1
|
John JR, Tannous WK, Jones A. Effectiveness of a Patient-Centre Medical Home model on diabetes and other clinically relevant outcomes among primary care patients diagnosed with type-2 diabetes in Sydney, Australia. Prim Care Diabetes 2021; 15:464-471. [PMID: 33547009 DOI: 10.1016/j.pcd.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/16/2020] [Accepted: 01/22/2021] [Indexed: 11/18/2022]
Abstract
AIM We aim to evaluate the effectiveness of patient-centred medical home (PCMH) model in improving diabetes and clinical outcomes among primary care patients diagnosed with T2D. METHODS The WellNet study used cohort design with a concurrent comparison group to evaluate changes in clinical outcomes across six general practices in Sydney, Australia. The treatment group comprised of 279 patients who received PCMH care whereas the matched comparison group included 3671 patients who received standard care. t-tests with analysis of covariance were conducted to evaluate significant mean differences and multivariate logistic regression was performed to determine predictors of glycaemic control at follow-up. RESULTS WellNet patients observed slightly larger within-group mean differences compared to comparison group patients (-0.2% vs -0.04%). Additionally, WellNet patients saw a larger increase in the percentage of patients achieving glycaemic control (7.9% vs 2.3%). A statistically significant mean difference was seen in waist circumference after adjusting for covariates (-2.41 cm, 95% CI -4.72 to -0.11; p < 0.05). Findings of multivariate logistic regression analysis showed that withdrawn patients and elevated HbA1c measures at baseline were associated with poor glycaemic control at follow-up. CONCLUSION The study findings may be beneficial to patients in terms of improved clinical outcomes and self-management support.
Collapse
Affiliation(s)
- James Rufus John
- Translational Health Research Institute, Western Sydney University, New South Wales 2560, Australia; Rozetta Institute, Level 4, 55 Harrington Street, Sydney, New South Wales 2000, Australia.
| | - W Kathy Tannous
- School of Business, Western Sydney University, Parramatta, New South Wales 2150, Australia.
| | - Amanda Jones
- Sonic Clinical Services, Level 21, 225 George Street, New South Wales 2000, Australia.
| |
Collapse
|
2
|
Griffith KN, Prentice JC, Mohr DC, Conlin PR. Predicting 5- and 10-Year Mortality Risk in Older Adults With Diabetes. Diabetes Care 2020; 43:1724-1731. [PMID: 32669409 PMCID: PMC7372062 DOI: 10.2337/dc19-1870] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 05/08/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Several diabetes clinical practice guidelines suggest that treatment goals may be modified in older adults on the basis of comorbidities, complications, and life expectancy. The long-term benefits of treatment intensification may not outweigh short-term risks for patients with limited life expectancy. Because of the uncertainty of determining life expectancy for individual patients, we sought to develop and validate prognostic indices for mortality in older adults with diabetes. RESEARCH DESIGN AND METHODS We used a prevalence sample of veterans with diabetes who were aged ≥65 years on 1 January 2006 (N = 275,190). Administrative data were queried for potential predictors that included patient demographics, comorbidities, procedure codes, laboratory values and anthropomorphic measurements, medication history, and previous health service utilization. Logistic least absolute shrinkage and selection operator regressions were used to identify variables independently associated with mortality. The resulting odds ratios were then weighted to create prognostic indices of mortality over 5 and 10 years. RESULTS Thirty-seven predictors of mortality were identified: 4 demographic variables, prescriptions for insulin or sulfonylureas or blood pressure medications, 6 biomarkers, previous outpatient and inpatient utilization, and 22 comorbidities/procedures. The prognostic indices showed good discrimination, with C-statistics of 0.74 and 0.76 for 5- and 10-year mortality, respectively. The indices also demonstrated excellent agreement between observed outcome and predictions, with calibration slopes of 1.01 for both 5- and 10-year mortality. CONCLUSIONS Prognostic indices obtained from administrative data can predict 5- and 10-year mortality in older adults with diabetes. Such a tool may enable clinicians and patients to develop individualized treatment goals that balance risks and benefits of treatment intensification.
