1.PATIENT AND PROVIDER PERSPECTIVES ON HYPERTENSION, DIABETES AND DYSLIPIDAEMIA SCREENING IN A LOW-INCOME SINGAPOREAN RENTAL-FLAT COMMUNITY
Liang En Wee ; Gerald Choon-Huat Koh
The Singapore Family Physician 2016;42(3):75-87
Aims:
Patient and provider barriers to cardiovascular disease
screening in disadvantaged Asian populations are
under-studied. We conducted a qualitative study of
attitudes to hypertension/diabetes/dyslipidaemia
screening within low-income communities in Singapore.
Methods:
Interviewers elicited barriers/enablers to blood
pressure measurement/fasting blood glucose/fasting
blood lipid amongst residents and healthcare providers
serving low-income communities. Transcripts were
analysed thematically and iterative analysis carried out
using established qualitative methodology.
Results:
Twenty patients and nine providers were interviewed.
Comments were grouped into seven content areas:
primary care characteristics (PCC), procedural issues,
knowledge, costs, priorities, attitudes, and information
sources. For hypertension screening, procedural issues
were enablers; however, for fasting blood tests,
procedural issues were perceived as both enablers and
barriers, including issues of pain, needle and blood
phobia, and lag between tests and results. Costs of
screening and treatment were cited as issues for
diabetes and cholesterol screening, but for
hypertension screening, concerns about cost of
treatment dominated. While blood pressure
measurement using sphygmomanometers and fasting
lipid tests were generally perceived as the accepted
screening tests for hypertension and hyperlipidaemia,
fasting glucose tests were not perceived as the accepted
screening test for diabetes. Barriers and enablers to
cardiovascular screening, as perceived by patients and
providers, were largely concordant.
Conclusion:
Procedural issues predominated in patients’ percept
ions of hypertension screening, while knowledge and
attitudes played a more significant role for diabetes
and dyslipidaemia. Interventions to raise screening
uptake in these disadvantaged communities must be
tailored to the main barriers for each modality.
2.House calls in Singapore – A Qualitative Study
Ling Ling Soh ; Gerald Choon-Huat Koh ; Rakhi Mittal
The Singapore Family Physician 2018;44(4):35-42
Background Historically, physicians routinely delivered medical care to sick patients in patients' homes. While house calls accounted for 40% of all doctor-patient encounters In the 1940s, the rate has since dwindled to less than 1%. Based on some studies done overseas, the reasons for the unpopularity of house calls were the lack of time and unsatisfactory remuneration. The aim of this study was to explore the attitudes of general practitioners (GPs) currently practicing in Singapore towards house calls. Design A qualitative study using phenomenological methodology was done by conducting one-to-one in-depth interviews with 12 GPs. Results All the GPs interviewed were aware of the benefits of house calls in the healthcare scene of Singapore. The commonest barrier was concern about the limitations perceived to be present during a house call and their possible medicolegal implications. GPs also struggled with charging appropriately for house calls and found them disruptive to their practices. Conclusion: The study shows that GPs recognize the value of making house calls but at the same time struggle with perceived limitations in the home setting as well as remuneration issues.
3.Singapore Gp Fee Survey 2013: A Comparison With Past
Andrew Epaphroditus Tay Swee Kwang ; Choo Kay Wee, Gerald Koh Choon Huat Koh
The Singapore Family Physician 2017;43(1):42-51
Introduction: The rising cost of healthcare in Singapore has resulted in calls for greater price transparency. With the GP (General Practitioner's) fees surveys done in 1996 and 2006, we undertook a similar survey in 2013 to investigate the change in GP fees and GP operating costs over the years.
Methods: The 2013 GP Fee Survey involved 992 GPs and solo clinic practitioners. Results from the 2013 GP Fee Survey were compared against the 1996 and 2006 GP Fees Surveys. Compound Annual Growth Rate (CAGR) was used to reflect the change in price data over the years and compared against the CAGR of the Consumer Price Index (CPI) and CPI-Health over the same periods.
Results: 113 participants (11.5%) responded. Between 1996 and 2013, the CAGR for CPI was 1.84% and CPI-Health was 2.97%. In comparison, the CAGR for the median patient fee was 3.12%; staff salary was 1.95%; property cost was 2.47%; and total monthly practice cost was 9.21%.
Conclusion: Between 1996 and 2013, the rise in the patient fee matched the rise in CPI-Health but the rise in practice cost outpaced CPI-Health by more than three-fold. However, the low response rate limits the generalizability of the data.
