Effects of SARS on consultations in primary care in Hong Kong

Abstract

Objective: To study the infection control measures and concerns in primary care practices, and the effects of SARS on primary care consultation using the Leicester Assessment Package (LAP) criteria during the SARS episode in Hong Kong. Design: A postal survey using a questionnaire. The questionnaire consisted of three parts on the demographic data, infection control precautions taken and concerns of the respondents, and the effect of SARS on consultations. Subjects: Full members and fellows of the HKCFP. Main outcome measures: Infection control precautions including performance of initial screening/triage, by whom and how these were carried out, actions for the triaged patients, use of personal protection equipments (PPE), organisation and format of infection control training of staff and decontamination practice; perceptions of adequacy of protection and areas of concern; and proportion and degree to which consultation skills were affected using the LAP criteria. Results: The response rate was 60%. 71.4% respondents triaged their patients. 85.9% took temperatures of their patients. All respondents wore a mask during consultations. 69.8% organised training for their staff and clinic. Most respondents regularly decontaminated their clinic. 56% felt adequately protected by their infection control precautions and use of PPE but 44% did not. The major concerns were the variable clinical presentations of SARS, the practicability of wearing full protection, and the lack of early and reliable diagnostic tests. The type of practice was found to be a factor affecting the choice of infection control precautions. Consultation skills were found to be affected in ≤ 25% of consultations. History taking, physical examination, management and problem solving were found to be more difficult but relationship with patients and anticipatory care became easier. Conclusion: Choice of infection control precautions was related to the type of practice. The major concerns of primary care physicians were the variable clinical presentations of SARS and the lack of early and reliable diagnostic tests. Consultation skills were affected in ≤ 25% of consultations but patients were found to be more receptive to anticipatory care.