Collapse
Affiliation(s)
- Kevin N Griffith
- Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, MA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA
| | - Julia C Prentice
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - David C Mohr
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA
| | - Paul R Conlin
- VA Boston Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
| |
Collapse
|
3
|
Gallo M, Ruggeri RM, Muscogiuri G, Pizza G, Faggiano A, Colao A. Diabetes and pancreatic neuroendocrine tumours: Which interplays, if any? Cancer Treat Rev 2018; 67:1-9. [PMID: 29746922 DOI: 10.1016/j.ctrv.2018.04.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 04/15/2018] [Accepted: 04/17/2018] [Indexed: 01/15/2023]
Abstract
Pancreatic neuroendocrine tumours (PanNETs) represent an uncommon type of pancreatic neoplasm, whose incidence is increasing worldwide. As per exocrine pancreatic cancer, a relationship seems to exist between PanNETs and glycaemic alterations. Diabetes mellitus (DM) or impaired glucose tolerance often occurs in PanNET patients as a consequence of hormonal hypersecretion by the tumour, specifically affecting glucose metabolism, or due to tumour mass effects. On the other hand, pre-existing DM may represent a risk factor for developing PanNETs and is likely to worsen the prognosis of such patients. Moreover, the surgical and/or pharmacological treatment of the tumour itself may impair glucose tolerance, as well as antidiabetic therapies may impact tumour behaviour and patients outcome. Differently from exocrine pancreatic tumours, few data are available for PanNETs as yet on this issue. In the present review, the bidirectional association between glycaemic disorders and PanNETs has been extensively examined, since the co-existence of both diseases in the same individual represents a further challenge for the clinical management of PanNETs.
Collapse
Affiliation(s)
- Marco Gallo
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
| | - Rosaria Maddalena Ruggeri
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Italy
| | | | - Genoveffa Pizza
- Unit of Internal Medicine, Landolfi Hospital, Solofra, Avellino, Italy
| | - Antongiulio Faggiano
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
| |
Collapse
|
4
|
Jackson SL, DesRoches CM, Frosch DL, Peacock S, Oster NV, Elmore JG. Will use of patient portals help to educate and communicate with patients with diabetes? PATIENT EDUCATION AND COUNSELING 2018; 101:956-959. [PMID: 29153758 DOI: 10.1016/j.pec.2017.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/24/2017] [Accepted: 11/03/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Chronic disease management can require daily attention, and increased levels of patient activation and engagement. We examined whether patients with diabetes perceive a greater benefit to having electronic access to their doctors' clinic notes compared to patients without diabetes. We hypothesized that easy electronic access to these notes may help patients with self-care by improving education and communication. METHODS Survey of patients with and without diabetes in Massachusetts and Pennsylvania about perceptions of potential benefits and risks of reading their visit notes via an electronic patient information portal. Administrative data were used to identify patients with diabetes; we compared their perceptions to those of patients without diabetes. RESULTS The majority of patients (both with and without diabetes) perceived a positive impact of using the portal. Patients with diabetes were significantly more likely to believe that having access to and reading their notes would help them take their medication better and take better care of themselves. CONCLUSIONS Patients with chronic diseases such as diabetes might receive an even greater benefit from access to their doctors' notes than the general patient population. PRACTICE IMPLICATIONS Doctors should encourage their patients with diabetes (or other chronic diseases) to use patient portals.
Collapse
Affiliation(s)
- Sara L Jackson
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States.
| | - Catherine M DesRoches
- Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline, MA, United States
| | - Dominick L Frosch
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States; Department of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Sue Peacock
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Natalia V Oster
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Joann G Elmore
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| |
Collapse
|
5
|
Wahdan-Alaswad RS, Edgerton SM, Salem HS, Thor AD. Metformin Targets Glucose Metabolism in Triple Negative Breast Cancer. ACTA ACUST UNITED AC 2018; 4. [PMID: 29780974 PMCID: PMC5959056 DOI: 10.4172/2476-2261.1000129] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Metformin is the most widely administered anti-diabetic agent worldwide. In patients receiving metformin for metabolic syndrome or diabetes, it reduces the incidence and improves the survival of breast cancer (BC) patients. We have previously shown that metformin is particularly potent against triple negative breast cancer (TNBC), with a reduction of proliferation, oncogenicity and motility, inhibition of pro-oncogenic signaling pathways and induction of apoptosis. These BCs are well recognized to be highly dependent on glucose/glucosamine (metabolized through anaerobic glycolysis) and lipids, which are metabolized for the production of energy and cellular building blocks to sustain a high rate of proliferation. We have previously demonstrated that metformin inhibits lipid metabolism, specifically targeting fatty acid synthase (FASN), cholesterol biosynthesis and GM1 lipid rafts in TNBC. We also reported that glucose promotes phenotypic aggression and reduces metformin efficacy. We now show that metformin inhibits several key enzymes requisite to glucose metabolism in TNBC, providing additional insight into why metformin is especially toxic to this subtype of BC. Our data suggests that the use of metformin to target key metabolic defects in lipid and carbohydrate metabolism in cancer may be broadly applicable, especially against highly aggressive malignant cells.
