INTRODUCTIONThe Singapore National Asthma Program (SNAP) was launched in 2001 to address the high burden of asthma in Singapore. One component of the SNAP was directed at improving asthma control in the community by promoting preventive treatment with inhaled corticosteroids. This paper describes the program on prescription patterns of preventor and reliever medication for asthma in the polyclinics.

MATERIALS AND METHODSWe monitored the prescription pattern for asthma as the preventor-reliever (PR) drug ratio. The PR ratio was employed both as a positive feedback tool and as a key performance indicator (KPI) for the program. Individual clinics were encouraged to implement locally relevant and effective initiatives to increase the KPI and facilitate this process. The different methods included chronic care models, multidisciplinary teams, enhanced primary care clinics, pre-counselling screening, decision support tools, self-management support, a patient information system and community education.

RESULTSIn the course of the program, the case load for asthma in the polyclinics increased by 31%. During the same period, the average PR ratio increased significantly from 0.68 to 1.80 (P <0.001).

CONCLUSIONSA simple audit and positive feedback program based on PR ratios, accompanied by sustained local quality improvement cycles has been associated with a significant shift in the drug treatment of asthma away from episodic quick relief medication towards long-term daily preventive treatment with inhaled steroids in polyclinics.

Administration, Inhalation ; Adrenal Cortex Hormones ; administration & dosage ; therapeutic use ; Ambulatory Care Facilities ; Asthma ; drug therapy ; prevention & control ; Drug Prescriptions ; Feedback ; Humans ; Medical Audit ; Program Evaluation ; Singapore

INTRODUCTIONChronic kidney disease (CKD) is a major public health problem where majority of patients are managed in the primary care. The major risk factors are advanced age, hypertension and diabetes mellitus, and risk factors control is paramount to prevent progression to CKD. The objective of the study is to describe the epidemiology and quality of care of patients with CKD stages 3 to 5 at National Healthcare Group Polyclinics (NHGP).

MATERIALS AND METHODSThe study was carried out using data from National Healthcare Group (NHG) Renal Registry. Patients were included if they were identified to have CKD based on ICD-9-CM codes and laboratory results.

RESULTSOverall, the number of CKD patients increased more than 2 fold from 4734 in 2007 to 10,245 in 2011. In 2011, the majority belonged to stages 3A (39.6%) and 3B (37.6%), had hypertension (98.2%), dyslipidemia (97.2%) and diabetes mellitus (68.7%). From 2007 to 2011, among those with hypertension, the use of angiotensin converting enzyme (ACE) inhibitors and/ or angiotensin receptor blockers increased from 78.4% to 84.1%, and the percentage with good systolic blood pressure control (<130 mmHg) improved from 18.7% to 36.3%. Among those with dyslipidemia, the use of statins increased from 81% to 87.1%, and the percentage of patients with low density lipoproteins (LDL) <2.6 mmol/L increased from 40% to 54.7%. However, among those with diabetes mellitus, mean glycated haemoglobin (HBA1c) increased from 7.4% to 7.6%, and the percentage of patients with HBA1c ≤7.0% decreased from 44.5% to 39.4%.

CONCLUSIONThe number of CKD patients in NHGP has increased significantly from 2007 to 2011 at an average annual rate of 21.3%. Majority of patients the study conducted in 2011 were in stage 3A and stage 3B. Blood pressure and LDL control are encouraging but glycaemic control can be further improved.

Humans ; Primary Health Care ; Quality of Health Care ; Registries ; Renal Insufficiency, Chronic ; drug therapy ; epidemiology ; Singapore ; epidemiology

Postgraduate Family Medicine (FM) training is important to train future primary care doctors to provide accessible and cost effective healthcare. In Singapore, a structured postgraduate FM training programme has been available for 20 years. This programme is characterised by involvement of both FM and non-FM doctors, well written modules and a rigorous assessment process. However, challenges faced by both the current healthcare system and training structure underlie the need to review the training structure to ensure its relevancy for future Family Physicians (FPs) to manage the needs of their patients. A workgroup was formed to review the current FM postgraduate programme and to explore the possibility of using the Accreditation Council for Graduate Medical Education (ACGME) framework to enhance our current system. The workgroup felt that broad-based training and comprehensive coverage of topics are areas that are important to retain in any new FM residency programme. Weaknesses identified included a lack of early FM exposure and the need to strengthen formative assessments. New organisational structures such as Family Medicine Centres (FMC) need to be established and the involvement of the private sector in any FM residency progammes could be enhanced. The implementation of the FM Residency Programme in 2011 presented a unique opportunity to realign FM postgraduate education in line with the national objectives and to equip FPs with the necessary knowledge and skills for managing the future healthcare needs of Singaporeans.
Clinical Competence ; standards ; Curriculum ; standards ; Education, Medical, Graduate ; organization & administration ; standards ; Family Practice ; education ; Humans ; Internship and Residency ; organization & administration ; Program Development ; Singapore

INTRODUCTION: Disease outbreaks such as the COVID-19 pandemic significantly heighten the psychological stress of healthcare workers (HCWs). The objective of this study was to understand the factors contributing to the perceived stress levels of HCWs in a public primary care setting during the COVID-19 pandemic, including their training, protection and support (TPS), job stress (JS), and perceived stigma and interpersonal avoidance. METHODS: This cross-sectional study using an electronic self-administered questionnaire was conducted at the National Healthcare Group Polyclinics in March 2020. Data was collected anonymously. Analysis was performed using regression modelling. RESULTS: The response rate was 69.7% (n = 1,040). The mean perceived stress level of HCWs in various departments ranged from 17.2 to 20.3. Respondents who reported higher perceived stress were those who made alternative living arrangements, were more affected by the current pandemic, reported higher JS and were Muslims. Respondents who reported lower perceived stress were those who had been through the severe acute respiratory syndrome epidemic in 2003 and H1N1 pandemic in 2009 as HCWs, and those who had higher confidence in the organisation's TPS. CONCLUSION All HCWs, regardless of their scope of work, were similarly stressed by the current pandemic compared to the general population. Improving the confidence of HCWs in their training, protection and the support of personal protective equipment, and retaining experienced HCWs who can provide advice and emotional support to younger colleagues are important. Adequate psychological support for HCWs in the pandemic can be transformed into reserves of psychological resilience for future disease outbreaks.
COVID-19/epidemiology* ; Cross-Sectional Studies ; Health Personnel/psychology* ; Humans ; Influenza A Virus, H1N1 Subtype ; Pandemics ; Primary Health Care ; SARS-CoV-2 ; Stress, Psychological