4.Predictors of Participation in Supervised Therapy by Post-Stroke Patients in the Singapore Community: a One Year Cohort Study
Gerald Choon-Huat Koh ; Denise Yan-Yin Lim ; Steven Liben Zhang ; Cynthia Chen Huijun ; Sanjiv Kishore Saxena ; Fong Ngan Phoon ; David Yong ; Tze-Pin Ng
The Singapore Family Physician 2015;41(1):63-74
Introduction: To determine the relationship between participation in supervised and unsupervised therapy, and predictors of participation in supervised therapy during the first post-stroke year.
Materials & Methods:
Design: Prospective longitudinal study with interviews at admission, discharge, one month, six months and one year after discharge.
Setting: Two subacute inpatient rehabilitation units and the community after discharge in Singapore.
Participants: 215 subacute non-aphasic stroke patients.
Intervention: Participation rate in supervised therapy (at outpatient rehabilitation centres) and unsupervised therapy (at home) defined as proportion of time spent performing therapy as prescribed by the subacute hospital’s multidisciplinary rehabilitation team at discharge.
Main Outcome Measure: Predictors of participation in supervised and unsupervised therapy.
Results: Patients who participated in supervised therapy (i.e. at an outpatient rehabilitation centre) >25% of the time recommended were more likely to participate in unsupervised therapy (i.e. at home) >75% of the time recommended at one, six and 12 months (crude odds ratio, OR = 4.41 [95%CI:2.09–10.17], 4.45 [95%CI:2.17–9.12], 6.93 [95%CI:2.60–18.48] respectively). Greater participation in supervised therapy at one and six months independently predicted greater participation in supervised therapy at six (adjusted OR=11.64 [95%CI:4.52-29.97]) and twelve months (adjusted OR=76.46 [95%CI:12.52-466.98]) respectively. Caregiver availability at six months independently predicted poorer participation in supervised therapy at 12 months.
Conclusion: Interventions to increase participation in supervised therapy in the first post-stroke year should focus on transition of care in the first month after discharge. Further studies are needed to understand why caregiver availability was associated with low participation in supervised therapy.
5.Medical and social domains of ageing research in Singapore (2008-2018): a scoping review.
Chen Hee TAM ; Elaine Qiao Ying HO ; Sumali Subhashini HEWAGE ; Shilpa TYAGI ; Gerald Choon Huat KOH
Singapore medical journal 2024;65(1):30-37
INTRODUCTION:
This scoping review examined the number, types and characteristics of journal publications on ageing in Singapore from 2008 to 2018 to determine how ageing research in medical and social domains in Singapore has transformed over time.
METHODS:
Using relevant search terms, articles were extracted from multiple databases and then screened and reviewed for eligibility and inclusion by independent reviewers. Data such as article title, authors, year of publication, name of journal, type of journal, study design and the kind of data used were charted from the included articles for evidence synthesis.
RESULTS:
Since 2008, there has been a steady increase in the number of publications on ageing in medical and social domains in Singapore. In the medical domain, publications on Ophthalmology (22%) made up the largest proportion of the existing medical literature on ageing in Singapore, followed by Physical Functioning (17%), which involved physiological measurements of physical well-being, and Geriatrics (16%). Non-medical publications comprised 38% of all the included publications, with publications on the social aspects of ageing (43%) forming the largest group in this cluster, followed by publications on Prevention (19%) and Healthcare services (18%). The study design was mostly observational (82%), with only 3% of interventional studies.
CONCLUSION
While ageing research had expanded in Singapore in the last decade, it was predominantly discipline specific and observational in design. As ageing issues are complex, with biology intersecting with psychology and sociology, we call for greater interdisciplinary collaboration, the conduct of more interventional studies, as well as more research in understudied and emerging areas.
Humans
;
Singapore
;
Aging
;
Geriatrics
;
Research Design
6.AN EVALUATION OF A STUDENT-LED FACULTY-SUPPORTED INTER-PROFESSIONAL STUDENT MEDICAL-NURSING EDUCATION CONFERENCE (SMEC)
Gerald Choon-Huat Koh ; Ae Ra Kee ; Jared Ryan Durnford ; Fang yi Lim ; Edwin Wei Xiang Chow ; Kimberly Hui Oen Qian ; Yew Seng Tan ; Prakash S Prajwala ; John Kit Chung Tam
The Singapore Family Physician 2016;42(3):70-74
Purpose: There are relatively few student-led medical
conferences worldwide. A group of medical and nursing
students from Yong Loo Lin School of Medicine,
National University of Singapore, organized an annual
student-led faculty-supported inter-professional
Student Medical-Nursing Education Conference
(SMEC), which consisted of plenary talks, lectures and
workshops, and a scientific competition. This research
focused on the evaluation of workshops conducted
during the 8th SMEC 2012.
Method: The authors used various process variables to
survey the conference participants on the educational
value of the 4 plenary lectures and 20 workshops, half of
which were run by experienced healthcare professionals
and the other half by current seniors or recent
graduates.