Collapse
Affiliation(s)
- R S Wahdan-Alaswad
- Department of Pathology, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, USA
| | - S M Edgerton
- Department of Pathology, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, USA
| | - H S Salem
- Department of Pathology, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, USA
| | - A D Thor
- Department of Pathology, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, USA
| |
Collapse
|
6
|
Jiao F, Fung C, Wan Y, McGhee S, Wong C, Dai D, Kwok R, Lam C. Effectiveness of the multidisciplinary Risk Assessment and Management Program for Patients with Diabetes Mellitus (RAMP-DM) for diabetic microvascular complications: A population-based cohort study. DIABETES & METABOLISM 2016; 42:424-432. [DOI: 10.1016/j.diabet.2016.07.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/30/2016] [Accepted: 07/14/2016] [Indexed: 11/28/2022]
|
7
|
Jiao F, Fung CSC, Wan YF, McGhee SM, Wong CKH, Dai D, Kwok R, Lam CLK. Long-term effects of the multidisciplinary risk assessment and management program for patients with diabetes mellitus (RAMP-DM): a population-based cohort study. Cardiovasc Diabetol 2015; 14:105. [PMID: 26268736 PMCID: PMC4535739 DOI: 10.1186/s12933-015-0267-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 07/31/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Studies on the long-term effectiveness of multidisciplinary risk-stratification based management in Chinese population were rare. This study aimed to evaluate the effectiveness of a multidisciplinary risk assessment and management program for patients with diabetes mellitus (RAMP-DM) in reducing the risks of cardiovascular complications and all-cause mortality. METHODS A prospective cohort study was conducted in 18,188 propensity score matched RAMP-DM participants and subjects with diabetes under usual primary care (9,094 subjects in each group). The study endpoints were the first occurrence of coronary heart disease (CHD), stroke, heart failure (HF), total cardiovascular disease (CVD) and all-cause mortality. We constructed multivariable Cox proportional hazard regressions to estimate the association between the RAMP-DM intervention and the first occurrence of study endpoints. RESULTS The median follow-up period was 36 months. Three hundred and ninety-nine CVD events occurred in the RAMP-DM group, as compared with 608 in the control group [adjusted hazard ratio, 0.629; 95% confidence interval (CI) 0.554-0.715; P < 0.001]. The total number of all-cause deaths in RAMP-DM group was less than half that of control group (202 vs 552, adjusted hazard ratio, 0.363; 95% CI, 0.308-0.428; P < 0.001). The adjusted hazard ratios of the RAMP-DM group for CHD, stroke, and HF were 0.570 (95% CI, 0.470-0.691; P < 0.001), 0.652 (95% CI, 0.546-0.780; P < 0.001), and 0.598 (95%CI, 0.446-0.802; P = 0.001), respectively. CONCLUSIONS The RAMP-DM intervention was associated with lower incidences of individual and total cardiovascular complications, as well as all-cause mortality over 3 years follow-up. The encouraging results provided evidence to support that the structured risk-stratification management leading by a multidisciplinary clinical team was an effective approach to reduce future cardiovascular complications in people with diabetes. CLINICAL TRIAL REGISTRY NCT02034695, http://www.ClinicalTrials.gov.
Collapse
Affiliation(s)
- Fangfang Jiao
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong.
| | - Colman Siu Cheung Fung
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong.
| | - Yuk Fai Wan
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong.
| | - Sarah Morag McGhee
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 5/F William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong.
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong.
| | - Daisy Dai
- Primary and Community Services, Hospital Authority Head Office, Hong Kong Hospital Authority, Hospital Authority Building, 147B Argyle Street, Kowloon, Hong Kong.
| | - Ruby Kwok
- Primary and Community Services, Hospital Authority Head Office, Hong Kong Hospital Authority, Hospital Authority Building, 147B Argyle Street, Kowloon, Hong Kong.
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong.
| |
Collapse
|
8
|
Gallo M, Mannucci E, De Cosmo S, Gentile S, Candido R, De Micheli A, Di Benedetto A, Esposito K, Genovese S, Medea G, Ceriello A. Algorithms for personalized therapy of type 2 diabetes: results of a web-based international survey. BMJ Open Diabetes Res Care 2015; 3:e000109. [PMID: 26301097 PMCID: PMC4537916 DOI: 10.1136/bmjdrc-2015-000109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 06/17/2015] [Accepted: 07/12/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE In recent years increasing interest in the issue of treatment personalization for type 2 diabetes (T2DM) has emerged. This international web-based survey aimed to evaluate opinions of physicians about tailored therapeutic algorithms developed by the Italian Association of Diabetologists (AMD) and available online, and to get suggestions for future developments. Another aim of this initiative was to assess whether the online advertising and the survey would have increased the global visibility of the AMD algorithms. RESEARCH DESIGN AND METHODS The web-based survey, which comprised five questions, has been available from the homepage of the web-version of the journal Diabetes Care throughout the month of December 2013, and on the AMD website between December 2013 and September 2014. Participation was totally free and responders were anonymous. RESULTS Overall, 452 physicians (M=58.4%) participated in the survey. Diabetologists accounted for 76.8% of responders. The results of the survey show wide agreement (>90%) by participants on the utility of the algorithms proposed, even if they do not cover all possible needs of patients with T2DM for a personalized therapeutic approach. In the online survey period and in the months after its conclusion, a relevant and durable increase in the number of unique users who visited the websites was registered, compared to the period preceding the survey. CONCLUSIONS Patients with T2DM are heterogeneous, and there is interest toward accessible and easy to use personalized therapeutic algorithms. Responders opinions probably reflect the peculiar organization of diabetes care in each country.
