The Health Bureau introduced the Chronic Disease Co-Care Pilot Scheme in November last year. With government subsidies, Hong Kong residents aged 45 or above and without a known history of diabetes mellitus, commonly known as diabetes, or hypertension can receive screening and follow-up services by matching them with a family doctor.

As of January 16, over 17,300 citizens have joined the scheme and were matched with family doctors. Of these individuals, over 11,000 have been assessed by their family doctors and nearly half have completed screening. For those who have completed screenings, over 30% were diagnosed with prediabetes, diabetes or hypertension, requiring further follow-ups.

Early detection

61-year-old Shirley joined the scheme last month through a district health centre.

After being matched with a family doctor, she went for screening, laboratory tests and doctor consultations in the private healthcare sector through government funding and was diagnosed with diabetes.

"My family doctor explained to me that my glycated hemoglobin levels were high, indicating diabetes. Although I do not need medication for now, I have to control my condition through diet," she said.

Shirley now maintains a balanced diet and limits her intake of sweets, such as her favourite ice cream and other desserts.

"I used to eat a lot of meat. I would eat as much as I liked. I thought I was young, so I was not worried. Now I typically eat more than two bowls of vegetables, and I try not to buy desserts."

Comprehensive care

Patients diagnosed with diabetes like Shirley, or those who are diagnosed with prediabetes or hypertension, will receive four to six government-subsidised consultations per year from their family doctors.

The district heath centres will also provide them with integrated care based on the diagnosis they receive from their family doctors.

According to Wong Tai Sin District Health Centre Care Co-ordinator Wong Tsz-wan, the multidisciplinary team consists of family doctors, nurses, dieticians, optometrists, podiatrists and physiotherapists.

"They play different roles that help patients via nutritional consultations, fitness exercise guidance, retinal examinations and foot care."

There are also classes on pathology, the importance of medication and common side effects.

Crucial screening

According to the Health Bureau's data, about 40% of patients with diabetes or hypertension are unaware of their condition.

Dr Lam Wing-wo, a family doctor involved in the scheme, notes that 45 is an ideal age for screening. He encourages citizens to get screened as soon as possible.

"Hypertension, diabetes and prediabetes are mostly asymptomatic during the early stages. If we leave them untreated, there will be higher risks of myocardial infarction, stroke, kidney failure, eye diseases and also sexual dysfunction and dementia."

He believes that the multidisciplinary team behind the scheme can provide patients with more attentive and effective care while patients wait for their follow-up appointments.

Win-win scheme

Under the scheme, costs of screenings, laboratory tests, consultations, medications, nurse clinics, and allied health services are partially subsidised by the Government. Participants only need to pay a certain co-payment fee.

The bureau stated that at present nearly 500 family doctors have joined the programme. Over 70% of them have set a co-payment fee at or below the $150 that the Government recommends.

Starting the first quarter of this year, eligible citizens can enrol in the scheme directly at participating family doctors' clinics. Further details will be announced in due course.