3.The Singapore National Healthcare Group Diabetes Registry--descriptive epidemiology of type 2 diabetes mellitus.
Bee Hoon HENG ; Yan SUN ; Jason T S CHEAH ; Michelle JONG
Annals of the Academy of Medicine, Singapore 2010;39(5):348-352
INTRODUCTIONThe National Healthcare Group (NHG) launched an enterprise-wide diabetes registry in 2007. We describe the epidemiology of type 2 diabetes mellitus from 2005 to 2008.
MATERIALS AND METHODSPatients with encounters in NHG from 2005 were identified for inclusion into the Diabetes Registry from existing stand-alone diabetes registries, ICD9CM diagnosis codes, anti-hyperglycaemic medication and laboratory confirmation. Variables extracted for analysis were demographics (age, gender, ethnicity), diabetes-related comorbidities and complications, most recent anti-hyperglycaemic agents dispensed, and the most recent glycated haemoglobin (HbA1C) measurement.
RESULTSThe diabetes registry grew 32% from 129,183 patients in 2005 to 170,513 patients in 2008, making up 12% to 15% of all patients in NHG. About half of the type 2 diabetes patients were aged 45 to 64 years. Females were generally older with a median age of 63 to 64 years vs 59 to 61 years in males. The Indian ethnic group accounted a disproportionately higher 13% of patients. Over 95% of type 2 patients had at least one diabetes-related comorbid condition, and diabetes-related complications were principally renal and cardiovascular complications. The majority (86.2% to 89.2%) of primary care patients were on oral anti-hyperglycaemic agents; however, the rate of insulin treatment increased from 10.8% to 13.8%. HbA1C levels in 2008 improved over that in 2005, with the percentage of patients with good glycaemic control improving with age.
CONCLUSIONThe registry has enabled a baseline assessment of the burden and the care of type 2 diabetes patients in NHG, which will provide critical "evidence" for planning future programmes.
Administration, Oral ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Comorbidity ; Diabetes Mellitus, Type 2 ; drug therapy ; epidemiology ; Female ; Humans ; Hypoglycemic Agents ; administration & dosage ; Injections, Intramuscular ; Male ; Middle Aged ; Registries ; Sex Distribution ; Singapore ; epidemiology
4.The evolving role of the community pharmacist in chronic disease management - a literature review.
Pradeep P GEORGE ; Joseph A D MOLINA ; Jason CHEAH ; Soo Chung CHAN ; Boon Peng LIM
Annals of the Academy of Medicine, Singapore 2010;39(11):861-867
INTRODUCTIONWe appraised the roles and responsibilities assigned to community pharmacists internationally and in Singapore.
MATERIALS AND METHODSA systematic search of international peer-reviewed literature was undertaken using Medline. Grey literature was identified through generic search engines. The search period was from 1 January 1991 to 30 July 2009. The search criteria were English language manuscripts and search terms "community pharmacist", "community pharmacy", "disease management" and "roles" as a major heading. Boolean operators were used to combine the search terms. Identified abstracts were independently reviewed and the findings were presented as a narrative summary.
RESULTSOverall, we reviewed 115 articles on an abstract level and retrieved 45 of those as full text articles for background information review and inclusion into the evidence report. Of the articles included in the review, 32% were from United Kingdom (UK). Literature highlights the multi-faceted role of the community pharmacist in disease management. Community pharmacists were involved in the management of asthma, arthritis, cardiovascular diseases, diabetes, depression, hypertension, osteoporosis and palliative care either alone or in the disease management team. Evidence of effectiveness for community pharmacy/ community pharmacist interventions exists for lipid, diabetes, and hypertension management and for preventive services such as weight management, osteoporosis prevention and fl u immunisation services. Majority of the community pharmacists in Singapore play the traditional role of dispensing. Attempts by the private community pharmacies to provide some professional services were not successful due to lack of funding. Factors found to impede the growth of community pharmacists are insufficient integration of community pharmacist input into healthcare pathways, poor relationship among pharmacists and physicians, lack of access to patient information, time constraints and inadequate compensation.
CONCLUSIONEvidence from observational studies points out the wide range of roles played by the community pharmacist and provides insights into their integration into chronic disease management programmes and health promotion.
