政府正全面檢視基層醫療服務規劃，構思建設以嶄新形式運作的地區康健中心，由政府出資，利用地區網絡購買服務，加強在社區內的醫護及復康服務，使市民在社區內獲得所需的照顧，減少對公立醫院急症室的依賴。這項利民建設應加快，改變市民以急症室為首選求診服務的習慣。 （標題為編輯所加） （摘錄自香港文匯報社評26-12-2018）
Ease the pressure on the A&E departments through the public-private partnerships
【譯文】Crowds of patients were forced to wait outside of emergency wards as the winter surge hits local hospitals during the Christmas holidays. On Christmas day, non-urgent patients visiting accident and emergency (A&E) wards at United Christian Hospital, Prince of Wales Hospital and Queen Elizabeth Hospital all had to wait for up to eight hours before being treated. A&E wards have been stretched to breaking point time and again during holidays, and it has added to the suffering of patients. The Hospital Authority (HA) should extend the number of general out-patient clinics that provide service during public holidays in order to divert patients from emergency wards. Publicity of its online platforms which show the A&E waiting time reference should also be stepped up, so as to enable the public to make more informed decisions when deciding where to seek medical attention. The HA should also hasten the development of community health centres through public-private partnerships with a view to making healthcare services more accessible to the public, for when the number of non-urgent patients visiting emergency wards is reduced, the pressure on A&E departments could be eased.
During the Christmas and Chinese New Year holidays, most of the general out-patient clinics and private clinics are closed. As the winter flu season usually peaks between the same period of time, patients with even the mildest symptoms are often left with no choice but to visit emergency wards at public hospitals. This exacerbates the pressure on A&E units, and further stretches patients' waiting time. During the 2017 Christmas and 2018 Chinese New Year festive periods, non-urgent patients' waiting time at A&E wards had gone up to over eight hours, while the occupancy rate of public hospital medical wards was over 100 per cent. Some patients waited for over 12 hours and still could not see a doctor, while some other decided to give up due to the long queue.
The primary function of A&E departments is to rescue those who are in critical conditions, not treating mild illnesses like common cold or flu. In her Policy Address delivered in October 2017, Chief Executive Carrie Lam Cheng Yuet-ngor said the government would allocate resources to improve the healthcare system and services. The relevant measures included vigorously promoting primary healthcare, reducing repetitive admission of patients to hospital, and rectifying the phenomenon where A&E services were regarded by members of the general public as the first point of contact in seeking medical consultation. However, emergency wards are still overflowed during every holiday season. Frontline medical workers are severely overworked and utterly exhausted, while patients have to suffer as they are made to endure long queues. Instead of seeing any improvements, the situation seemed to have deteriorated. The HA must take the problem seriously and commit to tackling it.
Currently, among the 73 general out-patient clinics under the HA, only 23 of them provide evening consultation services (i.e. from 6pm to 10pm) from Mondays to Fridays, and only 13 of them provide, in addition to evening consultation services, consultation services on Sundays and public holidays. As the demand for healthcare services during holiday seasons is growing, the HA should actively consider increasing the number of general out-patient clinics that open on public holidays, so as to alleviate the pressure on A&E departments. In addition, the Hong Kong Medical Association have pointed out that many private clinics are still open for business during holidays. Patients with milder conditions can seek medical care from the private sector first. The Association is now designing a mobile application that aims to assist the public in finding a private clinic through GPS.
Via the internet and its mobile app "HA Touch", the HA has started to publish emergency ward waiting time references for public hospitals since December 2016. However, most people are still not aware of this online notification system, rendering it ineffective in diverting patients. The HA should step up promotion and publicity work, and look into the possibility of adding private clinics that open for business on holidays into its notification system. By doing so, the general public could better choose the medical service that is more suitable for them via the system, and in turn, patients will no longer need to rush to A&E wards with even the slightest sickness.
The government is conducting a comprehensive review of the planning for primary healthcare services. A District health centre with a brand new operation mode and funding from the government is being planned. This centre will make use of the local network to procure services for strengthening medical and rehabilitation services in the community, so that the public can receive the necessary care in the community, and unwarranted use of public hospital services can be reduced. This idea would be beneficial to the public and should be expedited, so that patients will be less likely to consider A&E departments as their first choice for medical services.■Jeffrey Tse (firstname.lastname@example.org)
1. general practitioner (GP)
2. primary care
3. specialist out-patient clinics