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Help-seeking for depression and anxiety disorders from primary care physicians in Western countries is at three times the rate of China. Western help-seeking models for common mental disorders have limitations in the Chinese settings. This article argues that an adapted model based on Andersen's Behavioral Model of Health Services Use could be an appropriate tool to better understand patients' help-seeking behaviors and improve outcomes. We applied a narrative review approach to integrate research findings from China into Andersen's model to generate a model that fits the Chinese context. We found 39 relevant articles in PubMed, MEDLINE, and Chinese journal databases from 1999 to 2022. Findings were mapped onto predisposing, enabling, and need factors of the model. This model emphasizes that predisposing factors including demographics, social norms, and health beliefs influence help-seeking preferences. Mental health service users in China tend to be older and female. Chinese generally have high concern about psychotropic medications, and social norms that consider psychological distress a personal weakness may discourage help-seeking. However, help-seeking can be enhanced by enabling factors in the health system, including training of primary care physicians, longer consultation time, and continuity of care. Need factors for treatment increase with the severity of distress symptoms, and doctor's skills and attitudes in recognizing psychosomatic symptoms. While predisposing factors are relatively hard to change, enabling factors in the health system and need factors for treatment can be targeted by enhancing the role of family doctors and training in mental health. [ABSTRACT FROM AUTHOR]

Background: Although the necessity and benefits of having the open and public discussion about suicide have been recognized, youths' opinions regarding such discussion remain unknown. Aims: To explore youths' attitudes toward open suicide discussion, particularly concerning their preference of discussion contexts and impacts of Internet use. Method: This exploratory sequential mixed-methods study targeted Hong Kong youths aged 15 to 19. A total of six focus groups and 12 individual interviews were held (N = 40). Topics included adolescents' views of open suicide discussion, concerns, perceived benefits, and preferred contexts. The questionnaire survey (N = 1,676) was conducted subsequently to investigate the prevalence of youths' perspectives on public discussion of suicide and relationships with discussion contexts, use of social media platforms, and motivations of online expression. Results: Qualitative findings revealed three types of attitudes toward open suicide discussion: reluctance, support, and indifference. Major barriers included cultural norms, topic sensitivity, privacy concerns, contagion effect, fear of embarrassment, and unpleasant experiences in school programs. Results of quantitative analyses showed that reluctance was the dominant attitude among adolescents, and taboo was the top concern. Variations in youths' attitudes were related to gender, school academic banding, and suicide-related experiences. Notably, adolescents who had been exposed to suicide messages in contexts of peer networks and online platforms were more likely to endorse open suicide discussion. In addition, an increased likelihood of engaging in public suicide discussion was associated with the use of Instagram, WhatsApp, and Snapchat, and the motive of 'expressing emotions and opinions' online. Conclusions: Our results indicated a prevalent rejection among adolescents toward open suicide discussion, suggesting the issue of stigma, the need for tailored programs, the value of appropriate contexts, and the impact of Internet use. These findings may facilitate the development of school-based suicide prevention initiatives and the efficacy of online services for suicide-related communication. [ABSTRACT FROM AUTHOR]

Background: Primary care physicians (PCPs) in rural township health centers are the most easily accessible doctors to the residents in rural China, which covers 35% of the population. High prevalence of depression was reported among rural left-behind elderly and children as many workers had migrated to urban cities. Aim: This study explored mental health care provision by PCPs in rural China and the association with their training background. Methods: Rural township health centers in both developed and less developed counties of Zhejiang Province, China were chosen as the study sites. A total of 697 PCPs completed questionnaires between December 2019 and January 2020, and the number of valid questionnaires was 673, with a valid response rate of 79.3%. Results: The rural PCPs reported a median range of seeing 1 to 5 mental health patients per week. Over two-thirds (68.2%) of the respondents had never received any training on treating common mental health disorders (depression and anxiety) while 20.3% received at most 2 days of training; 6.4% received 3 to 20 days of training; and 5.1% received over 20 days of training. PCPs with mental health training were significantly associated with better mental health care in terms of confidence and practice characteristics (e.g. having patients who brought up mental health issues, providing follow-up), while years of practice made a difference in practice but not confidence. Conclusions: Training is the key determinant of the practice of mental health care by the PCPs in rural China. Our findings have implications for national policy to target two-thirds of rural PCPs who received no mental health training. [ABSTRACT FROM AUTHOR]

Objectives: Although the topic of antibiotic misuse is taught in medical schools, interns (fresh medical graduates) still encounter barriers to appropriate antibiotic prescription when they practice in hospitals under supervision. The impact of teaching in medical school, antibiotics stewardship program (ASP), and prescription guidelines was uncertain. This study explored the medical interns' views on antibiotic use and resistance, and their perceived enablers to appropriate antibiotic prescription. Methods: Two focus groups were conducted among medical interns with rotation experiences in different public hospitals of Hong Kong. The identified themes about attitudes to antibiotic resistance and enablers to appropriate antibiotic prescription were further examined by a questionnaire survey with 77 respondents. Results: The interns had lower preferences for tackling antibiotic resistance as they feared of delayed prescriptions. Guidelines provided by international evidence-based clinical resources and the interns' working hospitals were stronger enablers to appropriate antibiotic use than education materials from schools and the government. Qualitative findings revealed that the interns were aware of the existing ASP but doubted its effectiveness as it failed to get the prescribers' attention. They followed guidelines in their wards but perceived guidelines from local health authorities user-unfriendly. Knowledge from medical school was not very applicable. Varying prescribing practices between hospitals and the densely placed hospital beds made it difficult to prevent the spread of antimicrobial resistance. Conclusions: Minimizing delayed prescription is of a higher priority than tackling antibiotic resistance in medical interns' perspective. Interventions should target guidelines in hospitals and simplify the interface of local guidelines. [ABSTRACT FROM AUTHOR]

