Providing comprehensive and continuing care to patients is the forte of family physicians. The burden of providing such care to patients with complicated co-morbidities is increasing rapidly in ageing populations. Primary care systems around the world are ill equipped to face such a challenge. Family physicians need to hone their skills in this area of care. We propose the use of the SBAR4 model as a framework for managing complex co-morbidities. This model is easy to learn and use by family physicians as it is based on the familiar SBAR model of clinical communication and Pendelton’s 7 Tasks of consultation. We believe that the SBAR4 will assist the clinician to assess patients with complex co-morbidities and map out a comprehensive care plan that can be easily understood by a multidisciplinary team caring for such patients.

The increasing complexity of healthcare is accelerating the rate of specialisation in medicine, which in turn aggravates the fragmentation of care in hospitals. The hospitalist movement advocates for the return of generalist physicians to the hospital to provide general and more holistic medical care to inpatients. This can be seen as an adaptive response to care fragmentation. Starting in the mid-1990s in North America, where the impact of healthcare complexity and fragmentation has been most widely felt, the hospital movement has gained strength and spread across the continent rapidly. This paper examines the phenomenon of the hospitalist movement in the United States, Canada and Singapore. The conclusion is that variants of the hospital movement may emerge in different parts of the world as healthcare systems adapt to common global trends that drive the increasing complexity of healthcare.
Australia ; Diffusion of Innovation ; Hospitalists ; trends ; Hospitals ; Singapore ; United States

Providing comprehensive and continuing care to patients is the forte of family physicians. The burden of providing such care to patients with complicated co-morbidities is increasing rapidly in ageing populations. Primary care systems around the world are ill equipped to face such a challenge. Family physicians need to hone their skills in this area of care. In this article, we introduce the SBAR4 model and propose it as a framework for managing patients with complex co-morbidities. This model is easy to learn and use by family physicians as it is based on the familiar SBAR model of clinical communication and Pendleton’s 7 Tasks of consultation. We believe that the SBAR4 will assist the clinician to assess patients with complex co-morbidities and map out a comprehensive care plan that can be easily understood by a multidisciplinary team caring for such patients.

INTRODUCTION: Elderly persons who live alone are more likely to be socially isolated and at increased risk of adverse health outcomes, unnecessary hospital re-admissions and premature mortality. We aimed to understand the health-seeking behaviour of elderly persons living alone in public rental housing in Singapore. METHODS: In-depth interviews were conducted using a semi-structured question guide. Participants were selected using a purposive sampling approach. Interviews were conducted until theme saturation was reached. Qualitative data collected was analysed using manual thematic coding methods. RESULTS: Data analysis revealed five major themes: accessibility of healthcare services and financial assistance schemes; perceived high cost of care; self-management; self-reliance; and mismatch between perceived needs and services. CONCLUSION Elderly persons living in one-room rental flats are a resilient and resourceful group that values self-reliance and independence. Most of the elderly who live alone develop self-coping mechanisms to meet their healthcare needs rather than seek formal medical consultation. The insightful findings from this study should be taken into consideration when models of healthcare delivery are being reviewed and designed so as to support the disadvantaged elderly living alone.

INTRODUCTIONFrequent admitters to hospitals are high-cost patients who strain finite healthcare resources. However, the exact risk factors for frequent admissions, which can be used to guide risk stratification and design effective interventions locally, remain unknown. Our study aimed to identify the clinical and sociodemographic risk factors associated with frequent hospital admissions in Singapore.

METHODSAn observational study was conducted using retrospective 2014 data from the administrative database at Singapore General Hospital, Singapore. Variables were identified a priori and included patient demographics, comorbidities, prior healthcare utilisation, and clinical and laboratory variables during the index admission. Multivariate logistic regression analysis was used to identify independent risk factors for frequent admissions.

RESULTSA total of 16,306 unique patients were analysed and 1,640 (10.1%) patients were classified as frequent admitters. On multivariate logistic regression, 16 variables were independently associated with frequent hospital admissions, including age, cerebrovascular disease, history of malignancy, haemoglobin, serum creatinine, serum albumin, and number of specialist outpatient clinic visits, emergency department visits, admissions preceding index admission and medications dispensed at discharge. Patients staying in public rental housing had a 30% higher risk of being a frequent admitter after adjusting for demographics and clinical conditions.

CONCLUSIONOur study, the first in our knowledge to examine the clinical risk factors for frequent admissions in Singapore, validated the use of public rental housing as a sensitive indicator of area-level socioeconomic status in Singapore. These risk factors can be used to identify high-risk patients in the hospital so that they can receive interventions that reduce readmission risk.