Primary Care Setting In Singapore Research Articles

Health literacy and self-care among patients with chronic kidney disease in a primary care setting.

The study objective was to determine the levels of self-care and health literacy (HL) and their associations among patients with chronic kidney disease (CKD). This was a cross-sectional, questionnaire-based study conducted in a public primary care setting in Singapore. A total of 289 participants aged 21-80 years with hypertension were recruited. Self-care profiles were measured using the Hypertension Self-Care Profile (HTN-SCP; range 0-240, domain range 0-80). Health literacy was measured using the Short-Form Health Literacy Scale (HLS-SF12; range 0-50, limited literacy ≤33). The mean self-care score was 182.7 (standard deviation [SD] 23.2). The median HL score was 34.7 (interquartile range [IQR] 31.9-40.3), and 31.1% of participants had limited HL. Self-care was not associated with age, CKD status, household income and education, but was associated with gender and HL score. In the final regression model, lower HL scores (adjusted β = 1.03, 95% confidence interval [CI] 0.7 to 1.36, P < 0.001) and male gender (adjusted β = -5.29, 95% CI -10.56 to -0.03, P = 0.049) were associated with lower self-care scores. The HL scores were associated with self-care domains of self-efficacy (HL: β = 0.30, 95% CI 0.17 to 0.42, P < 0.001), motivation (HL: β = 0.40, 95% CI 0.26 to 0.53, P < 0.001) and behaviour (HL: β = 0.38, 95% CI 0.26 to 0.50, P < 0.001). Thirty-one percent of the participants had limited HL. Self-care was not associated with age, race, CKD status, household income or education. Male gender and limited HL were associated with lower self-care. Self-care was associated with self-efficacy, motivation and behaviour. Future research could focus on more targeted approaches to improve self-care and HL among patients with CKD.

Cross-sectional study assessing health outcome priorities of older adults with multimorbidity at a primary care setting in Singapore

ObjectivesManaging older adults with multimorbidity may be challenging due to the conflicting benefits and harms of multiple treatments. Thus, it is important to identify patients’ health outcome priorities to align...

Medical, legal and ethical issues arising from the use of telemedicine in the primary care setting in Singapore.

Medical, legal and ethical issues arising from the use of telemedicine in the primary care setting in Singapore.

Increasing the completion rate of the advance directives in primary care setting \u2013 a randomized controlled trial

BackgroundThe completion rate of Advance Directives (ADs) has been low. This study aims to examine the effectiveness of two interventions 1) active counseling sessions coupled with passive patient education pamphlets, and 2) patient education pamphlets alone, compared with 3) control group (usual care), in increasing the completion rates of ADs in the primary care setting.MethodsMulticenter randomised controlled trial in four public primary care clinics in Singapore under Singapore Health Services. Randomization was performed via block randomization with Sequential Numbered Opaque Sealed Envelopes. Participants were randomized into 1) active intervention group (both counseling by primary care physicians and patient education pamphlets) or 2) passive intervention group (only patient education pamphlets), and 3) control group (usual care) with follow-up at 6 weeks. The main outcome measure is the proportion of participants who completed / planned to complete) ADs six weeks post-intervention.ResultsFour hundred five participants were eligible to participate in the study. One hundred eighty-eight participants were recruited into the study (response rate = 46.4%), of which 158 completed the study. There was no significant difference between the control group, passive intervention group, and active intervention group, in terms of completion rates of ADs (29.4, 36.4, and 30.8% respectively).ConclusionsThis randomized controlled trial did not support the use of patient education pamphlets with or without active counseling sessions in increasing the completion of ADs in a primary care setting in Singapore. The optimal intervention strategy depends on each health system’s context and resources, taking into consideration patients’ profiles, which deserves further studies.Trial registrationRegistered on April 17, 2018 clinicaltrials.gov (NCT03499847).

