Editorial Policies ; Family Practice ; methods ; Humans ; Periodicals as Topic ; Singapore

OBJECTIVETo evaluate the necessity, scientificity, and feasibility of the drafted Practice Guidelines on Prevention and Treatment of Hypertension for Primary Care Physicians.

METHODSDerivative Dolphe Method was used to collect the responses from 50 experts in hypertension or related fields within the nation. An evaluation score of 1 to 5 was given to each item for selection, 1 for highly disagreed and 5 for highly agreed. The mean, standard deviation (SD) and coefficient of variance (CV) of the scores were calculated.

RESULTS(1) 90% experts responded to the evaluation sheet. (2) The mean score were above 4 for the five out of the six items related to necessity, the SD varied from 0.51 to 1.05, and the CV from 0.11 to 0.30. (3) Among the 28 items related to scientificity and rationality, the mean score was above 4 for 25 items and was between 3.5 and 4 for other three items. The CV was generally lower than 0.35. (4) Among the seven items related to feasibility, the mean score for five of them was lower than 4, and the CV varied from 0.21 to 0.33.

CONCLUSIONThe results indicate that the necessity and scientificity of the most content of the guidelines are confirmed by the invited experts.

Clinical Competence ; standards ; Humans ; Hypertension ; therapy ; Peer Review ; methods ; standards ; Physicians, Family ; Practice Guidelines as Topic ; standards ; Practice Patterns, Physicians' ; standards ; Reproducibility of Results ; Surveys and Questionnaires

The prevalence of postnatal depression (PND) was reported to be 6.8% in an obstetric setting in Singapore. Since primary care physicians are the healthcare clinicians most likely to interact with postnatal mothers in Singapore, they are in the best position to screen for PND and help new mothers. PND affects the well-being of the mother, her baby and those around her. If left untreated, depression can result in lasting adverse outcomes such as unfavourable parenting practices, impaired mother-infant bonding, impaired intellectual and emotional development of the infant, maternal suicide, and even infanticide. The Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire-2 are effective screening tools that can be easily used in primary care settings for screening at-risk mothers. Herein, we discuss the management options available in primary care settings, as well as share some local resources available to mothers and the benefits of timely intervention.
Depression, Postpartum ; diagnosis ; epidemiology ; psychology ; Family Practice ; Female ; Global Health ; Humans ; Incidence ; Mothers ; psychology ; Physician's Role ; Prevalence ; Psychometrics ; methods

This study was conducted to analyze the strengths and weaknesses of a 3-week family medicine clerkship program based on the results of an online survey taken by the students (N=127) and a structured interview with a focus group (n=10), aimed to improve the quality of the clerkship program. The online survey contained questions pertaining to goals, schedule, contents, arrangement, atmosphere, environment, evaluation, and satisfaction regarding the clerkship. The focus group interview addressed the schedule and achievements of the program. Scores were reported on a 5-point Likert scale. Most students were highly satisfied with the overall quality of the clerkship. The structured interview results showed that 97.6% of the clerkship program was executed according to the schedule. The focus group reported a perfect score of 5 points on several measures including: accomplishment of the educational goals of the family medicine clerkship, providing many chances to obtain medical histories and perform physical examinations on real patients, experience with various symptoms and diseases, positive attitudes of faculty members when teaching, notification of the guidelines for evaluation beforehand, well-constructed and effective clerkship schedule, and reflection of student feedback. However, the focus group gave low scores on: support for health accidents of students, access to patient information, enough opportunities to practice clinical skills, appropriate rest facilities for students, and fairness of clerkship evaluation process. In conclusion, the structured evaluation performed after the 3-week clerkship program motivated students and helped them ensure an efficient clerkship. This structured evaluation also suggested basic data to make the professor who is subject of the assessment. This study shows that structured assessment is an effective method which can be used to improve the quality of clerkships.
Appointments and Schedules ; Atmosphere ; Clinical Clerkship ; Clinical Competence ; Family Practice ; Focus Groups ; Humans ; Methods ; Physical Examination ; Self-Evaluation Programs ; Surveys and Questionnaires

Diabetes mellitus is common in our increasingly affluent and ageing population. Although it is an old friend of practising family physicians, there is a need to be familiar with and up to date about the disease. As patients become more informed and receptive to current medical information, family physicians also need to stay current. This article highlights the evidences that have shaped our current treatment targets for type 2 diabetes mellitus.
Diabetes Mellitus, Type 1 ; blood ; therapy ; Diabetes Mellitus, Type 2 ; blood ; therapy ; Family Practice ; methods ; Glycated Hemoglobin A ; metabolism ; Humans ; Physicians, Family

This review provides an update of education and training in family medicine in Singapore and worldwide. Family medicine has progressed much since 1969 when it was recognised as the 20th medical discipline in the United States. Three salient changes in the local healthcare landscape have been noted over time, which are of defining relevance to family medicine in Singapore, namely the rise of noncommunicable chronic diseases, the care needs of an expanding elderly population, and the care of a larger projected population in 2030. The change in the vision of family medicine into the future refers to a new paradigm of one discipline in many settings, and not limited to the community. Family medicine needs to provide a patient-centred medical home, and the discipline's education and training need to be realigned. The near-term training objectives are to address the service, training and research needs of a changing and challenging healthcare landscape.
Aged ; Family Practice ; education ; methods ; organization & administration ; Geriatrics ; methods ; Health Services Needs and Demand ; Humans ; Patient-Centered Care ; Program Development ; Singapore ; Societies, Medical