Despite widespread interest in social media use, little is known about the heterogeneity of underlying motivations for online engagement among at-risk adolescents. This study adopted a mixed-methods approach to evaluate the motives of online expression among Hong Kong youths aged 15–19, as well as their relationships to online help-seeking willingness and suicide risks. In total, 6 focus groups and 12 individual interviews were conducted (N = 40) to elicit information regarding online expression purposes and to construct questionnaire items. The cross-sectional survey (N = 1,676) was undertaken subsequently to determine the prevalence of motives, and their correlations with online help-seeking willingness and suicide risks. Qualitative interviews revealed two key themes: major motivations for online expression, and features of online expression and help-seeking among suicidal youths. Quantitative analyses demonstrated the prevalence of each online expression purpose, with most reporting on "emotional expression" and "life sharing and documentation," but variations identified by gender, school academic banding, and suicide-related experience. Notably, an ordinal logistic regression model revealed that motives of "emotional expression" and "image building" were associated with increased suicide risks, while the purpose of "life sharing" was associated with decreased suicide risks. Those who expressed online for "self-expression" and "friend making" showed a stronger willingness for online help-seeking. These findings provide a more holistic overview of the purposes of online expression, which suggested the likelihood of mental health issues and the need for support. Such insight may facilitate the development of more effective suicide prevention strategies and online intervention services. [ABSTRACT FROM AUTHOR]

While primary care physicians (PCPs) have opportunities to recognize patients who encounter domestic violence (DV) by intimate partners, warning symptoms such as unexplained physical injury, bruising, anxiety, and depression are often missed during clinic visits. This study investigated the barriers of Hong Kong PCPs toward managing DV, including recognition, management, and referrals of these patients. Four focus group interviews were conducted to explore the in-depth opinions of PCPs on managing DV in Hong Kong. The themes identified were investigated in a questionnaire survey with data from 504 PCPs working in public and private sectors. Factor analysis of the survey data suggested four major barrier factors: (a) worries about the potential harms of intervening in patients' domestic affairs and DV issues, (b) lack of guidelines and support services, (c) limited skills and time in managing DV, and (d) patients' reluctance in disclosing DV issues. PCPs with more years of practice had more worries about intervening in domestic issues (Factor 1), while the younger PCPs tended to perceive limited skills and time in managing DV cases as barriers (Factor 3). PCPs working in the public setting were more likely to ask patients about DV (M = 5.4 vs. 2.9), suspected DV (M = 3.8 vs. 2.3), and managed DV (M = 1.7 vs. 1.0) in the past 5 years compared with the private PCPs. Some PCPs in the focus groups expressed the view that DV cases should be handled by social workers instead of doctors. Survey respondents who held such views about doctors' limited role in DV management also scored higher in all of the barrier factors. The findings suggest that there are boundaries between domestic and medical realms, especially in a Chinese context. Resolving PCPs' worries by training, provision of DV management guidelines, and referral pathway to social workers may be good starting points to bridge the gaps. [ABSTRACT FROM AUTHOR]

Most studies highlighted the association between psychological distress and socioeconomic status (SES). There were weaker explanations for distress found in the middle classes, especially in Asian countries. We conducted a questionnaire survey with 1626 adult Chinese primary-care attenders from 13 private and 6 public clinics in different districts of Hong Kong. Their demographic background and distress level measured by GHQ-12 were analysed. We found that respondents with younger age, better education, and lower income were more likely to be distressed. In a multiple logistic regression model, age and income, but not education, were significant predictors for distress. Highest rates of distress were found among the unemployed (45.5%) and the students (37.1%), followed by service workers and shop sales workers (33.0%), associate professionals (32.0%), and clerks (29.2%). Craftworkers (9.1%), plant and machine operators (11.5%), and retired people (12.8%) were least likely to be distressed, followed by professionals (21.0%). Apart from SES, the findings suggest that young age, academic and job stressors, and low self-esteem are significant factors for distress. These factors may be intensified in a Chinese context by peer comparison resulting in a state of relative deprivation. [ABSTRACT FROM AUTHOR]

Background: Domestic violence is common in the community. Many of its victims present to primary care physicians (PCPs) but are not being recognized and managed. The barriers, with specific reference to a Chinese cultural context, were investigated earlier. This paper explored the factors which facilitated the process of recognizing and managing suspected cases of domestic violence by PCPs in Hong Kong. Methods: Four focus group interviews were conducted to explore in-depth the experiences of PCPs in recognition, management and referral of domestic violence cases from which facilitators were identified. The relevant themes were then investigated in a questionnaire survey with 504 PCPs working in public and private sectors. Results: The focus group participants emphasized mood symptoms as useful indicators for probable abuse and continuity of care was important to unmask issues of domestic violence. The top facilitators perceived by the respondents of the survey included: a trusting doctor-patient relationship (99.8%), good communication skills (99.0%), patients' unexplained bruises (96.3%), medical history (94.6%), and mood symptoms (94.4%). Further, the survey found that PCPs with longer years of practice, a medical degree obtained from Western countries, and postgraduate training in family counselling or psychological medicine perceived more facilitators in managing domestic violence. Conclusions: Without a local screening policy and training protocol to manage domestic violence, PCPs regarded their skills in mental healthcare and good relationships with patients as the key facilitators. While training in mental health care helps PCPs manage domestic violence, a specific protocol emphasizing medical-social collaboration is anticipated to facilitate them to take a more proactive and effective stance from screening to management. [ABSTRACT FROM AUTHOR]

Background: Public toilets are a common transmission vector of infectious diseases due to environmental contamination. Research on Chinese people's hygiene practices in public lavatories are lacking. This study examined Chinese people's hygiene practices in public lavatories in Hong Kong.Methods: We conducted qualitative interviews and a self-administered questionnaire survey with local residents from June 2016 to April 2018. Four focus group discussions and three individual interviews informed the design of the questionnaire. We recruited interviewees and survey respondents via social service centers. The interviews and questionnaire focused on the public's daily practices and hygiene behaviors in public toilets. Content analysis of qualitative data was conducted. Multivariable logistic regressions were used to examine the association between age and toilet hygiene behaviors.Results: Our qualitative component revealed a range of handwashing practices, from not washing at all, washing without soap, to washing for a longer time than instructions. Other toilet use practices were identified, such as not covering toilet lid before flushing and stepping on toilet seats due to dirtiness, and spitting into toilet bowls or hand basin. Totally, 300 respondents completed the questionnaire. Among them, 212 (70.9%) were female and 246 (86.1%) were aged 65 or below. More than two thirds always washed hands with soap (68.7%) and dried hands with paper towels (68.4%). Up to 16.2% reported stepping on toilet seats and 43.9% never covered the toilet lid before flushing. Over one fourth (26.4%) spit into squat toilets/ toilet bowl. Regression analyses showed that the elderly group were less likely to report stepping on toilet seats (adjusted odds ratio, AOR = 0.17, 95%CI 0.03-0.88), flushing with the toilet lid closed (AOR = 0.40, 0.16-0.96), but more likely to spit into squat toilets/ toilet bowl (AOR = 4.20, 1.50-11.74).Conclusions: Hong Kong Chinese's compliance to hygiene practices in public toilets is suboptimal. Stepping on toilet seat is a unique Chinese practice due to the dirtiness of toilet seats. Spitting practices may increase the risk of airborne infectious diseases and need improvement. Measures are needed to improve toilet hygiene behaviors, including public education campaigns and keeping toilet environment clean. [ABSTRACT FROM AUTHOR]

