INTRODUCTIONType 2 diabetes mellitus is of increasing healthcare concern worldwide, with incidence rising, complications leading to significant morbidity and mortality, posing strain on public healthcare funding. Health-related quality of life of diabetic patients is increasingly being recognised as "the ultimate goal of all health interventions". The aim of our study was to identify the quality of life predictors of diabetic patients in primary care. This study was conducted in 8 public primary care polyclinics from SingHealth Polyclinics.

MATERIALS AND METHODSWe carried out a cross-sectional, questionnaire-based survey on 699 diabetic patients, administered by medical students on a systematic sample of patients during their routine visit. Multiple regression analysis was used to investigate the socio-demographic and clinical characteristics as predictors of quality of life, measured by the Short Form 36 Health Survey (SF-36) and the EQ-5D self-report questionnaire.

RESULTSHigher quality of life in diabetic patients is associated with younger age, male gender, employed status, higher educational level and exercise. Lower quality of life is associated with comorbidities and diabetic complications. Short-term glycaemic control as measured by HbA1c did not correlate with quality of life. Most interestingly, confidence in doctor and satisfaction in clinic were related to better quality of life.

CONCLUSIONHealth-related quality of life is adversely associated with symptomatic complications of diabetes mellitus, but not with short-term diabetic control. This suggests that the diabetic patient may not appreciate the impact of good diabetic control immediately on his or her health-related quality of life. More effort should be invested into patient education of the importance of glycaemic control to prevent these long-term complications.

Analysis of Variance ; Body Mass Index ; Cross-Sectional Studies ; Diabetes Complications ; prevention & control ; psychology ; Diabetes Mellitus, Type 2 ; prevention & control ; psychology ; Female ; Glycated Hemoglobin A ; analysis ; Health Status ; Health Surveys ; Humans ; Linear Models ; Male ; Middle Aged ; Primary Health Care ; Psychometrics ; Quality of Life ; Singapore ; Surveys and Questionnaires ; Time Factors

Postgraduate Family Medicine (FM) training is important to train future primary care doctors to provide accessible and cost effective healthcare. In Singapore, a structured postgraduate FM training programme has been available for 20 years. This programme is characterised by involvement of both FM and non-FM doctors, well written modules and a rigorous assessment process. However, challenges faced by both the current healthcare system and training structure underlie the need to review the training structure to ensure its relevancy for future Family Physicians (FPs) to manage the needs of their patients. A workgroup was formed to review the current FM postgraduate programme and to explore the possibility of using the Accreditation Council for Graduate Medical Education (ACGME) framework to enhance our current system. The workgroup felt that broad-based training and comprehensive coverage of topics are areas that are important to retain in any new FM residency programme. Weaknesses identified included a lack of early FM exposure and the need to strengthen formative assessments. New organisational structures such as Family Medicine Centres (FMC) need to be established and the involvement of the private sector in any FM residency progammes could be enhanced. The implementation of the FM Residency Programme in 2011 presented a unique opportunity to realign FM postgraduate education in line with the national objectives and to equip FPs with the necessary knowledge and skills for managing the future healthcare needs of Singaporeans.
Clinical Competence ; standards ; Curriculum ; standards ; Education, Medical, Graduate ; organization & administration ; standards ; Family Practice ; education ; Humans ; Internship and Residency ; organization & administration ; Program Development ; Singapore

OBJECTIVEThis study aimed to determine the prevalence of short message system (SMS) and internet usage in patients visiting the SingHealth Polyclinics and to measure patients' acceptance of using these technologies in healthcare delivery.

MATERIALS AND METHODSA representative sample of patients visiting the 9 SingHealth Polyclinics were interviewed in-person by trained medical students. Collected information included demographic characteristics, access to and usage of mobile phone/SMS and internet, as well as acceptance and concerns on using these technologies in primary healthcare delivery.

RESULTSAmong 705 patients surveyed (mean age: 54.6 years, female: 50.6%, response rate: 92%), 407 (57.7%) were SMS users and 158 (22.4%) were internet users. Two hundred and eighty-four of 412 SMS and/or internet users (40.3% of the entire sample) were comfortable with the use of these technologies in healthcare delivery. Malay or Indian ethnicity, better education, and visiting the clinic for acute symptoms or screening were factors positively associated with willingness to use such technologies. The main concerns associated with the use of SMS and internet in healthcare delivery were preference for in-person consultation with a doctor (23.5%), reduced patient-doctor interaction (23.0%), and increased healthcare cost (20.8%).

CONCLUSIONThe present prevalence of SMS and internet usage among patients visiting the SingHealth Polyclinics and their concerns towards use of these technologies in healthcare delivery do not support current widespread implementation of services entailing SMS and internet in the study sites.

Adult ; Aged ; Attitude to Computers ; Communication ; Cross-Sectional Studies ; Delivery of Health Care ; Female ; Humans ; Internet ; utilization ; Interviews as Topic ; Male ; Middle Aged ; Patients ; Physician-Patient Relations ; Singapore ; Surveys and Questionnaires

INTRODUCTIONIt is uncommon for medical students to deliver public health talks as part of their medical education curriculum. This study evaluated the effectiveness of a novel training programme that required medical students to deliver public health talks during their family medicine (FM) clerkship in a Singapore primary care institution.

METHODSThe FM faculty staff guided teams of third-year medical students to select appropriate topics for health talks that were to be conducted at designated polyclinics. The talks were video-recorded and appraised for clarity, content and delivery. The appraisal was done by the student's peers and assigned faculty staff. The audience was surveyed to determine their satisfaction level and understanding of the talks. The students also self-rated the effectiveness of this new teaching activity.

RESULTSA total of 120 medical students completed a questionnaire to rate the effectiveness of the new teaching activity. 85.8% of the students felt confident about the delivery of their talks, 95.8% reported having learnt how to deliver talks and 92.5% perceived this new training modality as useful in their medical education. Based on the results of the audience survey, the speakers were perceived as knowledgeable (53.1%), confident (51.3%) and professional (39.0%). Assessment of 15 video-recorded talks showed satisfactory delivery of the talks by the students.

CONCLUSIONThe majority of the students reported a favourable overall learning experience under this new training programme. This finding is supported by the positive feedback garnered from the audience, peers of the medical students and the faculty staff.

Adult ; Curriculum ; Education, Medical, Undergraduate ; Family Practice ; education ; Female ; Humans ; Male ; Program Evaluation ; Public Health ; education ; Singapore ; Students, Medical ; Teaching ; education ; Video Recording