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HKU School of Public Health Reveals that Primary Care Attendances could Potentially Reduce Diabetes-related Avoidable Hospital Admissions

16 Nov 2017

The study was led by Dr Jianchao Quan, Clinical Assistant Professor of School of Public Health, Li Ka Shing Faculty of Medicine, HKU. 

The global prevalence of diabetes has increased fourfold over the past thirty-five years¹.  The prevalence of diabetes increases with population aging, obesity, and urbanisation - all of which are key trends in Hong Kong and the Asia-Pacific.  The School of Public Health at The University of Hong Kong (HKU) found that the prevalence of diabetes among Hong Kong adults has increased from 7.2% in 2006 to 10.3% in 2014 (latest figure available)².   The prevalence of diabetes ranged from <1% in 20-39 year olds, 7.6% among 40-59 year olds, 25.9% in 60-79 year olds, to 34.9% in those aged 80 and over.  There is welcome news in that the (age-standardised) rate of new diabetes cases has stabilised in Hong Kong in recent years.  However, the total number of people with diabetes will continue to increase as the population grows older, adding pressure on health services in Hong Kong.

Health care spending on diabetes is substantial.  In China, diabetes-related health care spending reached $51 billion USD (13% of China’s total health expenditure) in 2015.  The health care cost of diabetes in Hong Kong was estimated at around $2 billion HKD in 2006.  To tackle this health issue, the Food and Health Bureau’s Working Group on Primary Care published revised clinical guidelines this year for managing diabetes in primary care: Hong Kong Reference Framework for Diabetes Care for Adults in Primary Care Settings revised 2017.

A significant sum of money is spent on hospital admissions for diabetes-related complications such as heart disease, blindness and amputations that could have been avoided with better health management.  The HKU researchers, together with international collaborators, investigated hospital admissions for avoidable diabetes-related complications in Hong Kong, Beijing, Singapore and Japan from 2008 to 2014.  The rate of avoidable admissions was devised by Organization for Economic Cooperation and Development (OECD) as a quality indicator of the health care system.

The avoidable admissions rate in Hong Kong was found to be of comparable standard to other developed high-income OECD member countries.  A person with diabetes made on average more than 6 outpatient visits a year to the public health care system.  Nearly a quarter (23.4%) of all patients with diabetes were admitted to hospital during the period 2012-14, spending an average of 5.3 days on each admission.  This was a slight improvement from 2006 to 2008 when 24.1% of all patients with diabetes were admitted to hospital staying on average 6.8 days.

Hospital treatment for diabetes-related complications costs over $12,000 HKD for each admitted patient per year.  The annual medical costs for someone admitted in Hong Kong to a public-sector hospital with an avoidable diabetes-related complication were twenty times greater than for someone without.  Although the average annual medical spending on each patient with diabetes has fallen slightly from $4,387 HKD in 2006-08 to $3,820 HKD in 2012-14, the number of patients being treated by the public health care system has risen from 353,000 to 548,000 over this period.

The research team found that people with more primary care visits were less likely to experience an avoidable admission in the following year in the public sector, even after accounting for the severity of diabetes and the presence of other illnesses (statistically significant regression coefficient of -0.0209).  This pattern was also observed in the sister study sites, Japan and Singapore (Beijing had limited data).  These findings suggest that primary care management of diabetes could improve quality, reduce bad outcomes and save on costly hospital admissions.  In Hong Kong, efforts to maintain and improve primary care, such as implementing the newly updated treatment guidelines and raising the status of family medicine, could reduce avoidable hospital admissions and be cost-saving in the long run.

The details of this study have been published in the latest issue of the Health Affairs (https://goo.gl/QuZaAQ), the leading journal on health policy and health service research.

The study was led by Dr Jianchao Quan, Clinical Assistant Professor of School of Public Health, Li Ka Shing Faculty of Medicine, HKU; and Dr Karen Eggleston, Deputy Director and Senior Fellow of the Walter H. Shorenstein Asia-Pacific Research Center, Stanford University, USA.

About the School of Public Health, Li Ka Shing Faculty of Medicine, HKU

The School of Public Health, Li Ka Shing Faculty of Medicine of The University of Hong Kong has a long and distinguished history in public health education and high impact research. With world leading research in infectious diseases as well as on non-communicable diseases of both local and global importance, the School has made significant contributions through its research and advocacy to improve the health of populations and individuals, both locally and globally. The School is a leading research and teaching hub in public health on influenza and other emerging viruses, control of infectious and non-communicable diseases, tobacco control, air pollution, psycho-oncology, behavioral sciences, exercise science, life-course epidemiology, and health economics, health services planning and management. This work has informed international (e.g. the World Health Organization, Food and Agriculture Organization of the United Nations), national and local public health policies.

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Please contact Li Ka Shing Faculty of Medicine of The University of Hong Kong by email (medkefa@hku.hk).
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1  NCD Risk Factor Collaboration. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants. The Lancet. 2016 Apr 15;387(10027):1513–30.
2  Quan J, Li TK, Pang H, Choi CH, Siu SC, Tang SY, et al. Diabetes incidence and prevalence in Hong Kong, China during 2006–2014. Diabetic Medicine. 2017;34(7):902–8.