Chronic Disease ; Delivery of Health Care ; methods ; organization & administration ; trends ; Disease Management ; Humans ; Internationality ; Patient Care Team ; organization & administration ; Pharmacists ; statistics & numerical data ; Professional Role ; Singapore
5.Geriatric syndromes and depressed mood in lower-income Singaporeans with diabetes: implications for diabetes management and health promotion.
Lai Yin WONG ; Bee Hoon HENG ; Charis W L NG ; Joseph A D MOLINA ; Pradeep P GEORGE ; Jason T S CHEAH
Annals of the Academy of Medicine, Singapore 2012;41(2):67-76
INTRODUCTIONThis study aims to determine the association of geriatric syndromes and depressed mood among respondents with diabetes in a lower income community; and their association with self-management, lifestyle behaviour, and healthcare utilisation. This paper focuses primarily on the 114 respondents with diabetes aged 50+ to inform policy formulation at the community level.
MATERIALS AND METHODSA pilot community health assessment was conducted in 4 blocks of 1- and 2-room apartments in Toa Payoh district from July to November 2009. Using a standard questionnaire, interviewers conducted face-to-face interviews with household members on chronic diseases, geriatric syndromes and health-related behaviour. Data were analysed using SPSSv15.
RESULTSA total of 795 respondents were assessed with a response rate of 61.8%. Of 515 (64.8%) aged 50+ analysed in this study, 22.1% reported having diabetes, of whom 31.6% reported being depressed. Respondents with diabetes who reported being depressed had a higher prevalence of geriatric syndromes compared with those non-depressed; i.e. functional decline (30.6% vs 5.1%, P <0.001); falls (33.3% vs 10.3%, P = 0.003); stumbling (30.6% vs 10.3%, P = 0.007); urinary incontinence (33.3% vs 5.1%, P <0.001), progressive forgetfulness (27.8% vs 6.4%, P = 0.002) and poor eyesight (22.2% vs 6.4%, P = 0.014). They were less likely to comply with medications (86.1% vs 97.3%, P = 0.026) and performed exercise (13.9% vs 53.8%, P <0.001). More had hospital admissions (13.9% vs 7.7%); and they had more outpatient visits per person (2.4 visits vs 0.9 visits, P = 0.03) at Specialist Outpatient Clinics.
CONCLUSIONGeriatric syndromes were associated with the presence of depressed mood among persons with diabetes in the lower income group. As those with depressed mood had more unfavourable self-management and lifestyle behaviour, and utilise higher healthcare services, diabetes management must take these findings into consideration.
Activities of Daily Living ; Aged ; Depression ; epidemiology ; Diabetes Mellitus ; drug therapy ; psychology ; Disease Management ; Female ; Health Behavior ; Health Promotion ; Health Services ; utilization ; Humans ; Interviews as Topic ; Life Style ; Male ; Middle Aged ; Patient Acceptance of Health Care ; Poverty ; Singapore ; epidemiology ; Surveys and Questionnaires
6.Measuring the quality of care of diabetic patients at the specialist outpatient clinics in public hospitals in Singapore.
Matthias P H S TOH ; Bee Hoon HENG ; Chee Fang SUM ; Michelle JONG ; Siok Bee CHIONH ; Jason T S CHEAH
Annals of the Academy of Medicine, Singapore 2007;36(12):980-986
INTRODUCTIONThis study aims to measure the quality of care for patients with diabetes mellitus at selected Specialist Outpatient Clinics (SOCs) in the National Healthcare Group.
MATERIALS AND METHODSThe cross-sectional study reviewed case-records of patients from 6 medical specialties who were on continuous care for a minimum of 15 months from October 2003 to April 2005. Disproportionate sampling of 60 patients from each specialty, excluding those co-managed by Diabetes Centres or primary care clinics for diabetes, was carried out. Information on demographic characteristics, process indicators and intermediate outcomes were collected and the adherence rate for each process indicator compared across specialties. Data analysis was carried out using SPSS version 13.0.
RESULTSA total of 575 cases were studied. The average rate for 9 process indicators by specialty ranged from 47.8% to 70.0%, with blood pressure measurement consistently high across all specialties (98.4%). There was significant variation (P <0.001) in rates across the specialties for 8 process indicators; HbA1c, serum creatinine and lipid profile tests were over 75%, while the rest were below 50%. The mean HbA1c was 7.3% +/- 1.5%. "Optimal" control of HbA1c was achieved in 51.2% of patients, while 50.6% of the patients achieved "optimal" low-density lipoprotein (LDL)-cholesterol control. However, 47.3% of patients had "poor" blood pressure control. Adherence to process indicators was not associated with good intermediate outcomes.