A retrospective cohort study examining secondary prevention post stroke in primary care in an Asian setting

BackgroundStroke is one of the top contributors to burden of disability-adjusted life-years worldwide. Family physicians have key role in optimising secondary prevention following stroke by managing clinical risk factors and promoting overall control in accordance with clinical practice guidelines.MethodsOur objectives were: (i) to examine level of overall risk factor control together with control of singular risk factors one-year after an index-stroke event in individuals attending primary care facility and (ii) to describe factors associated with satisfactory risk factors control in individuals following stroke.Study Design: Retrospective cohort study.We conducted a study looking retrospectively at records from our electronic chronic disease database. Our study included individuals following stroke who visited primary care setting in Singapore between January 2012 to December 2016.ResultsThere were 24,240 individuals in our study. Overall control was better in individuals without diabetes following stroke (49.2%) as compared to those with diabetes (28.1%).Among individuals without diabetes following stroke, factors significantly associated with overall control were sex (male) [OR (reference: female): 1.23, 95% CI: 1.10, 1.39], ethnicity (Malay) [OR (reference: Chinese): 0.72, 95% CI: 0.58, 0.90], BMI (high risk) [OR (reference: low risk): 0.72, 95% CI: 0.62, 0.84) and atrial fibrillation [OR: 1.47, 95% CI: 1.21, 1.78].Among individuals with diabetes following stroke, factors significantly associated with overall control were sex (male) [OR (reference: female): 1.28, 95% CI: 1.12, 1.46], ethnicity (Malay) [OR (reference: Chinese): 0.81, 95% CI: 0.65, 0.99], ethnicity (Indian) [OR (reference: Chinese): 0.70, 95% CI: 0.55, 0.88], BMI (high risk) [OR (reference: low risk): 0.71, 95% CI: 0.59, 0.84), BMI (moderate risk) [OR (reference: low risk): 0.84, 95% CI: 0.72, 0.98), atrial fibrillation [OR: 1.24; 95% CI: 1.02, 1.51], chronic kidney disease [OR: 0.63, 95% CI: 0.54, 0.72] and smoking status [OR: 0.68, 95% CI: 0.54, 0.88].ConclusionWe reported sub-optimal level of overall control. Among individuals following stroke, those with diabetes had higher proportion of sub-optimal control as compared to those without diabetes. Irrespective of diabetic status, being female, having high BMI, and of Malay ethnicity as compared to Chinese ethnicity were associated with poorer overall risk factor control.

Collaborative care for primary care treatment of late-life depression in Singapore: Randomized controlled trial.

The effectiveness and portability of the collaborative care model in the primary care treatment of depression has not been demonstrated in many randomized controlled trials in healthcare settings across the world. We determined the effectiveness of collaborative care management of elderly depression in the primary care setting in Singapore. Eligible participants with depressive symptoms were randomized to 6-month duration usual care (UC, N = 112) or collaborative care (CC, N = 102). Outcome measures were HDRS-17, GDS, BDI and SF-12 MCS QOL measured at 3, 6, and 12-month, care satisfaction at 6-month, and also measured on 120 participants who refused referral (non-receipt of care, NC). Primary outcome was HDRS-17 measure of depression severity, response and remission at 6-month. HDRS scores in CC group compared to UC group were reduced more at 6-month (1.5 points difference in change from baseline), and also at 3 and 12-month, with similar observations of differences for GDS and BDI. There was significantly greater improvement for both CC and UC groups compared to NC group. The CC group was about 1.5 times more likely to show HDRS treatment response and remission, and more than two times likely to show GDS treatment response and remission than the UC and NC groups, as well as better quality of life improvement (P < .001) and better care satisfaction (P < .001). Collaborative care is effective for primary care treatment of older persons with depression and is portable in diverse health care settings.

Difficulties faced by patients with chronic diseases in the primary care setting in Singapore: a cross-sectional study.