Background and objective: Anorexia nervosa (AN) is one of the most difficult-to-treat psychiatric disorders. AN is associated with individual vulnerability, societal and family factors. There has been limited research in Asia regarding the patients or their families’ perceptions on its treatment. This study explored the perceived treatment outcomes among Chinese families having adolescents with AN. Methods: Qualitative interviews were conducted on parents of adolescents with AN recruited through an eating disorder association in Hong Kong to understand their views and experiences regarding the help-seeking and treatment process. Results: The parents expressed dissatisfaction towards help-seeking and treatment outcomes, including relationships with health professionals, hospitalization, health professionals’ knowledge of AN, understanding of the treatment model and parents’ role, amount of psychological support, and coordination among health professionals. The parents were unclear about the treatment plan as they received little explanation from the health professionals. The parents perceived that the AN treatment only focused on weight restoration with limited psychological support. Home diet monitoring was seen as a harsh task which worsened the relationship with their children. The parents often needed to take up the coordinator role and search around for different health professionals and integrate their advices by themselves. Conclusions: The study shows that limited psychoeducation, communication and coordination in the treatment for AN are major problems in a Chinese context. Open communication between the health professionals and the parents about the expected treatment outcomes and limitations is needed to enhance their mutual trust. Besides, treatment should emphasize not only family involvement but also empower them to fight against AN. [ABSTRACT FROM AUTHOR]

Background: Most of the previous studies of help seeking for psychological distress were conducted in Western countries. Chinese studies have had a stronger emphasis on psychosis.Objective: This study aims to understand how Hong Kong Chinese primary care attenders see psychological distress, including its causes, management approaches and recovery, and whether their views are different from Western views.Method: Nine focus groups and six individual interviews were conducted in Hong Kong among Chinese primary care attenders with/without known distress, patients' significant others and the general public, and a questionnaire survey was conducted with 1626 primary care attenders recruited from 13 private clinics and 6 public clinics.Results: More survey respondents agreed with psychological counselling (95.3%) than drugs (69.0%) to relieve psychological distress. Despite the belief in self-resilience (77.7%), only 34.8% respondents agreed that psychological distress could get better without professional help. Respondents with younger ages, better education and higher incomes tended to have stronger trust in counselling and self-resilience than drugs. Qualitative interviews revealed that although participants regarded psychological distress as a common problem in modern societies, distressed patients might be seen as being weak and troublesome. Some distressed patients found their recovery process painful because of discouragement from family and personnel at their workplace.Conclusions: Hong Kong Chinese patients' views of the causes and management approaches of psychological distress are similar to Western findings. However, help seeking and recovery are of greater concern in a Chinese context where patients may receive limited empathy for their conditions of psychological distress. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) has called for integration of mental health into primary care for a decade. In Western countries, around 15% to 25% of patients with common mental disorders including mood and anxiety disorders seek help from primary care physicians (PCPs). The rate is only about 5% in China. Aims: This article reviews the Chinese findings on the barriers to primary care for common mental disorders and how they compared with Western findings. Methods: A narrative literature review was conducted, focusing on literature published from mid-1990s in English or Chinese. Patient, PCP and health system factors were reviewed. Results: Although Chinese and Western findings show similar themes of barriers, the Chinese have stronger barriers in most aspects, including under-recognition of the need for treatment, stigma on mental illness, somatization, worries about taking psychiatric drugs, uncertainties in the role, competency and legitimacy of PCPs in mental health care and short consultation time. Conclusion: Current policies in China emphasize enhancement of mental health facilities and workforce in the community. Our review suggests that patients’ intention to seek help and PCPs’ competency in mental health care are other fundamental factors to be addressed. [ABSTRACT FROM AUTHOR]

This study investigated enablers to seeking professional help for psychological distress among Chinese primary care attenders in Hong Kong. Nine focus groups and six individual interviews were conducted among adult patients with/without known distress, significant others of the distressed, and the general public. The identified potential enablers were further investigated in a questionnaire survey with data from 1626 patients. Survey respondents who had sought professional help for distress ( n  = 231) and those without this experience ( n  = 1395) showed similar attitudes to the enabler items. However, the first group had more “strongly agree” responses and their top five enablers were: crisis caused by distress, distress affecting daily life, wanting to treat associated physical symptoms, having trust in doctor, and encouragement by family/friends to seek help. Qualitative interviews found that the patients often somatised distress and they felt comfortable to consult for somatic symptoms. There was strong family involvement in help-seeking whereas the doctors were the authoritative figures to convince the patients for treatment. The findings, in line with Western literature, indicate that crisis and interference in daily life due to distress are the top enablers to seeking professional help. The other three key enablers are likely to be influenced by Chinese culture. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: This study investigated the barriers and facilitators for psychiatrists in managing mental health patients under a Chinese context and a mixed private‐public health system. Methods: Two focus group interviews were conducted to explore the in‐depth opinions of psychiatrists in Hong Kong. The themes identified from the focus groups were investigated in a questionnaire survey with data from 83 psychiatrists working in public and private sectors. Results: No insurance coverage of mental health problems, patients' poor compliance of medication, and stigma of seeing psychiatrists were rated as the top barriers in the survey. Some psychiatrists mentioned in focus groups that they might write down the associated physical symptoms of the patients rather than the mental disorder diagnoses on the medical certificate. They observed some patients suspecting that psychiatric drugs were prescribed to control their behavior and make them more muddleheaded. The survey also found that consultation time constraint, long patient waiting list, and difficulty in discharging patients to primary care mostly affected public psychiatrists rather than private ones. However, they perceived similar facilitators, including public campaign to promote positive results of help‐seeking, adequate explanation by other health professionals to the patients before referrals, handling severe cases by casework approach, and having a regular primary care physician. Discussion: The top barriers are related to insufficient public awareness and negative attitudes towards mental illness and its treatment. Major solutions include promoting positive results of help seeking, enhancing collaboration with primary care physicians, and follow‐up of severe cases by a casework approach. [ABSTRACT FROM AUTHOR]

