Abstract
Introduction:Asthma patients are managed in private general practitioner clinics or government subsidized polyclinics under a fee for service, walk-in primary healthcare system in Singapore.Aim:To show the improved management of asthma patients in a typical polyclinic after adopting strategies of the Chronic Care Model (CCM) by Wagner EH.Method:The polyclinic at Pasir Ris manages approximately 300–500 asthma patients every month. Based on CCM, the polyclinic re-designs the delivery system (introducing appointment system, second tiered asthma clinic), enhances self-management (introduce patients’ use of symptom calendar and written asthma action plans) & decision support (chart for doctors to classify asthma severity and selection of inhaled asthma medication) and utilizes clinical information system (capturing data of asthma attendance and inhaled medications dispensed monthly) to form prepared proactive asthma team interacting with informed activated patients. The polyclinic assists the establishment of asthma support group to promote self-care and as a reach-out strategy in the community. Asthma collaborative is set up to diffuse effective measures to other polyclinics in the organization.Results:The prescribing pattern of the polyclinic doctors, as reflected in the preventer (inhaled steroid): reliever medication (inhaled bronchodilator) or PR ratio, which increased from 1.23 to 2.81. The cumulative number of written asthma action plan prescribed rose from 3 in Sept 2004 to >500 in Dec 2005. The nebulised bronchodilator rate, as a proxy indicator of acute asthma exacerbation rate, declined from 25% to 15%. Patients using inhaled steroid who are well-controlled in their asthma status increased from 50% in Feb 05 to 75% in Oct 05.Conclusion:Care of asthma patients can be improved using evidence-based measures and restructured system delivery based on CCM. Conflict of interest and funding No conflict of interest. No funding received.
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