Perceived facilitators and barriers to chronic disease management in primary care networks of Singapore : a qualitative study
Objective: The increasing chronic disease burden has placed tremendous strain on tertiary healthcare resources in most countries, necessitating a shift in chronic disease management from tertiary to primary care providers. The Primary Care Network (PCN) policy was promulgated as a model of care to o...
| Main Authors: | , , , , , , |
|---|---|
| Other Authors: | |
| Format: | Journal Article |
| Language: | English |
| Published: |
2021
|
| Subjects: | |
| Online Access: | https://hdl.handle.net/10356/151976 |
| _version_ | 1826119605186199552 |
|---|---|
| author | Foo, Chuan De Surendran, Shilpa Tam, Chen Hee Ho, Elaine Matchar, David Bruce Car, Josip Koh, Gerald Choon Huat |
| author2 | Lee Kong Chian School of Medicine (LKCMedicine) |
| author_facet | Lee Kong Chian School of Medicine (LKCMedicine) Foo, Chuan De Surendran, Shilpa Tam, Chen Hee Ho, Elaine Matchar, David Bruce Car, Josip Koh, Gerald Choon Huat |
| author_sort | Foo, Chuan De |
| collection | NTU |
| description | Objective: The increasing chronic disease burden has placed tremendous strain on tertiary healthcare resources in most countries, necessitating a shift in chronic disease management from tertiary to primary care providers. The Primary Care Network (PCN) policy was promulgated as a model of care to organise private general practitioners (GPs) into groups to provide GPs with resources to anchor patients with chronic conditions with them in the community. As PCN is still in its embryonic stages, there is a void in research regarding its ability to empower GPs to manage patients with chronic conditions effectively. This qualitative study aims to explore the facilitators and barriers for the management of patients with chronic conditions by GPs enrolled in PCN. Design: We conducted 30 semistructured interviews with GPs enrolled in a PCN followed by a thematic analysis of audio transcripts until data saturation was achieved. Setting: Singapore. Results: Our results suggest that PCNs facilitated GPs to more effectively manage patients through (1) provision of ancillary services such as diabetic foot screening, diabetic retinal photography and nurse counselling to permit a ‘one-stop-shop’, (2) systematic monitoring of process and clinical outcome indicators through a chronic disease registry (CDR) to promote accountability for patients’ health outcomes and (3) funding streams for PCNs to hire additional manpower to oversee operations and to reimburse GPs for extended consultations. Barriers include high administrative load in maintaining the CDR due to the lack of a smart electronic clinic management system and financial gradient faced by patients seeking services from private GPs which incur higher out-of-pocket expenses than public primary healthcare institutions. Conclusion: PCNs demonstrate great promise in empowering enrolled GPs to manage patients with chronic conditions. However, barriers will need to be addressed to ensure the viability of PCNs in managing more patients in the face of an ageing population. |
| first_indexed | 2024-10-01T05:02:47Z |
| format | Journal Article |
| id | ntu-10356/151976 |
| institution | Nanyang Technological University |
| language | English |
| last_indexed | 2024-10-01T05:02:47Z |
| publishDate | 2021 |
| record_format | dspace |
| spelling | ntu-10356/1519762023-03-05T16:47:35Z Perceived facilitators and barriers to chronic disease management in primary care networks of Singapore : a qualitative study Foo, Chuan De Surendran, Shilpa Tam, Chen Hee Ho, Elaine Matchar, David Bruce Car, Josip Koh, Gerald Choon Huat Lee Kong Chian School of Medicine (LKCMedicine) Centre for Population Health Sciences Science::Medicine Change Management Clinical Governance Objective: The increasing chronic disease burden has placed tremendous strain on tertiary healthcare resources in most countries, necessitating a shift in chronic disease management from tertiary to primary care providers. The Primary Care Network (PCN) policy was promulgated as a model of care to organise private general practitioners (GPs) into groups to provide GPs with resources to anchor patients with chronic conditions with them in the community. As PCN is still in its embryonic stages, there is a void in research regarding its ability to empower GPs to manage patients with chronic conditions effectively. This qualitative study aims to explore the facilitators and barriers for the management