Aged ; Attitude of Health Personnel ; Career Choice ; Geriatrics ; Humans ; Medicine ; Singapore ; Specialization ; Students, Medical

INTRODUCTIONThe medical community in Singapore is faced with a rapidly ageing demographic. This would result in an increase in the interaction between medical professionals and older adults. In anticipation of an increased exposure to elderly patients, we sought to determine the attitudes of our house officers (HO), medical officers (MO) and Registrars towards the elderly.

MATERIALS AND METHODSA descriptive pilot study of junior doctors from the Division of Medicine carried out during a luncheon in the largest tertiary-care public hospital in Singapore. A validated self-administered structured questionnaire using Kogan's Old People (KOP) Scale was used to evaluate attitudes towards older adults and basic demographics and medical educational data were collected.

RESULTSFifty-one questionnaires were completed. The mean KOP score was 114.4, suggesting an overall positive attitude towards older people in this sample. The prevalence of negative attitude was 7.8%. There was no significant difference in attitudes among doctors with different designation, age, marital status, medical school attended, nationality, years in medical practice and living arrangement. Doctors who had previous exposure with a posting in Geriatric Medicine had higher KOP scores but were just out of significance (P = 0.098). Respondents who found treating older people unrewarding had significantly lower KOP score (P <0.001).

CONCLUSIONIn this sample of junior doctors, overall attitudes towards older people as measured by the KOP scale were moderately positive. Exposure to a Geriatric Medicine posting during residency may positively influence a doctor's attitudes towards the older adults.

Adult ; Age Factors ; Aged ; Attitude of Health Personnel ; Female ; Hospitals, Public ; ethics ; Humans ; Male ; Physician-Patient Relations ; ethics ; Singapore ; Surveys and Questionnaires ; Young Adult

INTRODUCTION: The Patient-Centred Medical Home (PCMH) demonstration in Singapore, launched in November 2016, aimed to deliver integrated and patient-centred care for patients with biopsychosocial needs. Implementation was based on principles of comprehensiveness, coordinated care and shared decision-making. METHOD: We conducted a prospective single-arm pre-post study design, which aimed to perform cost analysis of PCMH from the perspectives of patients, healthcare providers and society. We assessed short-to-intermediate-term health-related costs by analysing data on resource use and unit costs of resources. RESULTS: We analysed 165 participants enrolled in PCMH from November 2017 to April 2020, with mean age of 77 years. Compared to the 3-month period before enrolment, mean total direct and indirect participant costs and total health system costs increased, but these were not statistically significant. There was a significant decrease in mean cost for primary care (government primary care and private general practice) in the first 3-month and second 3-month periods after enrolment, accompanied by a significant decrease in service utilisation and mean costs for PCMH services in the second 3-month period post-enrolment. This suggested a shift in resource costs from primary care to community-based care provided by PCMH, which had added benefits of both clinic-based primary care and home-based care management. Findings were consistent with a lower longer-term cost trajectory for PCMH after the initial onboarding period. Indirect caregiving costs remained stable. CONCLUSION The PCMH care model was associated with reduced costs to the health system and patients for usual primary care, and did not significantly change societal costs.
Aged ; Health Care Costs ; Humans ; Independent Living ; Patient-Centered Care ; Prospective Studies ; Singapore

Biomedical Research ; Frailty ; Geriatrics ; Health Policy ; Health Services ; Humans ; Practice Guidelines as Topic ; Singapore