Schizophrenia is a complex mental health disorder that has a huge burden on the individual’s physical health. Despite its low prevalence, the disorder has been listed among the top ten contributors of health burden and disability around the world. People with schizophrenia usually suffer from a myriad of physical health conditions with 33 percent of the patients having three or more physical health problems. Schizophrenia has been linked with up to threefold increased risk of cardiovascular mortality. Risk factors such as metabolic disorders and lifestyle behaviours are the major contributors to cardiovascular-related diseases (CVD). Treatment of schizophrenia and its comorbid physical conditions often presents a challenge to health care professionals and caregivers due to the presence of multiple psychological and physical disabilities. However, with appropriate intervention at early onset, the likelihood of recovery will be highest. Primary care professionals are often the stable point of consultation for patients to seek help in the community. The partnership between the patient and primary care professionals is paramount in optimal management and continuity of care for schizophrenia patients with chronic physical illness.

Schizophrenia is a complex mental health disorder that has a huge burden on the individual’s physical health. Despite its low prevalence, the disorder has been listed among the top ten contributors of health burden and disability around the world. People with schizophrenia usually suffer from a myriad of physical health conditions with 33 percent of the patients having three or more physical health problems. Schizophrenia has been linked with up to threefold increased risk of cardiovascular mortality. Risk factors such as metabolic disorders and lifestyle behaviours are the major contributors to cardiovascular-related diseases (CVD). Treatment of schizophrenia and its comorbid physical conditions often presents a challenge to health care professionals and caregivers due to the presence of multiple psychological and physical disabilities. However, with appropriate intervention at early onset, the likelihood of recovery will be highest. Primary care professionals are often the stable point of consultation for patients to seek help in the community. The partnership between the patient and primary care professionals is paramount in optimal management and continuity of care for schizophrenia patients with chronic physical illness.

This paper gives an overview of what the GP Partnership Programme (GPPP), an integrated care programme, has achieved over a span of ten years, since its implementation in 2003 by the Institute of Mental Health, a tertiary mental health institution in Singapore. The GPPP is a collaboration between the GPs and IMH, for the care and management of stable patients with mental illness in the community and primary care setting. Since 2003, more than 1300 patients have been referred through the GPPP to a team of 51 GP-Partners for continued care within the community.

INTRODUCTIONThe aim of our programme was to right site a selected group of patients to the care of the primary sector for follow-up management. Mental disorders are recognised as a major public health problem worldwide which places an enormous burden on health services. Patients on treatment in the hospitals are largely managed by specialists either in the restructured hospitals or in private practice with minimal involvement of general practitioners (GPs). Yet, there are many patients with chronic mental illnesses who are stable, require maintenance medications and are best managed in the community.

STRATEGIESGPs were given appropriate training and support to help them manage patients with mental illnesses in their clinics. The training involved in-depth, comprehensive training on mental illness, providing the GPs with the skills necessary to manage the stable patients within the community. It also facilitated Early Detection Intervention by enhancing the GPs capabilities to detect and manage the mentally ill. Patients screened by psychiatrists who fulfill the referral criteria agreed upon by both the specialist team and the GP partners were referred to the GPs with initial support from case managers when required. The benefits to patients include: increased convenience, savings in terms of transport costs and travel time, the flexibility of being seen during after office hours, less stigma and the option of managing their other medical conditions, if any, by the same doctor.

RESULTSTo date, a total of 200 patients have been successfully referred to the 30 GPs in the programme. This represents an average savings of more than 1000 consultation visits to the hospital per year.

CONCLUSIONThe programme allows for the right siting of care for patients and allows the hospital to channel precious resources to more appropriate uses.

Delivery of Health Care, Integrated ; Humans ; Mental Disorders ; therapy ; Mental Health Services ; Physician's Role ; Physicians, Family ; education ; Primary Health Care ; Singapore

The number of people living with dementia is increasing globally as a result of an ageing population. General practitioners (GPs), as the front-line care providers in communities, are important stakeholders in the system of care for people with dementia. This commentary describes a study conducted to understand GPs' attitudes and self-perceived competencies when dealing with patients with dementia and their caregivers in Singapore. A set of study information sheet and survey questionnaires were mailed to selected GP clinics in Singapore. The survey, comprising the "GP Attitudes and Competencies Towards Dementia" questionnaire, was administered. A total of 400 GPs returned the survey, giving the study a response rate of 52.3%. About 74% of the GPs (n=296) were seeing dementia patients in their clinics. Almost all the GPs strongly agreed that early recognition of dementia served the welfare of the patients (n=385; 96%) and their relatives (n=387; 97%). About half (51.5%) of the respondents strongly agreed or agreed that they felt confident carrying out an early diagnosis of dementia. Factor analysis of questionnaire revealed 4 factors representing "benefits of early diagnosis and treatment of patients with dementia", "confidence in dealing with patients and caregiver of dementia", "negative perceptions towards dementia care" and "training needs". GPs in Singapore held a generally positive attitude towards the need for early dementia diagnosis but were not equally confident or comfortable about making the diagnosis themselves and communicating with and managing patients with dementia in the primary care setting. Dementia education and training should therefore be a critical step in equipping GPs for dementia care in Singapore. Shared care teams could further help build up GPs' knowledge, confidence and comfort in managing patients with dementia.
Attitude of Health Personnel ; Caregivers ; psychology ; Clinical Competence ; Dementia ; diagnosis ; therapy ; General Practitioners ; psychology ; Humans ; Self Efficacy ; Singapore ; Surveys and Questionnaires