of patients with chronic conditions by GPs enrolled in PCN. Design: We conducted 30 semistructured interviews with GPs enrolled in a PCN followed by a thematic analysis of audio transcripts until data saturation was achieved. Setting: Singapore. Results: Our results suggest that PCNs facilitated GPs to more effectively manage patients through (1) provision of ancillary services such as diabetic foot screening, diabetic retinal photography and nurse counselling to permit a ‘one-stop-shop’, (2) systematic monitoring of process and clinical outcome indicators through a chronic disease registry (CDR) to promote accountability for patients’ health outcomes and (3) funding streams for PCNs to hire additional manpower to oversee operations and to reimburse GPs for extended consultations. Barriers include high administrative load in maintaining the CDR due to the lack of a smart electronic clinic management system and financial gradient faced by patients seeking services from private GPs which incur higher out-of-pocket expenses than public primary healthcare institutions. Conclusion: PCNs demonstrate great promise in empowering enrolled GPs to manage patients with chronic conditions. However, barriers will need to be addressed to ensure the viability of PCNs in managing more patients in the face of an ageing population. Ministry of Health (MOH) National Medical Research Council (NMRC) Published version This study was funded by two grants. The National Medical Research Council (NMRC) and Ministry of Health (MOH), Singapore, Health Service Research Grant (HSRG) (Funding Number: NMRC/HSRG/0086/2018) and the Centre Grant Programme Singapore Population Health Improvement Center (Funding Number: NMRC/CG/C026/2017_NUHS). 2021-10-28T03:39:35Z 2021-10-28T03:39:35Z 2021 Journal Article Foo, C. D., Surendran, S., Tam, C. H., Ho, E., Matchar, D. B., Car, J. & Koh, G. C. H. (2021). Perceived facilitators and barriers to chronic disease management in primary care networks of Singapore : a qualitative study. BMJ Open, 11(5), e046010-. https://dx.doi.org/10.1136/bmjopen-2020-046010 2044-6055 https://hdl.handle.net/10356/151976 10.1136/bmjopen-2020-046010 33947737 2-s2.0-85105525314 5 11 e046010 en NMRC/HSRG/0086/2018 NMRC/CG/C026/2017_NUHS BMJ Open © 2021 Author(s) (or their employer(s)). Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. application/pdf |
| spellingShingle | Science::Medicine Change Management Clinical Governance Foo, Chuan De Surendran, Shilpa Tam, Chen Hee Ho, Elaine Matchar, David Bruce Car, Josip Koh, Gerald Choon Huat Perceived facilitators and barriers to chronic disease management in primary care networks of Singapore : a qualitative study |
| title | Perceived facilitators and barriers to chronic disease management in primary care networks of Singapore : a qualitative study |
| title_full | Perceived facilitators and barriers to chronic disease management in primary care networks of Singapore : a qualitative study |
| title_fullStr | Perceived facilitators and barriers to chronic disease management in primary care networks of Singapore : a qualitative study |
| title_full_unstemmed | Perceived facilitators and barriers to chronic disease management in primary care networks of Singapore : a qualitative study |
| title_short | Perceived facilitators and barriers to chronic disease management in primary care networks of Singapore : a qualitative study |
| title_sort | perceived facilitators and barriers to chronic disease management in primary care networks of singapore a qualitative study |
| topic | Science::Medicine Change Management Clinical Governance |
| url | https://hdl.handle.net/10356/151976 |
| work_keys_str_mv | AT foochuande perceivedfacilitatorsandbarrierstochronicdiseasemanagementinprimarycarenetworksofsingaporeaqualitativestudy AT surendranshilpa perceivedfacilitatorsandbarrierstochronicdiseasemanagementinprimarycarenetworksofsingaporeaqualitativestudy AT tamchenhee perceivedfacilitatorsandbarrierstochronicdiseasemanagementinprimarycarenetworksofsingaporeaqualitativestudy AT hoelaine perceivedfacilitatorsandbarrierstochronicdiseasemanagementinprimarycarenetworksofsingaporeaqualitativestudy AT matchardavidbruce perceivedfacilitatorsandbarrierstochronicdiseasemanagementinprimarycarenetworksofsingaporeaqualitativestudy AT carjosip perceivedfacilitatorsandbarrierstochronicdiseasemanagementinprimarycarenetworksofsingaporeaqualitativestudy AT kohgeraldchoonhuat perceivedfacilitatorsandbarrierstochronicdiseasemanagementinprimarycarenetworksofsingaporeaqualitativestudy |