Background: The stepped care model for psychological distress has been promoted in recent years, leading to the enhancing roles of primary care professionals and alternative sources of help. However, most of the research findings come from Western countries. This study investigates help-seeking behaviours of Chinese patients among different types of professional and alternative sources for psychological distress in Hong Kong. Methods: A questionnaire survey was conducted with 1626 adult primary care attenders from 13 private and 6 public clinics, 650 (40.0%) reported that they had ever experienced psychological distress. Their help-seeking behaviours, demographic background and current distress level (measured by GHQ-12) were analysed. Results: Among the respondents with experience of psychological distress, 48.2% had sought help from professional and/or alternative sources for their distress [10.2% from professionals only, 12.6% from alternative sources only, and 25.4% from both]. Those who had sought help from professionals only were more likely to be less educated and with lower income. In contrast, those using alternative sources only were more likely to be younger, better educated, and have higher income. Allowing multiple responses, psychiatrists (22.3%) was reported to be the most popular professional source, followed by primary care physicians (17.5%), clinical psychologists (12.8%) and social workers/counsellors (12.0%). Family members/friends (28.6%) was the top alternative source, followed by exercise/sports (21.8%), religious/spiritual support (16.9%) and self-help websites/books/pamphlets (8.9%). Conclusion: While psychiatrists remain the most popular professional source of help to the Chinese patients in Hong Kong, primary care professionals and alternative sources also play significant roles. Distressed patients who are younger, better educated and have higher income are more likely to use alternative sources only. The outcomes need further research. [ABSTRACT FROM AUTHOR]

Background: Most of the previous studies on help seeking for psychological distress were derived from Western countries. This study investigated the barriers to help-seeking for psychological distress among Chinese primary care attenders in Hong Kong.Methods: Nine focus groups and 6 individual interviews were conducted among Chinese primary care attenders with/without known distress, patients' significant others and the general public. The identified barriers were investigated in a questionnaire survey with data from 1626 primary care attenders recruited from 13 private clinics and 6 public clinics.Results: Worries about side effects of drugs (79.9%, 95% CI:(77.9%, 81.8%)) and drug dependency (74.7%, 95% CI:(72.5%, 76.8%)) were rated as the top barriers in the survey. Qualitative interviews found both worries and actual experience of the side effects of drugs, which weakened patients' trust in the treatment. Factor analysis on all barrier items suggested three factors: 1) worries of treatment, 2) uncertainties on primary care physicians' capacity, 3) public's limited knowledge on distress and sources of help. Distress level, education level and age were associated with factor 1, whereas distress level and healthcare setting were associated with the other two factors. Qualitative interviews revealed that not having a regular primary care physician in the public setting discouraged disclosure of psychological problems.Limitations: The findings were based on self-reported data from the respondents. Hong Kong is influenced by a mixed Chinese and Western culture.Conclusions: Relevant public education in a Chinese context should target at reducing patients' worries of drug treatment and strengthening the image of primary care physicians as a feasible source of help. [ABSTRACT FROM AUTHOR]

Introduction This study aims to describe the attitudes of primary care physicians towards mental health patients in Hong Kong, especially to examine the doctors' views on schizophrenia and depression, and the influence of their demographic variables. Methods A questionnaire developed by the research team was sent to members of Hong Kong College of Family Physicians. Potential respondents were allocated on equal basis to one of the two sets of questionnaire, set 1 for clinical vignette of schizophrenia and set 2 for depression. Results A response rate of 37% (500 of 1,360) was achieved. There were 255 and 245 returned questionnaires for set 1 and set 2, respectively. Comparing the two clinical vignettes, there were large differences in their willingness to have the patient on practice list for mental issues (40.0% for schizophrenia versus 71.5% for depression) and to deal with the patient's needs (37.0% versus 60.9%). Multiple ordinal logistic regression analysis showed that doctors with the following demographic factors tended to have more worries or stigma on mental health patients: 'having longer years of practice,' 'being female,' 'working in hospital,' 'employed in public sector,' and 'not having a relative/friend with mental health problems.' Discussion Our study shows that two-thirds of primary care doctors are prepared to look after patients with depression, which is substantially higher than that for schizophrenia. In contrast with the Australian findings, the experienced doctors in Hong Kong have more negative attitudes towards mental health patients than the younger ones. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has exacerbated the pre-existing global crisis of physician burnout. Physician and particularly medical educator well-being, has come into focus as educators can influence their own and learners' well-being. Measuring this construct is one important step towards promoting well-being in the work and learning environments. The 5-item World Health Organization Well-Being Index (WHO-5) has been validated in different populations worldwide for assessing well-being. Yet, its psychometric acceptability remains unexplored among medical educators in Asia including Hong Kong (HK). This study evaluates the validity of the WHO-5 when used among HK medical educators. Using data from 435 medical educators, we employed combined within-network (confirmatory factor analysis; CFA) and between-network approaches (correlation and regression) to scale validation. CFA results indicated that our data fit the a priori WHO-5 model, suggesting structural validity. Results of comparison of means indicated no gender differences, but there were significant differences when participants were compared by age and professional backgrounds. Resilience predicted well-being as measured by the WHO-5, suggesting construct criterion validity. Our findings extend the validity evidence for the WHO-5 to HK medical educators examined in this study. This enables their well-being to be assessed when evaluating the impact of future well-being programmes. [ABSTRACT FROM AUTHOR]