Singapore is facing an increasing noncommunicable disease burden due to its ageing population. Singapore's primary healthcare services, provided by both polyclinic physicians and private general practitioners, are available to the public at differential fees for service. The resultant disproportionate patient loads lead to dissatisfaction for both healthcare providers and consumers. This article describes the 'PAIR UP' approach as a potential endeavour to facilitate primary care physicians (PCPs) in public and private sectors to collaborate to deliver enhanced primary care in Singapore. PAIR UP is an acronym referring to Policy, Academic development, Integration of healthcare information system, Research in primary care, Utility and safety evaluation, and Practice transformation. The current healthcare landscape is favourable to test out this multipronged approach. PCPs in both sectors can ride on it and work together synergistically to provide quality primary care in Singapore.
Aged ; Aging ; Family Practice ; methods ; Geriatrics ; methods ; organization & administration ; Health Policy ; Humans ; Medical Informatics ; Physicians ; Primary Health Care ; organization & administration ; Singapore ; Treatment Outcome

This study aimed to evaluate current clinical assessments and management of obesity in the primary care setting in Korea since anti-obesity agents have become available. A questionnaire was sent to eligible primary care physicians selected from a national probability sample in two specialties: family physicians and internists. Of 939 randomly selected physicians, 452 (48.1%) replied. We found that 51.8% of physicians were aware of the definition of obesity, and 33.8% were aware of the definition of abdominal obesity proposed by Asia-Pacific guideline. When evaluating apparently obese patients, 50.0% of respondents measured body mass index (BMI) and 20.4% measured waist circumference. Fewer than 50% of physicians measured blood glucose or lipid profiles, both of which are risk factors for obesity. About 47.3% of physicians prescribed an anti-obesity medication without allowing sufficient time for nonpharmacologic therapy to take effect, and 68.8% of physicians prescribed anti-obesity medications to patients that requested them regardless of obesity status. The majority of respondents did not appropriately evaluate obesity and its risk factors, and were readily susceptible to prescribing anti-obesity medications. Our findings suggest that primary care physicians in Korea need additional education on obesity and its management.
Adult ; Age Factors ; Anti-Obesity Agents/*pharmacology ; Blood Glucose/metabolism ; Body Mass Index ; Family Practice/*methods ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Korea ; Lipids/metabolism ; Male ; Middle Aged ; Obesity/metabolism/*therapy ; Physician's Practice Patterns ; Physicians, Family ; Questionnaires ; Risk Factors ; Weight Loss

INTRODUCTIONMedical talks, newsletter circulars, scientific meetings and conferences, and interaction with members of the pharmaceutical industry, have become convenient means of carrying out continuing medical education (CME) for many busy doctors.

MATERIALS AND METHODSTo study the perceived importance of these various CME activities, a self-completed posted questionnaire survey was conducted among registered practitioners of a densely populated urban state in Malaysia.

RESULTSOf the 172 respondents [male, 77%; hospital-based, 37%; general practitioner (GP), 55%; private practice, 70%; respondent rate of 19.5%], most preferred local conferences and endorsements by local experts to their foreign counterparts. Meetings or conferences sponsored by the pharmaceutical industry were ranked similarly with those without such links, while the reputation of the pharmaceutical firms was of foremost importance. Among GPs (n = 95) and non-GPs (n = 77), medical society newsletters were rated significantly higher by GPs while overseas conferences were rated higher by non-GPs.

CONCLUSIONOur findings provide an important first look at this under-explored area among Malaysian doctors and described a high degree of acceptance for the involvement of the pharmaceutical industry in CME activities.

Adult ; Attitude of Health Personnel ; Congresses as Topic ; utilization ; Education, Medical, Continuing ; methods ; Evidence-Based Medicine ; education ; Family Practice ; education ; standards ; Female ; Health Care Surveys ; Humans ; Malaysia ; Male ; Middle Aged ; Periodicals as Topic ; utilization ; Societies, Medical ; Surveys and Questionnaires

Symptom control is the essence of palliative care but is not without problems, especially in the difficult socio-economic conditions of a developing country. We present our experience with over 2000 hospice admissions over six years in India's first hospice, to highlight our problems and the measures we have taken to solve them. The prevalent habit of tobacco smoking and chewing in India gives rise to a high incidence of head and neck cancers which form 50% of our admissions. Another 24% is formed by breast and gynaecological cancers. The difficult symptoms in head and neck cancers are pain, dysphagia, fungation and trismus. Almost 25% of our head and neck cancers have feeding tubes, which we feel are justified and most useful for medication and basic nutrition. Difficult problems in gynaecological cancers are pain, chronic blood loss, ulcerations and fistulae. The inadequate or sporadic availability of oral and injectable morphine adds to our problems in pain control. Non-compliance of patients to take adequate medications and the resistance from relatives make it sometimes difficult to achieve optimum symptom control. India has many systems of alternate and unorthodox medicine. We find that these are best tried outside the hospice unless they are in fully-studied clinical trials. In the end there is always the difficult choice of either remaining in the hospice for optimal symptom control or going back to their homes, where this may not be available.
Breast Neoplasms ; physiopathology ; therapy ; Choice Behavior ; Complementary Therapies ; Family ; psychology ; Female ; Genital Neoplasms, Female ; physiopathology ; therapy ; Head and Neck Neoplasms ; physiopathology ; therapy ; Hospice Care ; methods ; Humans ; India ; Male ; Patient Acceptance of Health Care ; Pharmaceutical Preparations ; supply & distribution ; Practice Patterns, Physicians' ; Socioeconomic Factors ; Treatment Refusal