A primary care perspective on gender-focused mental health services in Singapore: Correspondence.

Chronic arthritic pain is one of the major causes of physical suffering and disability among older people. Primary care and allied health clinicians use various approaches to help their older clients better manage their arthritic pain. The growing uptake of technology among older people offers the potential for clinicians to integrate an arthritic pain app into their patients' self-management plans. This study explored the perspectives of Australian primary care and allied health clinicians regarding the use of pain self-management apps to help their older patients/clients better manage their arthritic pain. Qualitative design using a semistructured interview approach. Interviews were conducted via telephone with primary and allied health clinicians (N = 17) across Australia. The overarching theme underlying participants' views on integration of apps into older people's pain self-management strategy was that this approach is an idealistic but uniquely challenging endeavor. Four subthemes emerged, namely: 1) self-management apps are a potentially useful tool but require careful consideration; 2) clinicians' involvement is crucial yet potentially onerous; 3) no single app is right for every older person with arthritic pain; and 4) patient data access is beneficial, but caution is needed for real-time data access. The predominant clinician perspective of integrating apps into their older patients/clients' pain self-management strategies was that this approach is an idealistic but uniquely challenging endeavor. Apps were seen as having potential to support various aspects of patients' self-management behaviors; however, there were notable concerns with regards to the challenges inherent in this approach for both clinicians and older users (patients/clients).

Although quitting smoking benefits mental health, people with mental health conditions tend to have higher smoking rates and more severe tobacco use disorders. Integration of smoking cessation into mental healthcare, or vice versa, could help to meet the needs of this population. While Singapore offers specialist smoking cessation and mental health services, it is unclear how these services address the needs of people with comorbid tobacco use and mental health issues. This study aimed to explore the integration of smoking cessation and mental health services in Singapore from the perspective of healthcare professionals. We conducted one-on-one semi-structured interviews with 21 Singaporean health professionals with expertise in mental health (n = 5), smoking cessation (n = 5), primary healthcare (n = 3), specialist respiratory or emergency care (n = 3) or health systems and policy (n = 5). We recruited participants from the authors' professional networks and subsequently via snowballing. We used inductive coding methods to identify themes that emerged from the data. Health professionals were divided on whether smoking and mental health are sufficiently interconnected to justify more integrated or tailored services. Smoking cessation and mental health were generally approached in a siloed manner, reflecting systemic barriers to integration as well as ranging levels of awareness among health professionals on the association between smoking and mental health. While some participants welcomed the integration of smoking cessation and mental health services as a more convenient, effective and equitable way to address the needs of this population, others deemed it unnecessary and viewed smoking as a lifestyle habit, distinct from other mental health issues. There is a need to educate health professionals on smoking as a mental health issue and to consider more tailored programmes designed to address smoking cessation and mental health needs simultaneously.

Introduction: Prompt recognition of cardiac arrest and initiation of cardiopulmonary resuscitation (CPR) and defibrillation is necessary for good outcomes from out-of-hospital cardiac arrest (OHCA). This study aims to describe the recognition and treatment of OHCA in patients conveyed by non-emergency ambulance services (EAS) in Singapore. Materials and Methods: This is a multi-centre, retrospective chart review, of cases presenting to public emergency departments (EDs), conveyed by non-EAS and found to be in cardiac arrest upon ED arrival. The study was from October 2002 to August 2009. The following variables were examined: ability to recognise cardiac arrest, whether CPR was carried out by the ambulance crew and whether an automated external defibrillator (AED) was applied. Results: Eighty-six patients were conveyed by non-EAS and found to be in cardiac arrest upon ED arrival. Mean age was 63 years (SD 21.8), 70.9% were males. A total of 53.5% of arrests occurred in the ambulance while 70.9% were found to be asystolic upon ED arrival. Seven patients had a known terminal illness. Survival to discharge was 3.5%. Cardiac arrest went unrecognised by the ambulance crew in 38 patients (44.2%). CPR was performed in 35 patients (40.7%) of the 86 patients and AED was applied in only 10 patients (11.6%). Conclusion: We found inadequate recognition and delayed initiation of treatment for OHCA. Possible reasons include a lack of training in patient monitoring and detection of cardiac arrest, lack of CPR training, lack of confidence in performing CPR, lack of AEDs on ambulances and lack of training in their use. Key words: Automated external defibrillator (AED), Cardiopulmonary resuscitation (CPR), Emergency medical services, Prehospital

Barriers to expanding primary care roles for chiropractors: the role of chiropractic as primary care gatekeeper