Background. The health care systems in many countries are focused on specialist care. In those countries that have recently changed to a primary care-based system, some doctors and patients were dissatisfied with the change.Objective. To explore the opinions of the general public and the doctors on the change to a family medicine (FM)-based health care system.Methods. Qualitative study with focus groups of doctors working in different practice settings. Quantitative study with questionnaires sent to all doctors registered in Hong Kong and a telephone survey targeting the general public aged ≥18.Results. Doctors in the focus groups generally supported a FM-based health care system. They were concerned that there were not enough family doctors for such a system and the patients’ current free choice of any doctor for primary care would impede its success. Thousand six hundred and forty-seven adults took part in the telephone survey (response rate 67.6%) and 2310 doctors (22.8%) responded to the questionnaire. Nearly 95% of the general public respondents agreed to the FM system though only 66.3% of them had ever heard of the term family doctor. About 65% of the doctors supported this system but only 33% agreed that the system would work. The specialist-doctors were less supportive of mandatory referral than the non-specialists, while the public was equally divided on this issue.Conclusions. The public accepts the FM-based system but needs education on the benefits of primary health care. Direct access to the specialist would be the greatest barrier. Government involvements are essential for the reform. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Context China has a long tradition of education and medicine. However, limited economic conditions and a huge population mean that further development of medical education in China must be tailored to meet the country's needs. Objectives The aim of this paper is to describe current medical education practice in China with reference to the general and historical purposes of education in China and how they have affected and continue to affect student learning. Reference is also made to both Western medicine and traditional Chinese medicine. Methods It is argued that traditional educational practices in China have encouraged rote learning and that creativity is not cultivated. This affects the way many Chinese students learn medicine. Since 1949, the Chinese medical education system has developed according to its own needs. The current system for training medical students is complex, with medical school curricula lasting 3−8 years. However, medical education reform is taking place and new teaching methods are being introduced in some schools. Discussion Medical education is important to China's large population. The undergraduate medical education system is being streamlined and national standards are being established. Innovations in medical education have recently been encouraged and supported, including the adoption of problem-based learning. It is important that the momentum is kept up so that the health care of a fifth of the world's population is assured. [ABSTRACT FROM AUTHOR]

This study aimed to explore the expectations on medications of Chinese fishermen, a group of culturally distinct people, when they consult their family doctors. A qualitative method of semistructured focus group interviews was used for data collection. Twenty-nine participants took part in eight focus group interviews. They were all from the southern district of Hong Kong Island where many of the residents have a fishing background. Their expectations of doctors’ willingness to give them medicines might originate from their previous experiences with traditional therapies. Although some would prefer the medicines to be potent while others like them not to be too strong, they all wanted the medicines to lead them to fast recovery. It is therefore important for their western-trained family doctors to be culturally sensitive to their expectations and, hence, make more effort in explaining the use and misuse of medicines. [ABSTRACT FROM AUTHOR]

The article provides information on the "Asia Pacific Journal of Family Medicine" which was conceptualized in 1996 and launched in 2002. Several people and institutions are cited which contributed to the operation of the said journal including Blackwell Publishing Asia and the Philippine Academy of Family Physicians. Also, the journal calls upon the family medicine community in the Asia Pacific to visit its Web site and submit comments as well as research papers.

A letter to the editor is presented in response to the editorial "Psychiatric Service With No Psychiatrist: Developing Primary Care Psychiatry."

Editorial. Analyzes the effectiveness of family medicine in the Asian Pacific region. Influence of culture on the medicine of general practice; Traditional Chinese medical theory related to relationship between vision and the health status of liver; Definition of family physician as given by the journal Wonca in 1991 and 2002.

Background: Hygiene behaviors in public toilets are important to prevent the transmission of infectious diseases, especially during the pandemic. All through the novel coronavirus (COVID-19) pandemic, governments in many countries published guidance on personal hygiene for the general population to prevent disease transmission. This study aimed to investigate improvements in residents' hygiene awareness and behaviors in public toilets before and during the pandemic.Methods: We recruited 316 residents between November and December 2018 before the pandemic, and 314 residents between December 2020 and January 2021 during the pandemic in the same study sites in Hangzhou, a well-developed city in China. Residents' hygiene behaviors in public toilets, hygiene awareness, risk perception, and sociodemographic factors were collected. Bivariate analysis and multivariable logistic regressions were used to test the differences between the two rounds. We conducted an observational study to record the provision of hygiene amenities at toilets during the pandemic.Results: After controlling for sociodemographic factors (gender, marital status, age, education level, and monthly household income), compared with respondents recruited before the pandemic, respondents recruited during the pandemic were more likely to perceive the risks of infection when using public toilets (aOR = 1.77, 95%CI [1.20, 2.60]), and were more likely to be aware of the risks of touching contaminated toilet facilities (aOR = 1.72, 95%CI [1.17, 2.54]) and the risks of not using soap to wash one's hands after using the toilet (aOR = 1.93, 95%CI [1.38, 2.72]). They were more likely to always clean their toilet seat with alcohol (aOR = 1.88, 95%CI [1.01, 3.51]), wash hands with soap (aOR = 1.52, 95%CI [1.09, 2.10]) and dry their hands with a dryer (aOR = 1.78, 95%CI [1.16, 2.71]), but they were less likely to always wash their hands after using the toilets (aOR = 0.57, 95%CI [0.32, 1.00]). Among 70 public toilets observed, 9 provided alcohol for toilet seat disinfection, 52 provided soap, 33 provided paper towels, and 41 had working hand dryers.Conclusions: Despite the overall improvement, residents' hygiene behaviors in public toilets and the supply of hygiene amenities were still suboptimal during the pandemic. Further hygiene education and an adequate supply of hygiene amenities in public toilets are needed to promote residents' hygiene behaviors. [ABSTRACT FROM AUTHOR]

Workplace violence (WPV) in the health sector is a global public health issue. The magnitude of WPV is a particular concern in China's health system. To examine the potential causes of WPV, we analyzed 3,045 qualitative responses to an open-ended question in a survey with health workers in the Zhejiang province, China. We adapted a four-level socio-ecological framework (societal/systemic, community/organizational, interpersonal, and individual) to thematically analyze the data. Ten sub-themes emerged. Within the societal/systemic level, we identified three sub-themes: (a) lack of legislation against WPV, (b) suboptimal accessibility and affordability of health services due to maldistributed health resources, commercialized health services, and inadequate health insurance, and (c) unregulated mass media reports. Within the community/organizational level, three sub-themes emerged: (a) lack of supportive health facility leadership, (b) inaction by government authorities, and (c) inefficient law enforcement agencies. Within the interpersonal level, two sub-themes were identified: (a) poor provider–patient communication and (b) distrust between health workers and patients. Finally, we identified the personal characteristics of health workers (e.g., competence and professionalism) and patients (e.g., sociodemographic background and expectations/satisfaction) as two individual-level sub-themes. We recognized interactions among different levels. The weak state of Chinese legislation in this area and lack of high-level political will and guidance (societal/systemic) has left health facilities and law enforcement agencies (community/organizational) unclear about how to address WPV. The maldistribution of quality health resources (societal/systemic) has led to overcrowded outpatient clinics at higher-level care facilities (community/organizational). In light of the insufficient government funding and profit-oriented health services (societal/systemic), health workers were motivated to seek profits by providing unnecessary services, which compromised their professionalism (individual). Provider–patient relationships deteriorated (interpersonal), and patients sometimes held unrealistically high expectations associated with high medical expenses (individual). We propose multisectoral prevention strategies to address WPV in the health sector at all levels using a socio-ecological framework. [ABSTRACT FROM AUTHOR]