Results: A total of 270 medical and nursing students
completed the survey. Good to excellent educational
value was reported for most of the workshops. Higher
educational value was associated with use of props
(correlation coefficient, r=0.733 and 0.568), adherence
to workshop topic/focus (r=0.608 and 0.815) and
openness of presenter to questions (r=0.555 and 0.453).
Conclusion: A student-led, faculty-supported interprofessional
conference organized by medical and
nursing students had good to excellent self-reported
education value in helping their fellow medical and
nursing students learn about various healthcare
disciplines and prepare for medical and nursing school.
7.THE ASSOCIATION BETWEEN PATIENT PROFILE AND CAREGIVER FACTORS AMONGST RECENT STROKE SURVIVORS ADMITTED TO COMMUNITY HOSPITALS IN SINGAPORE
Gerald Choon-Huat Koh ; Julia Shi Yu Tan ; Alvona Zi Hut Loh ; Peck-Hoon Ong ; Liang En Wee ; Cynthia Chen ; Angela Cheong ; Ngan Phoon Fong ; Kin Ming Chan ; Boon Yeow Tan ; Edward Menon ; Kok Keng Lee ; Robert Petrella ; Amardeep Thind
The Singapore Family Physician 2016;42(3):88-100
Caregivers are important in post-stroke rehabilitation,
but little work has been done on the caregivers of
stroke survivors in Asian cultures. We examined the
association between patient profile (age, gender,
socioeconomic status, functional level, religion, and
ethnicity) and caregiver availability, number of
potential caregivers and primary caregiver identity
amongst Singaporean community hospitals' stroke
patients.
Data was obtained from all Singaporean community
hospitals from 1996-2005. 3796 patients fulfilled
inclusion criteria. Mixed logistic regression identified
independent predictors of caregiver availability and
primary caregiver identity. Mixed Poisson modelling
identified independent predictors of the number of
caregiver(s).
Among recent stroke survivors, 95.8% (3640/3796) had
potential caregivers, of which 94.2% (3429/3640) had
identified primary caregivers. Of the latter, 41.2% relied
on live-in hired help (foreign domestic workers-FDWs),
27.6% on spouses and 21.6% on first-degree relatives.
Independent patient factors associated with caregiver
availability and number were older, female, married,
higher socioeconomic status, having a religion and lower
functional level at admission. Independent
patient factors associated with FDW caregivers were
older age, female, Chinese compared to Malay, with
higher socioeconomic class and lower functional level at
admission. Caregiver availability for post-stroke patients in
Singapore community hospitals is relatively high, with
heavy dependence on FDWs.
8.Underdiagnosis of delirium on admission and prediction of patients who will develop delirium during their inpatient stay: a pilot study.
Yuin Cheng CHIN ; Gerald Choon Huat KOH ; Yee Kian TAY ; Chay Hoon TAN ; Reshma Aziz MERCHANT
Singapore medical journal 2016;57(1):18-21
INTRODUCTIONThe study aimed to determine the prevalence and documentation of delirium among the elderly and if the Clock Drawing Test (CDT) can be used to predict which patients had delirium on admission and those who may develop delirium during their stay in acute medical wards.
METHODSA single researcher performed the Mini-Mental State Examination (MMSE) and CDT on admission and discharge of 57 elderly adults at the National University Hospital, Singapore. Delirium was defined as a ≥ 3-point improvement or ≥ 2-point decline in MMSE scores from admission to discharge, where a fall denotes development of delirium and a rise denotes resolution. The case notes of the same patients were reviewed for documentation of delirium. All inpatients from two acute medical wards were examined. One CDT score and a pair of MMSE scores were collected from each patient.
RESULTSA total of 57 patients (28 male, 29 female) were involved in the study. Their mean age was 76.0 ± 8.7 years. The prevalence of delirium based on MMSE scores was 40.4%; 16 patients had delirium on admission while seven developed delirium during their inpatient stay. However, delirium was documented in the case notes of only 7 (30%) of the 23 patients. CDT score was better than baseline MMSE score at predicting a decline in MMSE score.
CONCLUSIONThe prevalence of delirium in the acute medical setting is high but underdiagnosed. The CDT may be a good screening tool to identify patients at risk of delirium during their inpatient stay. Baseline cognition screening should be performed in every elderly patient admitted to hospital.
Aged ; Cognition ; physiology ; Delirium ; diagnosis ; epidemiology ; physiopathology ; Diagnostic Errors ; Female ; Follow-Up Studies ; Humans ; Inpatients ; Male ; Middle Aged ; Neuropsychological Tests ; Pilot Projects ; Prevalence ; Prognosis ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Singapore ; epidemiology