Collapse
Affiliation(s)
- Marco Gallo
- Department of Oncological Endocrinology, AOU Città della Salute e della Scienza-Molinette, Turin, Italy
| | - Edoardo Mannucci
- Department of Diabetes Agency, Careggi Teaching Hospital, Florence, Italy
| | - Salvatore De Cosmo
- Unit of Internal Medicine, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Sandro Gentile
- Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | | | | | | | - Katherine Esposito
- Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Stefano Genovese
- Department of Cardiovascular and Metabolic Diseases, Istituto di Ricovero e Cura a Carattere Scientifico Gruppo Multimedica, Sesto San Giovanni, Italy
| | - Gerardo Medea
- Italian College of General Practitioners (Società Italiana di Medicina Generale), Florence, Italy
| | - Antonio Ceriello
- Department of Endocrinology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigacion Biomèdica en Red de Diabetes y Enfermedades Metabolicas Asociadas (CIBERDEM), Barcelona, Spain
| |
Collapse
|
9
|
Jiao FF, Fung CSC, Wong CKH, Wan YF, Dai D, Kwok R, Lam CLK. Effects of the Multidisciplinary Risk Assessment and Management Program for Patients with Diabetes Mellitus (RAMP-DM) on biomedical outcomes, observed cardiovascular events and cardiovascular risks in primary care: a longitudinal comparative study. Cardiovasc Diabetol 2014; 13:127. [PMID: 25142791 PMCID: PMC4145236 DOI: 10.1186/s12933-014-0127-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/13/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To assess whether the Multidisciplinary Risk Assessment and Management Program for Patients with Diabetes Mellitus (RAMP-DM) led to improvements in biomedical outcomes, observed cardiovascular events and predicted cardiovascular risks after 12-month intervention in the primary care setting. METHODS A random sample of 1,248 people with diabetes enrolled to RAMP-DM for at least 12 months was selected and 1,248 people with diabetes under the usual primary care were matched by age, sex, and HbA1c level at baseline as the usual care group. Biomedical and cardiovascular outcomes were measured at baseline and at 12-month after the enrollment. Difference-in-differences approach was employed to measure the effect of RAMP-DM on the changes in biomedical outcomes, proportion of subjects reaching treatment targets, observed and predicted cardiovascular risks. RESULTS Compared to the usual care group, RAMP-DM group had lower cardiovascular events incidence (1.21% vs 2.89%, P = 0.003), and net decrease in HbA1c (-0.20%, P < 0.01), SBP (-3.62 mmHg, P < 0.01) and 10-year cardiovascular disease (CVD) risks (total CVD risk, -2.06%, P < 0.01; coronary heart disease (CHD) risk, -1.43%, P < 0.01; stroke risk, -0.71%, P < 0.01). The RAMP-DM subjects witnessed significant rises in the proportion of reaching treatment targets of HbA1c, and SBP/DBP. After adjusting for confounding variables, the significance remained for HbA1c, predicted CHD and stroke risks. CONCLUSIONS The RAMP-DM resulted in greater improvements in HbA1c and reduction in observed and predicted cardiovascular risks at 12 months follow-up, which indicated a risk-stratification multidisciplinary intervention was an effective strategy for managing Chinese people with diabetes in the primary care setting. TRIAL REGISTRY ClinicalTrials.gov, NCT02034695.
Collapse
Affiliation(s)
- Fang Fang Jiao
- />Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong
| | - Colman Siu Cheung Fung
- />Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong
| | - Carlos King Ho Wong
- />Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong
| | - Yuk Fai Wan
- />Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong
| | - Daisy Dai
- />Primary and Community Services, Hospital Authority Head Office, Hong Kong Hospital Authority, Hospital Authority Building, 147B Argyle Street, Kowloon, Hong Kong
| | - Ruby Kwok
- />Primary and Community Services, Hospital Authority Head Office, Hong Kong Hospital Authority, Hospital Authority Building, 147B Argyle Street, Kowloon, Hong Kong
| | - Cindy Lo Kuen Lam
- />Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong
| |
Collapse
|