1.Peripheral arterial disease in community-based patients with diabetes in Singapore: Results from a Primary Healthcare Study.
Raj Mohan Lekshmi NARAYANAN ; Woon Puay KOH ; Jonathan PHANG ; Tavintharan SUBRAMANIAM
Annals of the Academy of Medicine, Singapore 2010;39(7):525-527
INTRODUCTIONPeripheral arterial disease (PAD) is an important complication of diabetes mellitus (DM), significantly associated with increased morbidity and mortality secondary to amputations, strokes and coronary artery disease. Information on DM patients with PAD is limited in our ethnically diverse population in Singapore. We aimed to determine the prevalence, risk factors and co-morbidities of PAD in patients managed for DM in the primary care setting.
MATERIALS AND METHODSA cross-sectional study was conducted among 521 diabetics in 9 of the 18 government-aided clinics in the community. Data including demographics, presence of co-morbidities and vascular risk factors were collected using an interviewer-administered questionnaire, and Ankle-Brachial Index (ABI) was calculated from systolic ankle and brachial pressure measurements.
RESULTSThe prevalence of PAD, defi ned as resting ABI of <0.9 on either leg and/or a history of gangrene or non-traumatic amputation was 15.2% [95% confidence interval (CI), 12.3-18.5]. This prevalence of PAD was higher in patients with pre-existing microvascular and other macrovascular complications. In multivariate analysis, prevalence of PAD was positively associated with increasing age (OR, 1.08; 95% CI, 1.05-1.12), Malay versus Chinese ethnicity (OR, 2.27; 95% CI, 1.09-4.70), low HDL-cholesterol (OR, 1.87; 95% CI, 1.04- 3.37), and insulin treatment (OR, 2.98; 95%CI, 1.39-6.36).
CONCLUSIONPAD is an important cause of concern among patients with diabetes, with a high prevalence which further increases with increasing age and duration of DM, and exhibits ethnic variation. Risk factors identified in this study may improve early identification of PAD, allowing for prompt interventions, with a potential to reduce long-term morbidity and mortality.
Adult ; Age Distribution ; Aged ; Ambulatory Care Facilities ; statistics & numerical data ; China ; Diabetic Angiopathies ; epidemiology ; ethnology ; Female ; Humans ; India ; Indonesia ; ethnology ; Male ; Middle Aged ; Peripheral Arterial Disease ; epidemiology ; ethnology ; Prevalence ; Sex Distribution ; Singapore ; epidemiology
2.Evaluating user satisfaction with an electronic prescription system in a primary care group.
Woan Shin TAN ; Jonathan Sk PHANG ; Lay Kheng TAN
Annals of the Academy of Medicine, Singapore 2009;38(6):494-497
INTRODUCTIONElectronic prescribing has been proposed as an important strategy to reduce medication errors, improve the quality of patient care and create savings in health care costs. Despite these potential advantages, user satisfaction plays a significant role in the success of its implementation. Hence, this study aims to examine users' satisfaction and factors associated with satisfaction regarding an electronic prescription system implemented in the National Healthcare Group Polyclinics in Singapore.
MATERIALS AND METHODSAn anonymous survey was administered in October 2007 to all physicians, pharmacists and pharmacy technicians working in the 9 National Healthcare Group Polyclinics.
RESULTSRespondents included 118 doctors and 61 pharmacy staff. The overall level of satisfaction with electronic prescribing was high. Doctors and pharmacists reported a high degree of agreement that electronic prescribing reduces prescribing errors and interventions, and they did not want to go back to the paper-based system. Users were generally satisfied with the functionality of the system but there was some degree of workflow interference particularly for the pharmacy staff. Only 56.9% of the pharmacy respondents expressed satisfaction with the review function of the electronic prescription system and only 51.8% and 60% were satisfied when processing prescriptions that included items to be purchased from an external pharmacy or prescriptions with amendments. The results also revealed that satisfaction with the system was more associated with users' perceptions about the electronic prescription system's impact on productivity than quality of care.
CONCLUSIONThe survey results indicate that the implementation of the electronic prescription system has gone reasonably well. The survey findings provide opportunities for system and workflow enhancement, which is important as these issues could affect the acceptability of a new technology and the speed of diffusion within an organisation.
Consumer Behavior ; Cross-Sectional Studies ; Diffusion of Innovation ; Electronic Prescribing ; Health Care Surveys ; Humans ; Medical Order Entry Systems ; Pharmaceutical Services ; Pharmacists ; psychology ; Physicians ; psychology ; Singapore
3.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