Background As a minority group, transgender and gender diverse (TGD) individuals may experience healthcare stressors due to stigma, transphobia and healthcare staff who lack the knowledge about their specific needs, impacting primary care entry and attendance. Extant literature is concentrated on TGD individuals’ perspectives of primary care with the main message being that it is inadequate. Aim To explore the primary care provider (PCP) perspective of experiences with adult TGD patients. Methods A scoping review was conducted using Arksey and O’Malley’s five-step framework to map and de-scribe the literature relating to PCP perspectives’ of experiences with TGD adults. Four databases were searched: PubMed, Embase, PsycINFO and CINAHL Plus. The process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The final dataset (n = 22) were charted and analysed thematically. Results Following application of exclusion criteria and removal of duplicates, twenty-two studies across five countries were included in the review. Studies include qualitative studies, surveys, mixed methods studies, a retrospective review and a pilot study with a pre- and postintervention analysis. Key themes identified related to the attitudes of PCPs towards TGD individuals, education of PCPs on TGD health issues and the barriers/facilitators to caring for TGD patients from a PCP perspective. Conclusion The review highlights the need for improved access to TGD-specific education. Future research should explore the best way to provide this to PCPs, inform implementation into relevant policies and include a broader range of countries to strengthen global applicability.

BackgroundThere is a lack of studies that explore the views and experiences of people with neurodevelopmental disorders of their mental health. This study explored the experiences of five adults with neurodevelopmental disorders who receive outpatient mental health services in Singapore.MethodTwo participants attended one‐to‐one semi‐structured interviews and three participants attended a focus group. The data were analyzed using interpretative phenomenological analysis.ResultsFour master themes emerged: (1) Sense of self, (2) people who matter to me, (3) having choice and autonomy, and (4) hopes and dreams. Three subthemes were further identified in the second master theme.ConclusionThe themes identified the negative impact of mental illness on self‐esteem and their experiences of receiving specialist mental health service in Singapore. Participants also specified desirable traits of professional staff and expressed a wish to have greater participation in the community through employment. Implications of the findings are discussed in the context of improving services for this population and addressing their psychosocial needs during the treatment process.

Given the growing interest in integrated care, this study sought to investigate the perception of psychiatry residents towards managing general medical conditions in their psychiatric patients. Between July-October 2017, all 46 residents at an adult psychiatry program were asked to complete an online survey. Sixty-seven percent responded. Most residents (81%) indicated they were knowledgeable and/or comfortable in managing medical conditions with supervision/consultation from a primary care provider. Residents also indicated that they would "like to" (48%) and/or "should" be able to (71%) manage the general medical conditions of their patients in the future with supervision/consultation from a primary care provider. An additional 26% indicated that they would like to and/or should be able to independently manage both behavioral and general medical conditions for their patients. Nicotine dependence, hypertension, dyslipidemias, and non-insulin-dependent diabetes were among the top conditions residents felt they should be able to manage (≥ 74%). A lack of knowledge, experience, training, and supervision were the most frequent barriers residents listed in providing general medical care to patients (71%). Residents noted that supervision from a primary care physician (29%) and additional education (54%) would help increase their comfort in managing medical conditions. Psychiatry residents were generally interested in managing basic medical issues. Opportunities to expand residency training in integrated care should be considered. With new models of integrated care emerging, future studies should explore how resident attitudes might evolve over time, as well as the attitudes and opinions of practicing psychiatrists and supervisors on this topic.

PurposeThis qualitative study aims to examine key stakeholders' perspectives of primary care group/trust prescribing strategies. Within the context of general practice prescribing, the paper also debates the wider issue of whether GPs' prescribing autonomy is under threat from managerial expansion following recent organisational changes in primary care.Design/methodology/approachData were obtained from focus groups and a series of individual semi‐structured interviews with GPs and key primary care organisation stakeholders.FindingsThe data underlie a tension between the managerial objective of cost‐restraint and GPs' commitment to quality improvement and individual clinical patient management. In presenting both managerial and medical narratives, two divergent and often conflicting discourses emerge, which leads to speculation that managerial attempts to constrain prescribing autonomy will achieve only limited success. The contention is that GPs' discourse features as a challenge to a managerial discourse that reflects attempts to regulate, standardise and curtail clinical discretion. This is due not only to GPs' expressed hegemonic ideals that clinical practice centres on the interests of the individual patient, but also to the fact that the managerial discourse of evidence‐based medicine encapsulates only a limited share of the knowledge that GPs draw on in decision making. However, while managers' discourse presented them as unwilling to impose change or directly challenge clinical practice, evidence also emerged to suggest that is not yet possible to be sufficiently convinced of the future retention of prescribing autonomy. On the other hand, the use of peer scrutiny posed an indirect managerial influence on prescribing, whilst the emergence of prescribing advisors as analysts of cost‐effectiveness may threaten doctors' dominance of medical knowledge.Research limitations/implicationsThere is a continuing need to analyse the impact of the new managerial reforms on primary care prescribing.Originality/valueThis study provides a snapshot of managerial and GP relations at a time of primary care transition.

