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Chronic Disease Management in Singapore Polyclinics
Malaysian Family Physician, 2006
Address for correspondence: Dr Verna Lee Kar Mun, Senior Lecturer, Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur. Tel: 603-91733333, Fax: 603-91738153, Email: ...
Chronic conditions, such as chronic heart failure, chronic obstructive pulmonary disease, cancer and diabetes are common and burdensome for individuals, their families and societies. Globally, these conditions are the leading cause of mortality in the world, representing 60% of all deaths. Of the 57 million deaths that occurred globally in 2008, 36 million were due to non-communicable diseases. Social determinants of health (SDH) refers to the milieu in which people are born, grow, live, work and age. Socioeconomic status, education, access to healthcare, employment, and social support networks influence health outcomes. Increasingly, SDH are attracting attention in order to reduce health care disparities. Nurses need to understand the impacts of SDH on individuals, communities and nations. In order to address the impact that SDH have on well-being, interventions need to be targeted at the individual, health care provider and health care system in order to optimize health outcomes. Creating an interface and dialogue between policy, practice, education and research is critical for improving chronic care outcomes.
Introduction: While opioids are effective in carefully selected patients with chronic non-cancer pain (CNCP), they are associated with potential risks. Therefore, treatment recommendations for the safe and effective use of opioids in this patient population are needed. Materials and Methods: A multidisciplinary expert panel was convened by the Pain Association of Singapore to develop practical evidence-based recommendations on the use of opioids in the management of CNCP in the local population. This article discusses specifi c recommendations for various common CNCP conditions. Results: Available data demonstrate weak evidence for the long-term use of opioids. There is moderate evidence for the short-term benefi t of opioids in certain CNCP conditions. Patients should be carefully screened and assessed prior to starting opioids. An opioid treatment agreement must be established, and urine drug testing may form part of this agreement. A trial duration of up to 2 months is necessary to determine effi cacy, not only in terms of pain relief, but also to document improvement in function and quality of life. Regular reviews are essential with appropriate dose adjustments, if necessary, and routine assessment of analgesic effi cacy, aberrant behaviour and adverse effects. The reasons for discontinuation of opioid therapy include side effects, lack of effi cacy and aberrant drug behaviour. Conclusion: Due to insuffi cient evidence, the task force does not recommend the use of opioids as fi rst-line treatment for various CNCP. They can be used as secondor third-line treatment, preferably as part of a multimodal approach. Additional studies conducted over extended periods are required.
Rejuvenating chronic disease management in Malaysian private general practice – a global perspective
Malaysian Family Physician, 2010
Implementing the Wagner Chronic Care Model in primary care Over the past decades, several high quality chronic disease management models in primary care have been developed. The most notable is the Wagner Chronic Care Model (CCM), 5-6 which has greatly influenced reorganization of chronic disease care in many developed countries such as Australia and the United Kingdom. 7-9 This model was developed based on extensive evidence with the goal to produce system reform in which informed, motivated patients interact with prepared, proactive care teams. 6 A growing body of evidence has now shown that primary care practice redesigned in accord with the CCM generally improve the quality of care and the outcomes for patients with various chronic conditions. 10,11 Evidence has also shown that system approaches which address even one of the components were helpful in improving quality. 10 Evidence on the cost-effectiveness of CCM is ABSTRACT Rapid epidemiological transition globally has witnessed a rising prevalence of major chronic diseases such as hypertension, diabetes, hyperlipidaemia, obesity, chronic respiratory diseases and cancers over the past 30 years. In Malaysia, these conditions are commonly managed in primary care and published evidence has consistently shown suboptimal management and poor disease control. This in turn, has led to the massive burden of treating complications in secondary care, burden to the patients and their families with regards to morbidity and premature death, and burden to the country with regards to premature loss of human capital. The crushing burden and escalating health care costs in managing chronic diseases pose a daunting challenge to our primary care system, as we remain traditionally oriented to care for acute, episodic illnesses. This paper reexamines the current evidence supporting the implementation of Wagner Chronic Care Model in primary care globally; analyses the barriers of implementation of this model in the Malaysian private general practice through SWOT (strengths, weaknesses, opportunities and threats) analysis; and discusses fundamental solutions needed to bridge the gap to achieve better outcomes.