CONCLUSIONSThere was large variance in the adherence rate of process and clinical outcome indicators across specialties, which could be improved further.
Adult ; Aged ; Aged, 80 and over ; Cholesterol, LDL ; Cross-Sectional Studies ; Diabetes Mellitus ; therapy ; Female ; Glycated Hemoglobin A ; Hospitals, Public ; Humans ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Outpatient Clinics, Hospital ; Outpatients ; Patient Acceptance of Health Care ; Patient Compliance ; Quality of Health Care ; Retrospective Studies ; Singapore
7.Bridging the gap between primary and specialist care--an integrative model for stroke.
Narayanaswamy VENKETASUBRAMANIAN ; Yan Hoon ANG ; Bernard Pl CHAN ; Parvathi CHAN ; Bee Hoon HENG ; Keng He KONG ; Nanda KUMARI ; Linda Lh LIM ; Jonathan Sk PHANG ; Matthias Phs TOH ; Sutrisno WIDJAJA ; Loong Mun WONG ; Ann YIN ; Jason CHEAH
Annals of the Academy of Medicine, Singapore 2008;37(2):118-127
Stroke is a major cause of death and disability in Singapore and many parts of the world. Chronic disease management programmes allow seamless care provision across a spectrum of healthcare facilities and allow appropriate services to be brought to the stroke patient and the family. Randomised controlled trials have provided evidence for efficacious interventions. After the management of acute stroke in a stroke unit, most stable stroke patients can be sent to their family physician for continued treatment and rehabilitation supervision. Disabled stroke survivors may need added home-based services. Suitable community resources will need to be harnessed. Clinic-based stroke nurses may enhance service provision and coordination. Close collaboration between the specialist and family physician would be needed to right-site patients and also allow referrals in either direction where necessary. Barriers to integration can be surmounted by trust and improved communication. Audits would allow monitoring of care provision and quality care enhancement. The Wagner model of chronic care delivery involves self-management support, shared clinical information systems, delivery system redesign, decision support, healthcare organisation and community resources. The key and critical feature is the need for an informed, activated (or motivated) patient, working in collaboration with the specialist and family physician, and a team of nursing and allied healthcare professionals across the continuum of care. The 3-year Integrating Services and Interventions for Stroke (ISIS) project funded by the Ministry of Health will test such an integrative system.
Delivery of Health Care, Integrated
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organization & administration
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Evidence-Based Medicine
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Humans
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Ischemic Attack, Transient
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Medicine
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Middle Aged
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Models, Organizational
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Neurology
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Primary Health Care
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Rehabilitation Nursing
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Singapore
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Specialization
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Stroke
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nursing
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Stroke Rehabilitation
8.Perception of disease, well-being and financial burden by patients with chronic hepatitis B: A self-reported assessment.
Ruojun DING ; Gayathry MORVIL ; Boon Bee George GOH ; Thinesh Lee KRISHNAMOORTHY ; Pei Yuh CHIA ; Hiang Keat TAN ; Victoria Sze Min EKSTROM ; Chang Chuen Mark CHEAH ; Jin Yang Terence TAN ; Pek Siang Edmund TEO ; Pik Eu Jason CHANG ; Chee Kiat TAN ; Xiaohui XIN ; Wan Cheng CHOW ; Rajneesh KUMAR
Annals of the Academy of Medicine, Singapore 2022;51(6):378-380
9.The role of PIVKA-II in hepatocellular carcinoma surveillance in an Asian population.
Wai Yoong NG ; Daniel Yan Zheng LIM ; Si Yu TAN ; Jason Pik Eu CHANG ; Thinesh Lee KRISHNAMOORTHY ; Chee Hooi LIM ; Damien Meng Yew TAN ; Victoria Sze Min EKSTROM ; George Boon Bee GOH ; Mark Chang Chuen CHEAH ; Rajneesh KUMAR ; Chin Pin YEO ; Chee Kiat TAN
Annals of the Academy of Medicine, Singapore 2023;52(2):108-110