Background: Among Western countries, it has been found that physicians tend to manage their own illnesses and tend not have their own independent family physicians. This is recognized as a significant issue for both physicians and, by extension, the patients under their care, resulting in initiatives seeking to address this. Physicians' personal health care practices in Asia have yet to be documented. Methods: An anonymous cross-sectional postal questionnaire survey was conducted in Hong Kong, China. All 9570 medical practitioners in Hong Kong registered with the Hong Kong Medical Council in 2003 were surveyed. Chi-square tests and logistic regression models were applied. Results: There were 4198 respondents to the survey; a response rate of 44%. Two-thirds of respondents took care of themselves when they were last ill, with 62% of these self-medicating with prescription medication. Physicians who were graduates of Hong Kong medical schools, those working in general practice and non-members of the Hong Kong College of Family Physicians were more likely to do so. Physician specialty was found to be the most influential reason in the choice of caregiver by those who had ever consulted another medical practitioner. Only 14% chose consultation with a FM/GP with younger physians and non-Hong Kong medical graduates having a higher likelihood of doing so. Seventy percent of all respondents believed that having their own personal physician was unnecessary. Conclusion: Similar to the practice of colleagues in other countries, a large proportion of Hong Kong physicians self-manage their illnesses, take self-obtained prescription drugs and believe they do not need a personal physician. Future strategies to benefit the medical care of Hong Kong physicians will have to take these practices and beliefs into consideration. [ABSTRACT FROM AUTHOR]

Abstract Background: Chronic diseases are becoming the major global burden of disease. Information on their impact on health services and quality of life of individual patients can facilitate the provision of appropriate care. Objectives: To determine the self reported prevalence of chronic diseases and their impact on health service utilization and quality of life of individual patients. Methods: A cross sectional random telephone survey was conducted on 2410 Chinese adults from the general population in Hong Kong using both a structured questionnaire and the 36 item short form Health Survey (SF-36). The effects of chronic diseases on consultation rates, hospitalization risk and the SF-36 scores were analyzed by multivariate stepwise regressions, controlling for sociodemographic variables and comorbidity. Results: A total of 38% of subjects reported one or more chronic diseases with 59% being less than 60 years. Chronic joint problems were the most common. Every additional chronic disease increased the annual number of consultations by 60% and the likelihood of hospitalization in the last year by 79%. Most chronic diseases had a negative impact on quality of life with most associated with psychological problems. Conclusions: One in three Chinese adults in Hong Kong reported having chronic diseases. The total number of chronic diseases had a linear relationship with service utilization, which could be a useful medical risk adjustment factor. Enhancing quality of life should be an important aim in the management of chronic diseases. [ABSTRACT FROM AUTHOR]

Background: A study conducted as part of the development of the Eleventh International Classification of Mental Disorders for Primary Health Care (ICD-11 PHC) provided an opportunity to test the relationships among depressive, anxious and somatic symptoms in PHC. Method: Primary care physicians participating in the ICD-11 PHC field studies in five countries selected patients who presented with somatic symptoms not explained by known physical pathology by applying a 29-item screening on somatic complaints that were under study for bodily stress disorder. Patients were interviewed using the Clinical Interview Schedule-Revised and assessed using two five-item scales that measure depressive and anxious symptoms. Structural models of anxious-depressive symptoms and somatic complaints were tested using a bi-factor approach. Results: A total of 797 patients completed the study procedures. Two bi-factor models fit the data well: Model 1 had all symptoms loaded on a general factor, along with one of three specific depression, anxiety and somatic factors [ x 2 (627) = 741.016, p < 0.0011, RMSEA = 0.015, CFI = 0.911, TLI = 0.9]. Model 2 had a general factor and two specific anxious depression and somatic factors [ x 2 (627) = 663.065, p = 0.1543, RMSEA = 0.008, CFI = 0.954, TLI = 0.948]. Conclusions: These data along with those of previous studies suggest that depressive, anxious and somatic symptoms are largely different presentations of a common latent phenomenon. This study provides support for the ICD-11 PHC conceptualization of mood disturbance, especially anxious depression, as central among patients who present multiple somatic symptoms. [ABSTRACT FROM AUTHOR]

Background: A new diagnosis of anxious depression (AD), characterized by both depressive and anxious symptoms at case level, has been proposed for the classification of mental disorders for primary care for ICD-11 (ICD-11 PHC). The ICD-11 PHC proposes a duration requirement for anxiety symptoms of 2 weeks, in line with the requirement for depressive symptoms. This study examined diagnostic assignment under ICD-11 PHC as compared to the previous classification, the ICD-10 PHC, and the relationship of anxiety duration to disability and suicidal ideation.Methods: Primary care physicians in five countries referred patients based on either perceived psychological distress or distressing somatic symptoms to a research assistant who administered a computer-guided diagnostic interview. Complete data were obtained for 2279 participants.Results: Under ICD-11 PHC 47.7% participants received a diagnosis of AD and had greater disability than other diagnostic groups. Under ICD-10 PHC, in addition to meeting requirements for depressive episode, most of these patients met requirements for either generalized anxiety disorder (41.5%) or mixed anxiety and depressive disorder (45.4%). One third of individuals diagnosed with AD had anxiety durations between 2 weeks and 3 months and presented as much disability and suicidal ideation as individuals with longer anxiety durations.Limitations: The study was not designed to establish prevalence of these conditions.Conclusion: The proposed ICD-11 PHC encourages early identification and management of significant anxiety symptoms in primary care, particularly when these co-occur with depression. This study provides support for the clinical relevance of these symptoms and the importance of early identification. [ABSTRACT FROM AUTHOR]