Chronic disease management: a primer for physicians
Internal Medicine Journal, 2008
Approximately one in three Australians or 6.8 million individuals suffer from one or more chronic diseases, the most prevalent being ischaemic heart disease, congestive heart failure, chronic obstructive lung disease, diabetes and renal disease. Potentially avoidable hospitalizations related to chronic disease comprise 5.5% of all admissions nationally and cluster in older age groups and socioeconomically disadvantaged regions. In an effort to reduce mortality and morbidity, programmes of chronic disease management have evolved with the aim of achieving formalized, population-wide implementation of elements of the chronic care model developed by Wagner et al. Results of rigorous evaluations of such programmes suggest improved survival and/or disease control with reductions in hospitalizations and adverse clinical events. This paper aims to provide an overview of available evidence for chronic disease management programmes for practising physicians who will be increasingly invited to take an active leadership role in designing and operationalizing such programmes.
Comparison of the Outcome of Treatment of Chronic
2013
Background: Chronic osteomyelitis is still common in the developing world and presents a continuing therapeutic challenge. Antibiotics cannot penetrate the dense fibrotic scar tissue that surrounds infected and avascular bone which perpetuates the infection. Surgical debridement/sequestrectomy is the cornerstone to treatment and aims to create a viable, vascularized base which promotes healing. Surgical debridement necessarily creates a dead space which must be dealt with to prevent re-infection. Local antibiotic delivery systems serve the dual purpose of obliterating dead space and creating a sterile local environment with high bactericidal concentrations. Aim: To determine the outcomes in patients with chronic osteomyelitis who received debridement/sequestrectomy alone, and those who received the procedure combined with a local antibiotic delivery system in the University of Calabar Teaching Hospital. Patients and Methods: A prospective descriptive analysis of patients managed surgically for chronic osteomyelitis from July 2007 to December, 2012. Patients' biodata, aetiology, organisms, treatment options and outcomes were analysed. Results: Forty-four patients presented with the condition and accepted surgery. Male:Female ratio was 2.1:1, and mean age was 27.27 ± 17.48 years. The tibia was the most commonly affected bone (45.5%), Staphylococcus aureus was the commonest organism (56.8% of sinus cultures; 73% of marrow/sequestral cultures) and previous acute haematogenous osteomyelitis was the commonest mechanism. The use of a local antibiotic delivery system improved cure rates from 57.7% to 77.8%). Conclusion: Multiple surgical interventions increase the socioeconomic costs of treating this condition and have a direct impact on the economies of individuals especially in the developing world. Surgical interventions should aim at achieving maximum impact with minimum repetition of the processes. Adequate surgical debridement combined with a local antibiotic delivery system offer improved chances of obtaining cure in this therapeutically challenging disease.
2004
Chronic conditions are increasingly the primary concern of healthcare systems throughout the world. In response to this challenge, the World Health Organization has joined with the MacColl Institute for Healthcare Innovation to adapt the Chronic Care Model (CCM) from a global perspective. The resultant effort is the Innovative Care for Chronic Conditions (ICCC) framework which expands community and policy aspects of improving health care for chronic conditions and includes components at the micro (patient and family), meso (healthcare organisation and community), and macro (policy) levels. The framework provides a flexible but comprehensive base on which to build or redesign health systems in accordance with local resources and demands. See end of article for authors ’ affiliations
Symptom prevalence, severity, distress and management among patients with chronic diseases
BMC Nursing
Background Advanced knowledge, technology, and treatment approaches resulted in longer survival rates for patients suffering from chronic diseases. However, symptoms of these diseases persist and affect the individual’s entire life and normal functioning. Aim To assess symptoms prevalence, severity, distress, and management among patients with chronic obstructive pulmonary diseases (COPD), chronic heart failure (CHF), and end-stage renal disease (ESRD) in Oman. Design A descriptive cross-sectional design was used. Sample and settings The study sample comprised 340 participants who were recruited between May and December 2021 from two referral hospitals and one large dialysis unit in the Sultanate of Oman, Muscat Governate using a convenience sampling technique. Results The highly prevalent symptoms among patients with selected chronic diseases were lack of energy (60.9%), pain (57.4%), numbness (53.2%), difficulty sleeping (49.4%), and shortness of breath (45.9%). The most severe sy...