Developing integration among stakeholders in the primary care networks of Singapore: a qualitative study

Surendran, Shilpa; Foo, Chuan De; Matchar, David B.; Ansah, John P.; Car, Josip; Koh, Gerald Choon Huat

doi:10.1186/s12913-022-08165-1

Cited by 5 publications

(2 citation statements)

References 28 publications

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“…Conflicts between providers are not uncommon, especially across care entities [68]. Power dynamics between providers might also be a source of conflicting instructions and general dissatisfaction if left unresolved [69]. Installing strong leadership to spearhead such programmes is integral for ensuring that care offered to patients is not disrupted due to team management or interpersonal reasons [70].…”

Section: Discussionmentioning

confidence: 99%

Identifying Key Themes of Care Coordination for Patients with Chronic Conditions in Singapore: A Scoping Review

et al. 2023

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A projected rise in patients with complex health needs and a rapidly ageing population will place an increased burden on the healthcare system. Care coordination can bridge potential gaps during care transitions and across the care continuum to facilitate care integration and the delivery of personalised care. Despite having a national strategic vision of improving care integration across different levels of care and community partners, there is no consolidation of evidence specifically on the salient dimensions of care coordination in the Singapore healthcare context. Hence, this scoping review aims to uncover the key themes that facilitate care coordination for patients with chronic conditions in Singapore to be managed in the community while illuminating under-researched areas in care coordination requiring further exploration. The databases searched were PubMed, CINAHL, Scopus, Embase, and Cochrane Library. Results from Google Scholar were also included. Two independent reviewers screened articles in a two-stage screening process based on the Cochrane scoping review guidelines. Recommendation for inclusion was indicated on a three-point scale and rating conflicts were resolved through discussion. Of the 5792 articles identified, 28 were included in the final review. Key cross-cutting themes such as having standards and guidelines for care programmes, forging stronger partnerships across providers, an interoperable information system across care interfaces, strong programme leadership, financial and technical resource availabilities and patient and provider-specific factors emerged. This review also recommends leveraging these themes to align with Singapore’s national healthcare vision to contain rising healthcare costs.

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Section: Discussionmentioning

confidence: 99%

Identifying Key Themes of Care Coordination for Patients with Chronic Conditions in Singapore: A Scoping Review

et al. 2023

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“…Previous PCN studies obtained perspectives of GPs, 18 PCN representatives 19 and type 2 diabetes patients 20 on care delivery for chronic conditions. To capture differing perspectives of the healthcare professionals (HCPs) on diabetes care delivery in the PCNs, 21 this study involved the GPs, nurses and care coordinators across all 10 PCNs.…”

Section: Introductionmentioning

confidence: 99%

Integrated patient-centred care for type 2 diabetes in Singapore Primary Care Networks: a mixed-methods study

Goh,

Siah,

Szücs

et al. 2024

BMJ Open

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ObjectivePatients with type 2 diabetes require patient-centred care as guided by the Chronic Care Model (CCM). Many diabetes patients in Singapore are managed by the Primary Care Networks (PCNs) which organised healthcare professionals (HCPs) comprising general practitioners, nurses and care coordinators into teams to provide diabetes care. Little is known about how the PCNs deliver care to people with type 2 diabetes. This study evaluated the consistency of diabetes care delivery in the PCNs with the CCM.DesignThis was a mixed-method study. The Assessment of Chronic Illness Care (ACIC version 3.5) survey was self-administered by the HCPs in the quantitative study (ACIC scores range 0–11, the latter indicating care delivery most consistent with CCM). Descriptive statistics were obtained, and linear mixed-effects regression model was used to test for association between independent variables and ACIC total scores. The qualitative study comprised semi-structured focus group discussions and used thematic analysis.SettingThe study was conducted on virtual platforms involving the PCNs.Participants179 HCPs for quantitative study and 65 HCPs for qualitative study.ResultsIntegrated analysis of quantitative and qualitative results found that there was support for diabetes care consistent with the CCM in the PCNs. The mean ACIC total score was 5.62 (SD 1.93). The mean element scores ranged from 6.69 (SD 2.18) (Health System Organisation) to 4.91 (SD 2.37) (Community Linkages). The qualitative themes described how the PCNs provided much needed diabetes services, their characteristics such as continuity of care, patient-centred care; collaborating with community partners, financial aspects of care, enablers for and challenges in performing care, and areas for enhancement.ConclusionThis mixed-methods study informs that diabetes care delivery in the Singapore PCNs is consistent with the CCM. Future research should consider using independent observers in the quantitative study and collecting objective data such as patient outcomes.

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Methodological quality and clinical recommendations of guidelines on the management of dyslipidaemias for cardiovascular disease risk reduction: a systematic review and an appraisal through AGREE II and AGREE REX tools

Deffert,

Vilela,

Cobre

et al. 2024

Family Practice

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Background Clinical practice guidelines (CPGs) are statements to assist practitioners and stakeholders in decisions about healthcare. Low methodological quality guidelines may prejudice decision-making and negatively affect clinical outcomes in non-communicable diseases, such as cardiovascular diseases worsted by poor lipid management. We appraised the quality of CPGs on dyslipidemia management and synthesized the most updated pharmacological recommendations. Methods A systematic review following international recommendations was performed. Searches to retrieve CPG on pharmacological treatments in adults with dyslipidaemia were conducted in PubMed, Scopus, and Trip databases. Eligible articles were assessed using AGREE II (methodological quality) and AGREE-REX (recommendation excellence) tools. Descriptive statistics were used to summarize data. The most updated guidelines (published after 2019) had their recommendations qualitatively synthesized in an exploratory analysis. Results Overall, 66 guidelines authored by professional societies (75%) and targeting clinicians as primary users were selected. The AGREE II domains Scope and Purpose (89%) and Clarity of Presentation (97%), and the AGREE-REX item Clinical Applicability (77.0%) obtained the highest values. Conversely, guidelines were methodologically poorly performed/documented (46%) and scarcely provided data on the implementability of practical recommendations (38%). Recommendations on pharmacological treatments are overall similar, with slight differences concerning the use of supplements and the availability of drugs. Conclusion High-quality dyslipidaemia CPG, especially outside North America and Europe, and strictly addressing evidence synthesis, appraisal, and recommendations are needed, especially to guide primary care decisions. CPG developers should consider stakeholders’ values and preferences and adapt existing statements to individual populations and healthcare systems to ensure successful implementation interventions.

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Developing integration among stakeholders in the primary care networks of Singapore: a qualitative study

Cited by 5 publications

References 28 publications

Identifying Key Themes of Care Coordination for Patients with Chronic Conditions in Singapore: A Scoping Review

Identifying Key Themes of Care Coordination for Patients with Chronic Conditions in Singapore: A Scoping Review

Integrated patient-centred care for type 2 diabetes in Singapore Primary Care Networks: a mixed-methods study

Methodological quality and clinical recommendations of guidelines on the management of dyslipidaemias for cardiovascular disease risk reduction: a systematic review and an appraisal through AGREE II and AGREE REX tools

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