows:

The HKMA’s Recommendations to the Public:

1. Eligible candidates are recommended to join the Scheme.
2. Diabetes and hypertension are common. They are risk factors for cardiovascular diseases including ischaemic heart diseases and stroke.  Diabetes in itself carries serious complications including chronic kidney failure and blindness.  Early detection of the conditions allows early interventions and the prevention of complications.
3. Frequent, overlapping screening is not recommended. There are other screening schemes such as yearly body check from insurance schemes or employment benefits, and the important opportunistic screening when you see your family doctor for other reasons.  Overlapping screening for the same condition will not add any benefit for early detection.
4. There are important screening programmes for other conditions, such as lipid screening, cancer screening and mental health screening. This CDCC pilot scheme is only a part of the early detection programme.  Other screenings are equally important.
5. While the concept of risk prevention (such as control of prediabetes, diabetes and hypertension, smoking cessation, weight reduction) is important, another approach is to encourage healthy living. Active engagement in a healthy diet and regular exercise is encouraged.
6. Candidates not eligible to join the scheme, particularly those below 45, are reminded to take note of risk factors such as strong family history, smoking, overweight, concomitant medical conditions and medications used. Screening should be individualised and candidates should approach their family doctors.
7. Candidates who take part in the scheme should take note of the details of the scheme, particularly the scope of the scheme and the copayment of different doctors.

The HKMA’s Recommendations to Our Members/ Doctors:

1. Members are recommended to join the Scheme.
2. Before joining the scheme, members are recommended to study carefully details of the scheme and to take into consideration of individual practice conditions including workload, manpower, opening hours and computer software.
3. Members are recommended to set realistic copayment amounts according to individual clinic conditions.
4. The HKMA will make no comment on the subsidy amount or the copayment set by individual doctors.
5. It would be helpful to spell out clearly the clinic service time for the scheme and additional charges for services outside the scope of the scheme.
6. The HKMA has set up a support group: the HKMA Support Group for the CDCC to provide support to our members. Requests, comments and complaints can be submitted via email to cdcc@hkma.org. There are designated staff and Council Members for the support group. There will be high-level communication between the support group and the Primary Healthcare Office.
7. The HKMA Network has infrastructure of 18 District Health Networks in place which correspond to the 18 DHCs. The HKMA Network serves to coordinate and communicate with the local DHCs on matters concerning our members.
8. The HKMA has upgraded its CMS to The HKMA CMS 5.0 for members who are interested to join the CDCC programme for which eHRSS adoption is a prerequisite.
9. Members are recommended to continue their screening programmes other than those covered by the CDCC. Screening should also be provided to candidates who do not join the CDCC as routine screening and opportunistic screening.
10. Members are recommended to take note of candidates who are not eligible for the CDCC, particularly those below age 45, but are at high risk of metabolic conditions including prediabetes, diabetes and hypertension.

The HKMA’s Recommendations to the Primary Healthcare Office (PHO):

1. The HKMA is dedicated to working closely with the PHO in the CDCC.
2. The PHO is recommended to spell out clearly the scope of the scheme to users and providers. Services outside the scheme would not be provided by doctors, or would be provided with extra charges paid by the users.
3. There would be differences in service hours, time allocated to each candidate, and copayment required by different doctors. The PHO is recommended to allow such information to be disseminated to users. The users have free choices based on such information. The PHO is recommended not to comment on individual doctors especially on the amount of copayment.
4. The PHO is recommended to review the scheme regularly.
5. The PHO is recommended to provide support to doctors on technical issues and the management of patients. The HKMA has set up a support group: the HKMA Support Group for the CDCC to provide support to our members. The HKMA Network has infrastructure of 18 District Health Networks in place which correspond to the 18 DHCs. And, the HKMA Network serves to coordinate and communicate with the local DHCs on matters concerning our members.

Media Contact:           

Irene GOT, Senior Manager (Services)                                                         

Tel:  2527 8941                               E-mail:  media@hkma.org

Website:  www.hkma.org                                  

Notes to editors:

The Hong Kong Medical Association, founded in 1920, aims to bring together Hong Kong's government, institutional, university and private medical practitioners for an effective exchange of views and co-ordination of efforts.  The foremost objective of the HKMA is to safeguard and promote public health.  The HKMA speaks collectively for its members and aims to keep its members abreast of medical ethics, issues and advances around the world.  In fulfilling these goals, the HKMA hopes to better serve the people of Hong Kong.