Objective: Physicians' prescribing patterns may be influenced by how they perceive their patients' expectations of medical care. This study explored doctors' perceptions of patient expectations of medical care.Design: Qualitative interviews and a cross-sectional survey (September 2014-September 2015).Setting: Primary- and tertiary-care facilities in Zhejiang province, China.Participants: Primary care practitioners (PCPs) and hospital specialists.Main Outcomes: Perceived patients' expectations.Results: Seven focus groups and 21 individuals were interviewed. Questionnaires were completed by 460 PCPs and 651 specialists (response rate: 78%). About 36.8% of doctors reported generating profit for the facility at which they practiced as a foremost consideration. Participants perceived patients as holding high expectations of clinical performance and use of medical products. Respondents perceived that their patients expected either drug prescriptions (48.2%) or intravenous (IV) therapy (45.2%). Perceived patient expectations of an arrangement of tests and consultation fee refunds if no prescriptions were made were reported by 29.7 and 22.7%, respectively. Doctors reported feeling undervalued and disrespected when patients requested consultation fee refunds. Compared to those who did not report a need for profit-making, doctors who did were significantly more likely to perceive that their patients expected medication-based treatments (AOR = 1.62, P < 0.001), IV therapy (AOR = 1.32, P = 0.037), the arrangement of tests (AOR = 2.06, P < 0.001), and consultation fee refunds when no prescriptions were made (AOR = 1.92, P < 0.001).Conclusions: Most doctors believed that patients had high expectations. Workplace profit-orientation demonstrated a strong association with doctors' perceptions. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization is revising the classification of common mental disorders in primary care for ICD-11. Major changes from the ICD-10 primary care version have been proposed for: (i) mood and anxiety disorders; and (ii) presentations of multiple somatic symptoms (bodily stress syndrome). This three-part field study explored the implementation of the revised classification by primary care physicians (PCPs) in five countries.Methods: Participating PCPs in Brazil, China, Mexico, Pakistan and Spain were asked to use the revised classification, first in patients that they suspected might be psychologically distressed (Part 1), and second in patients with multiple somatic symptoms causing distress or disability not wholly attributable to a known physical pathology, or with high levels of health anxiety (Part 2). Patients referred to Part 1 or Part 2 underwent a structured diagnostic interview. Part 3 consisted of feedback from PCPs regarding the classification.Results: In Part 1, anxious depression was the most common disorder among referred patients. PCPs assigned the highest severity ratings to anxious depression, and the next highest to current depression; current anxiety was rated as least severe. Considerable overlap was found between bodily stress syndrome (BSS) and health anxiety (HA). The psychiatric interview recorded higher rates of mood and anxiety disorders diagnoses among patients with BSS than did PCPs. PCPs' satisfaction with the revised classification was high.Conclusions: Results generally supported the inclusion of the new categories of anxious depression, BSS and HA for ICD-11 PHC and suggested that PCPs could implement these categories satisfactorily. [ABSTRACT FROM AUTHOR]

Background: In this field study of WHO's revised classification of mental disorders for primary care settings, the ICD-11 PHC, we tested the usefulness of two five-item screening scales for anxiety and depression to be administered in primary care settings.Methods: The study was conducted in primary care settings in four large middle-income countries. Primary care physicians (PCPs) referred individuals who they suspected might be psychologically distressed to the study. Screening scales as well as a structured diagnostic interview, the revised Clinical Interview Schedule (CIS-R), adapted for proposed decision rules in ICD-11 PHC, were administered to 1488 participants.Results: A score of 3 or more on one or both screening scale predicted 89.6% of above-threshold mood or anxiety disorder diagnoses on the CIS-R. Anxious depression was the most common CIS-R diagnosis among referred patients. However, there was an exact diagnostic match between the screening scales and the CIS-R in only 62.9% of those with high scores.Limitations: This study was confined to those in whom the PCP suspected psychological distress, so does not provide information about the prevalence of mental disorders in primary care settings.Conclusions: The two five-item screening scales for anxiety and depression provide a practical way for PCPs to evaluate the likelihood of mood and anxiety disorders without paper and pencil measures that are not feasible in many settings. These scales may provide substantially improved case detection as compared to current primary care practice and a realistic alternative to complex diagnostic algorithms used by specialist mental health professionals. [ABSTRACT FROM AUTHOR]

Purpose: To examine the public's views towards their choice of first-contact care and its associated factors in urban China.Methods: A mixed-method study was adopted using individual interviews, focus group interviews and a cross-sectional survey. The study was conducted among the general public between September 2014 and September 2015 in Zhejiang province, China.Results: Six focus groups and 13 individual interviews were conducted. The questionnaire was completed by 1248 respondents with a response rate of 83%. Survey results showed that 70% of the respondents preferred hospital-based services for first-contact care, it is especially the case with paediatric patients (83.3%). The qualitative data revealed that a major cause was the public distrust in the competence of primary care practitioners with lower educational qualifications. In the decision-making process, compared to cost factors like medical expenses and waiting times, participants attached greater emphasis on organizational characteristics. Respondents who rated sophisticated medical equipment, reputation of the facility, average education of doctors as important were significantly more inclined to choose hospital services. Respective adjusted odds ratios (AOR) were 2.14 (P < 0.001), 1.83 (P < 0.001) and 1.40 (P = 0.043) for their own conditions and 2.19 (P = 0.004), 1.94 (P = 0.002) and 1.86 (P = 0.003) for their children's conditions. Availability of medications and perceived severity of illness were also significantly associated with their choice of hospital services for their children.Conclusion: The public's preference for hospital-based services for first-contact care places a huge obstacle to promoting community-based primary care. Addressing the public's concerns about the primary care practitioners' competence is worth more efforts. [ABSTRACT FROM AUTHOR]

Objective: A World Health Organization (WHO) field study conducted in five countries assessed proposals for Bodily Stress Syndrome (BSS) and Health Anxiety (HA) for the Primary Health Care Version of ICD-11. BSS requires multiple somatic symptoms not caused by known physical pathology and associated with distress or dysfunction. HA involves persistent, intrusive fears of having an illness or intense preoccupation with and misinterpretation of bodily sensations. This study examined how the proposed descriptions for BSS and HA corresponded to what was observed by working primary care physicians (PCPs) in participating countries, and the relationship of BSS and HA to depressive and anxiety disorders and to disability.Method: PCPs referred patients judged to have BSS or HA, who were then interviewed using a standardized psychiatric interview and a standardized measure of disability.Results: Of 587 patients with BSS or HA, 70.4% were identified as having both conditions. Participants had an average of 10.9 somatic symptoms. Patients who presented somatic symptoms across multiple body systems were more disabled than patients with symptoms in a single system. Most referred patients (78.9%) had co-occurring diagnoses of depression, anxiety, or both. Anxious depression was the most common co-occurring psychological disorder, associated with the greatest disability.Conclusion: Study results indicate the importance of assessing for mood and anxiety disorders among patients who present multiple somatic symptoms without identifiable physical pathology. Although highly co-occurring with each other and with mood and anxiety disorders, BSS and HA represent distinct constructs that correspond to important presentations in primary care. [ABSTRACT FROM AUTHOR]