Patients with chronic diseases face difficulties when navigating the healthcare system. Using the Healthcare System Hassles Questionnaire (HSHQ) developed by Parchman et al, this study aimed to explore the degree of hassles faced by patients in primary care in Singapore and identify the characteristics associated with greater hassles. A cross-sectional study was conducted on patients with chronic diseases at Hougang Polyclinic, Singapore, using the interviewer-administered HSHQ. The mean HSHQ score was compared with that reported by Parchman et al. The associations between the number of chronic diseases, demographic variables and healthcare hassles were assessed using multivariate linear logistic regression analysis. In total, 217 outpatients aged 21 years and above were enrolled. Their overall mean HSHQ score (4.77 ± 6.18) was significantly lower than that of patients in the study by Parchman et al (15.94 ± 14.23, p < 0.001). Patients with five or more chronic diseases scored 3.38 (95% confidence interval [CI] 0.11-6.65, p = 0.043) points higher than those with one chronic disease did. With each increasing year of age, the mean HSHQ score decreased by 0.17 (95% CI -0.26 to -0.08, p = 0.001) points. Patients with polytechnic/diploma/university education and higher scored 2.65 (95% CI 0.19-5.11, p = 0.035) points higher than those with primary education and lower did. Patients in our population reported less hassles than those in the study by Parchman et al did. Increasing age and lower education level were associated with less hassles. Further analysis of the types of chronic diseases may yield new information about the association of healthcare hassles with the number and types of chronic diseases.

Struggling for normality: experiences of patients with diabetic lower extremity amputations and post-amputation wounds in primary care.

To explore the experiences of patients living with diabetic lower extremity amputation (DLEA) and its post-amputation wound in primary care. DLEA, including both minor and major amputation, is a life-altering condition that brings numerous challenges to an individual's life. Post-amputation physical wound healing is complicated and challenging because of wound dehiscence and prolonged healing times. Understanding patients' experiences after DLEA with a post-amputation wound will enable healthcare professionals to develop interventions to assist patients in physical healing and psychosocial recovery. This study employs a qualitative design using interpretative phenomenological analysis (IPA). A purposive maximum variation sample of nine patients who had had lower extremity amputations and post-amputation wound attributed to diabetes in the previous 12 months was recruited from a primary care setting in Singapore. Semi-structured audio recorded one-to-one interviews with a duration of 45-60 min each were conducted between September 2018 and January 2019. The interviews were transcribed verbatim and analysed using IPA. The essential meaning of the phenomenon 'the lived experiences for patients with DLEA and post-amputated wound' can be interpreted as 'struggling for "normality"' which encompasses four domains of sense making: physical loss disrupted normality, emotional impact aggravated the disrupted normality, social challenges further provoked the disrupted normality, and attempt to regain normality. The study highlights the complex physical and psychosocial transition facing patients after DLEA before post-amputation wound closure. In primary care, an amputation, whether minor or major, is a life-altering experience that requires physical healing, emotional recovery, and social adaptation to regain normality. Patients living with DLEA and a post-amputation wound may benefit from an interdisciplinary team care model to assist them with physical and psychosocial adjustment and resume normality.

Mapping the Dynamic Complexity of Chronic Disease Care in Singapore: Using Group Model Building in Knowledge Elicitation

This study describes a group model building exercise that aims to develop a deeper understanding of the dynamic complexity of chronic disease care delivery within a primary care setting in Singapore, leveraging on the insights of stakeholders with personal and institutional knowledge of the health care system. A group model building exercise, which included 50 stakeholders, was used to develop the qualitative model. The qualitative model helped to bring a feedback perspective to understanding the dynamic complexity of chronic disease care delivery. The feedback perspective helped in identifying the systemic issues within chronic disease care delivery, which has the potential to inform system‐wide interventions and policies to improve health. Enhancing chronic care in Singapore will require an enhancement of both the capacity and capability of the primary care sector. © 2018 John Wiley &amp; Sons, Ltd.

Results from a Patient-Based Health Education Intervention in Reducing Antibiotic Use for Acute Upper Respiratory Tract Infections in the Private Sector Primary Care Setting in Singapore.