Maternal experiences and preference of maternity services in Singapore: A descriptive qualitative study

IntroductionThere are insufficient scalable, evidence-based treatments to meet increasing mental health needs of young people. Offering interim, brief interventions for young persons with psychological distress can improve access to care...

Families of children with special needs face sustained emotional, psychological, and social challenges that can profoundly influence both caregiver well-being and child health outcomes. Primary care clinicians are uniquely positioned to address these needs longitudinally, yet the psychosocial dimensions remain under-recognized in routine practice. This review aims to synthesize existing evidence on caregiver burden and identify opportunities for enhanced primary care engagement. A narrative review was conducted using PubMed, PsycINFO, and Google Scholar to identify articles on "caregiver burden," "special needs children," and "primary care support." Eligible studies included peer-reviewed research, reviews, and guidelines addressing psychosocial outcomes and primary care interventions. Literature was analyzed through a primary care perspective, emphasizing caregiver mental health, family functioning, and healthcare system navigation. Evidence consistently demonstrates high rates of caregiver stress, anxiety, depression, and burnout, compounded by marital strain, role imbalance, and financial burden. Key risk factors include socioeconomic disadvantage, fragmented care coordination, and lack of culturally responsive support. Protective factors encompass strong social networks, access to multidisciplinary care, and proactive primary care engagement. Despite existing guidelines advocating family-centered models, gaps persist in systematic screening, timely referral pathways, and integration of psychosocial interventions into primary care workflows. The emotional and psychological health of families raising children with special needs is integral to optimal child outcomes. Primary care must evolve toward comprehensive, family-centered frameworks that embed mental health screening, caregiver support, and coordinated interprofessional care into routine practice. Addressing these gaps will require policy alignment, workforce training, and targeted research to operationalize psychosocial support as a core element of pediatric primary care.

Paediatric group A streptococcal disease in England: a primary care perspective

The world we live in: Health policy from a primary care perspective

IntroductionThe PSP has been implemented in Catalonia in 2006 in an attempt to improve the Primary Care treatment of the most common mental disorders and addictions. It’s based on a collaborative model, made up between Primary Care and Mental Health professionals.ObjectivesTo identify the strengths and limitations of the PSP from the perspective of Primary Care and Mental Health professionals.MethodsQualitative, exploratory and interpretive study based on Grounded Theory, made between 2018 and 2019 with Primary Care and Mental Health professionals. Group interviews were conducted with triangulated analysis. The study got the approval from the Research Ethics Committee of the Sant Joan de Deu’s foundation.Results11 group interviews were conducted in 6 primary care centers and 5 mental health centers in Barcelona. Intrinsic and extrinsic factors impacting the programme functioning were detected. Within the extrinsic factors, elements related to professionals, patients and public health system have been observed. All the professionals agree that the PCSP has a favorable impact on inter-professional relationships and patients, facilitating the management of cases. In contrast the heterogeneity implementation, the lack of training, and the health care burden in is considered to negatively influence an optimal development of the programme. Professionals suggest communication and inter-professional collaboration would be improved by creating more a horizontal structure that eliminates vertical lines of command and disagreements in clinical judgement, thus facilitating shared decisions.ConclusionsPrimaryCare and MentalHealth professionals value the PSP positively, but conclude there are communication and organizative barriers that should be addressed in order to improve the overall programme’s efficiency.

Syndemics of poor mental health also drive poorer sexual health outcomes. This study used three scales, the Alcohol Use Disorders Identification Test (AUDIT), the Drug Abuse Screening Test (DAST-10), and the Depression Anxiety Stress Scale (DASS-21) among beneficiaries of sexual health services in Singapore (n=975), respectively. We found that a prevalence of 20.4% and 18.6% of hazardous and moderate-severe alcohol use disorders and substance use risks, respectively. About 13.7%, 18.1% and 10.5% of participants reported severe to extremely severe symptoms of depression, anxiety, and stress, respectively. Further investigation and integrated interventions for mental health in sexual health settings are warranted.