Background: Recent studies have reported a lack of collaboration and consensus between primary care physicians (PCPs) and psychiatrists.Objective: To compare the views of PCPs and psychiatrists on managing common mental health problems in primary care.Methods: Four focus group interviews were conducted to explore the in-depth opinions of PCPs and psychiatrists in Hong Kong. The acceptance towards the proposed collaborative strategies from the focus groups were investigated in a questionnaire survey with data from 516 PCPs and 83 psychiatrists working in public and private sectors.Results: In the focus groups, the PCPs explained that several follow-up sessions to build up trust and enable the patients to accept their mental health problems were often needed before making referrals. Although some PCPs felt capable of managing common mental health problems, they had limited choices of psychiatric drugs to prescribe. Some public PCPs experienced the benefits of collaborative care, but most private PCPs perceived limited support from psychiatrists. The survey showed that around 90% of PCPs and public psychiatrists supported setting up an agreed protocol of care, management of common mental health problems by PCPs, and discharging stabilized patients to primary care. However, only around 54-67% of private psychiatrists supported different components of these strategies. Besides, less than half of the psychiatrists agreed with setting up a support hotline for the PCPs to consult them.Conclusions: The majority of PCPs and psychiatrists support management of common mental health problems in primary care, but there is significantly less support from the private psychiatrists. [ABSTRACT FROM AUTHOR]

Objective. Peak expiratory flow rates (PEFRs) differ among populations and between times. The new EU scale of the mini-Wright flow-meter has been introduced since 2004. This study updated the PEFR nomograms with the new scale for Chinese children and adolescents (aged 6-19 years) in Hong Kong. Methods. A convenience sample was recruited from 34 primary care practices (patients' companions/children) and four schools. Standardization workshops were run for the physicians, and the proper use of the flow-meter was demonstrated to students prior to the data collection. Brand new meters were used. For each sex, the linear regression model was used to determine the relationship between PEFR and the variables of age and body height. The open-source software PyNomo was used to generate the nomograms. Results. After excluding 66 participants with past/current history of respiratory tract diseases, heart disease, incomplete data, and poor effort, PEFRs were collected from 798 males and 794 females. The PEFR had a linear relationship with age but a curvilinear relationship with height. The regression equations for predicted PEFR were ln(PEFR) = 1.810256*ln(height) + 0.038297*age - 3.734139 for males and ln(PEFR) = 1.525509*ln(height) + 0.033275*age - 2.368592 for females. The corresponding nomograms were constructed. They were tested with 230 patients in primary care; 9.6% (12 males and 10 females) had PEFR less than the predicted value by ≥20%. Conclusion. The body height was a stronger determinant than age for PEFR. The predicted PEFR with these determinants bear a curvilinear relationship. [ABSTRACT FROM AUTHOR]

This study was designed to find out whether health-related quality of life (HRQOL) was an independent determinant of health service utilisation of a Chinese population and to determine whether the addition of HRQOL data to sociodemographic and morbidity factors could significantly increase the explanatory power of risk-adjustment models. A cross-sectional random telephone survey of the general adult Chinese population in Hong Kong was conducted among 2410 Chinese aged 18?88 yr old, 52% were females and 38% had one or more chronic diseases. Health service utilisation was measured by annual consultation, monthly consultation and hospitalisation rates. HRQOL was measured by the SF-36. Multivariate regressions were used to test the dependence of service utilisation rates on sociodemographic factors, chronic morbidity and the SF-36 scores. Structured multiphase regression analyses were used to determine the magnitude of the effect of the SF-36 scores, in addition to those of sociodemographic and chronic morbidity factors, on service utilisation. Five of eight SF-36 scores were independent determinants of consultation rates. They doubled and tripled the percentages of variance explained for annual and monthly consultation rates, respectively. Role limitation by physical problems and bodily pain scores had a significant effect on hospitalisation rates. This was the first study showing a linear relationship between HRQOL and service utilisation on a Chinese population. It confirmed the clinical relevance of the SF-36 to a culture and health care system that is different from that of the United States where the instrument originated. [ABSTRACT FROM AUTHOR]

Participants in Hong Kong viewed pairs of doctor-patient interviews, each pair with 1 doctor-centered and 1 patient-centered interview. They evaluated each doctor and selected 1 doctor of the pair they would prefer for themselves and family members. Seventy-eight percent preferred the patient-centered physician. When the evaluations were compared, participants rated the patient-centered doctor in the pair significantly higher than the doctor-centered doctor on 31 of 32 behaviors. Patient-centered doctors were rated significantly higher on all 6 subscales assessing differing dimensions of doctor behavior. When given the choice, Hong Kong patients strongly preferred the patient-centered interviewing style despite a health care system that is strongly doctor centered. [ABSTRACT FROM AUTHOR]

Background: Among Western countries, it has been found that physicians tend to manage their own illnesses and tend not have their own independent family physicians. This is recognized as a significant issue for both physicians and, by extension, the patients under their care, resulting in initiatives seeking to address this. Physicians' personal health care practices in Asia have yet to be documented.Methods: An anonymous cross-sectional postal questionnaire survey was conducted in Hong Kong, China. All 9570 medical practitioners in Hong Kong registered with the Hong Kong Medical Council in 2003 were surveyed. Chi-square tests and logistic regression models were applied.Results: There were 4198 respondents to the survey; a response rate of 44%. Two-thirds of respondents took care of themselves when they were last ill, with 62% of these self-medicating with prescription medication. Physicians who were graduates of Hong Kong medical schools, those working in general practice and non-members of the Hong Kong College of Family Physicians were more likely to do so. Physician specialty was found to be the most influential reason in the choice of caregiver by those who had ever consulted another medical practitioner. Only 14% chose consultation with a FM/GP with younger physicians and non-Hong Kong medical graduates having a higher likelihood of doing so. Seventy percent of all respondents believed that having their own personal physician was unnecessary.Conclusion: Similar to the practice of colleagues in other countries, a large proportion of Hong Kong physicians self-manage their illnesses, take self-obtained prescription drugs and believe they do not need a personal physician. Future strategies to benefit the medical care of Hong Kong physicians will have to take these practices and beliefs into consideration. [ABSTRACT FROM AUTHOR]