ABSTRACTWe investigated the efficacy of patient-targeted education in reducing antibiotic prescriptions for upper respiratory tract infections (URTIs) among adults in the private primary care setting in Singapore. Our randomized controlled trial enrolled patients aged 21 years and above presenting at general practitioner (GP) clinics with URTI symptoms for 7 days or less. Intervention arm patients were verbally educated via pamphlets about the etiology of URTIs, the role of antibiotics in treating URTIs, and the consequences of inappropriate antibiotic use. Control arm patients were educated on influenza vaccinations. Both arms were compared regarding the proportions prescribed antibiotics and the patients' postconsultation views. A total of 914 patients consulting 35 doctors from 24 clinics completed the study (457 in each arm). The demographics of patients in both arms were similar, and 19.1% were prescribed an antibiotic, but this varied from 0% to 70% for individual GPs. The intervention did not significantly reduce antibiotic prescriptions (odds ratio [OR], 1.20; 95% confidence interval [CI], 0.83–1.73) except in patients of Indian ethnicity (OR, 0.28; 95% CI, 0.09–0.93). Positive associations between the intervention and the view that antibiotics were not needed most of the time for URTIs (P = 0.047) and on being worried about the side effects of antibiotics (P = 0.018) were restricted to the Indian subgroup. GPs in limited liability partnerships or clinic chains prescribed less (OR, 0.36; 95% CI, 0.14 to 0.92), while certain inappropriate patient responses were associated with the receipt of antibiotics. Follow-up studies to investigate differences in responses to educational programs between ethnicities and to explore GP-targeted interventions are recommended.

Uropathogens and antimicrobial susceptibility patterns in urinary tract infections diagnosed in the primary care setting in Singapore

Uropathogens and antimicrobial susceptibility patterns in urinary tract infections diagnosed in the primary care setting in Singapore

Evaluating performance of natural language processing for detection of symptoms presence and duration within primary care setting in Singapore

Evaluating performance of natural language processing for detection of symptoms presence and duration within primary care setting in Singapore

The prevalence of albuminuria among diabetic patients in a primary care setting in Singapore.

Microalbuminuria is an early sign of kidney damage. The prevalence of microalbuminuria in Singapore has been reported to be 36.0%-48.5%. However, the prevalence of microalbuminuria reported in these studies was determined with one urine sample using a qualitative urine test. The aim of this study was to determine the prevalence of micro- and macroalbuminuria using a more stringent criterion of two positive quantitative urine albumin-creatinine ratio (ACR) tests. We conducted a cross-sectional study of patients with type 2 diabetes mellitus (T2DM) who were followed up at a primary care clinic in Singapore. Patients were diagnosed to have albuminuria if they had two positive ACR tests within a seven-month period. A total of 786 patients with T2DM met the study's inclusion criteria. 55.7% were already on an angiotensin-converting enzyme inhibitor (ACEI) and/or angiotensin receptor blocker (ARB). The prevalence rates of micro- and macroalbuminuria were 14.2% and 5.7%, respectively. Patients with albuminuria were more likely to have hypertension (odds ratio [OR] 3.47, 95% confidence interval [CI] 1.55-7.80). Diabetics with poorer diabetic control (OR 1.88, 95% CI 1.26-2.79), and higher systolic (OR 1.69, 95% CI 1.14-2.49) and diastolic (OR 1.96, 95% CI, 1.20 to 3.22) blood pressures were more likely to have albuminuria. In the present study, the prevalence of microalbuminuria is significantly lower than that previously reported in Singapore. The presence of hypertension, poor diabetic control and suboptimal blood pressure control are possible risk factors for albuminuria in patients with T2DM.

Younger adult type 2 diabetic patients have poorer glycaemic control: a cross-sectional study in a primary care setting in Singapore.

BackgroundThe aim was to study the glycaemic control of type 2 diabetic patients, and to identify factors associated with unacceptable glycaemic control (defined as HbA1c >8.0%).MethodsAnalysis of data collected in a cross-sectional survey of type 2 diabetic patients in eight SingHealth Polyclinics in January 2009. HbA1c value was measured on the day of the survey, while information on patient and diabetic characteristics was obtained through a questionnaire. Odds ratio of having unacceptable glycaemic control was estimated for selected variables using multiple logistic regression models.ResultsA total of 688 patients were included in the analysis. The mean (± standard deviation) and median (range) HbA1c levels were 7.6% (± 1.35) and 7.3% (5.0% to 14.0%), respectively. 25.4% of the patients had an unacceptable HbA1c level of >8.0% and the odds of this were higher (p < 0.05) in patients with the following characteristics: younger age, longer diabetes duration, presence of insulin treatment, and poorer compliance to medication.ConclusionYounger adult patients were found to have poorer glycaemic control, and hence targeted educational and behaviour modification programmes would be required to effectively manage this group of patients.