Hong Kong’s Public Hospitals Overhaul Drug Prescribing MechanismHong Kong’s Public Hospitals Overhaul Drug Prescribing Mechanism Henry Fan Hung-ling, Chairman of the Hospital Authority in Hong Kong, has denounced the “unacceptable” practice of prescribing more than 400 days’ worth of medication to a single patient. This comes after reports of an 83-year-old geriatric patient receiving 425 days of prescribed drugs for psychiatric conditions after a brief hospital stay. Fan has promised a thorough review of the drug prescribing mechanism, expressing concern over the excessive duration of prescriptions for psychiatric medications. He acknowledged that prescribing for chronic diseases is at the discretion of doctors, but emphasized that such prolonged prescriptions are unacceptable. The Hospital Authority plans to explore prescribing fewer drugs in clinics and reducing the maximum duration to 16 weeks. However, Fan noted that the review will take time, as the authority seeks to provide patients with alternative locations for refilling prescriptions. Public hospitals in Hong Kong are already facing significant challenges, including long waiting times and overwhelmed services. The excessive prescription of medication has added to these burdens. The patient in question, who suffers from multiple illnesses including dementia and anxiety, was initially treated for a fever at Eastern Hospital. Despite being referred to a community psychiatrist, he was prescribed an extensive list of medications by an intern doctor. Eastern Hospital has defended its actions, stating that the extended duration of medication was intended to ensure the patient had sufficient supplies before his specialist appointment. However, the hospital has admitted that the prescribing arrangement was not ideal and will be reviewed. The spokesperson for Eastern Hospital emphasized that prescriptions are made based on individual patient needs and clinical circumstances. They stressed that doctors should arrange consultations within an appropriate timeframe when prescribing medications for extended durations, involving pharmacists in the monitoring and review process.
The head of Hong Kong’s public hospitals has called it “unacceptable” for a patient to receive more than 400 days of medication at one time, and promised a major overhaul of the drug prescribing mechanism.
Hospital Authority Chairman Henry Fan Hung-ling criticized the measure on Thursday, two days after a private geriatrician said on social media that his 83-year-old patient was prescribed 425 days of drugs, mainly for psychiatric conditions, by Pamela Youde Nethersole Eastern Hospital in April after being treated for a fever for nine days.
“Prescribing medicines to patients with chronic diseases is always the discretion of doctors, but what happened this time was unacceptable. How can you prescribe 400 days of psychiatric drugs in one go?” Fan said.
“The situation was not ideal. We will conduct a thorough review, on top of an ongoing review, to look at the possibility of prescribing fewer drugs to patients in clinics, and whether (even) giving drugs for 16 weeks would not be too much.”
But the authority would need time to carry out the review as it hoped to provide patients with a location other than hospitals where they could fill their prescriptions, he added.
The city’s public hospitals are already struggling with long waiting times and overloaded services.
Some of the medicines prescribed by the hospital to the elderly patient. Photo: Handout
Private geriatrician Dr. Paul Shea Tat-ming began treating the patient in 2020. Shea told the Post that the patient had multiple illnesses, including dementia, depression, anxiety, high blood pressure, high cholesterol and heart disease.
He was sent to Eastern Hospital in Chai Wan in April due to fever and was treated for nine days.
He was also referred to a community psychiatrist, with the first consultation scheduled to take place in June next year.
Shea therefore wrote a referral letter describing the man’s condition and the medications he had been taking for the hospital’s reference.
But a doctor at the public hospital, whom Shea said was an intern, prescribed about 20 types of medications for more than 400 days.
In a response to the Post, Eastern Hospital said the patient was given an extended duration of medication upon discharge to ensure he had sufficient supplies before his specialist appointment.
“To ensure treatment compliance and continuity of treatment, doctors will generally avoid dispensing psychiatric medications in phases, so as not to compromise the effectiveness of the treatment,” a spokesperson said.
“Following a review of the case, we felt it was not ideal to prescribe the patient’s medication for a longer duration and we will monitor and review the prescribing arrangement.”
He added that prescriptions were based on the patient’s needs, taking into account clinical circumstances and follow-up appointments.
If it is deemed necessary to prescribe medications for a longer duration, the doctor should arrange a consultation within an appropriate time frame, involving pharmacists to monitor the clinical condition and review the prescription, the spokesperson added.
