The challenge with managing diabetes is that the disease is closely linked to the lifestyle of the individual. The eating and exercise patterns are influenced by the individual's social and motivation factors. Adherence to medication can be a challenge for some due to reasons such as financial issues, cognitive impairment, fear of side effects, just to name a few. These factors should to be sought whenever we manage a diabetic but it can be challenging through conventional way of providing care.
Through this presentation, I will share case studies and SingHealth Polyclinic’s approach to managing diabetics from those newly diagnosed to those who are poorly controlled and have significant psycho-social issues. Through initiatives such as Case Management and Team Based Care, we have developed a more holistic approach for Diabetes Management.
Topic 2:
“Get Me Walking Again!”
The Unique Role of Family Physicians in Providing General and Rehabilitation Medicine
Speaker: Dr Farhad Fakhrudin Vasanwala
Family Physicians are experts at consolidating the multiple medical comorbidities, care coordination, and care transitions. However, the rehabilitation medicine knowledge family physicians possess is not adequate, especially when faced with increasingly complex rehabilitation needs in the subacute and slow stream medicine settings. Sengkang Health's Family Medicine department and Singapore General Hospital's Rehabilitation Medicine department are currently implementing a new model of care, especially for our patients in subacute and slow stream rehabilitation. We have incorporated various evidenced-based scales into the care of our patients, and have introduced structured clinical teaching for our doctors in both Rehabilitation and Family Medicine, on how our patients can be rehabilitated and monitored more objectively based on best evidenced data and practices.
The physicians from both disciplines do joint rounds for all patients in the ward, leveraging on the strength of each other's discipline. This results in speedier recovery, shorter hospital stays and greater satisfaction for our patients. As a result of the close collaboration of physicians from two different disciplines,our family physicians will be well equipped with cross-disciplinary skills. This talk will showcase examples of the outcomes achieved, aspirations for the future, and possible avenues for research to further improve patients care in a community hospital.
Topic 3:
Urinary Incontinence - "Fixing the Leak"
Speaker: Dr Lim Jietong
Urinary incontinence (UI) is a common condition with a female predominance. The Singapore Continence Society estimates UI prevalence amongst community-dwelling women to be 30%; fewer than half of the affected seek help. Timely diagnosis and treatment of reversible causes can maintain dignity and prevent long-term consequences.
Our primary aim was to determine the prevalence of UI amongst older women with comorbidities. The secondary aims were to identify common presenting symptoms, factors associated with UI, and its health impact. We conducted a cross-sectional study of women aged ≥45 years attending SingHealth Polyclinics (Geylang, Bedok and Sengkang) for chronic disease. An interviewer-administered questionnaire was used, incorporating the International Consultation on Incontinence Modular Questionnaire (ICIQ), demographics, medical history, and quality-of-life factors. Patients scoring ≥1 on the ICIQ were classified as having UI.
A total of 413 women (aged 66.3±13.4years) were recruited between 23rd and 28th May 2016. The prevalence of UI was seen in 226 patients (54.6%), of whom 63 (27.9%) and 21 (9.3%) experienced moderate UI and severe UI, respectively. Seventy-one women (31.4%) required protection for urine leakage. The most common type of UI was stress-induced UI (45.6%). On multivariate analysis, prior stroke was associated with UI. Calcium channel blocker use was protective. Eighty-four women (37.1%) reported that UI had adversely impacted their lives. However, only 38 women (16.8%) had reported their UI symptoms to a doctor. Top reasons for not seeking professional help were: thinking their condition was not serious (64.6%), and assuming UI was a normal part of aging (27.9%). Urinary incontinence is a highly prevalent condition that can reduce quality of life. Physicians managing patients with chronic diseases need to look out for urinary incontinence to institute interventions in a timely manner.
Topic 4:
“Warfarin: A Dr Jekyll and Mr Hyde Drug"
Making it Safe through the SingHealth Polyclinic’s Pharmacist-managed Anticoagulation Therapy Service
Speaker: Ms Maureen Tan
Warfarin has been used as an anticoagulant since
1954. Though it is efficacious in the prevention and treatment of venous
thromboembolic events, it also comes with its own set of adverse reactions, in
which some can be rather serious. SingHealth Polyclinic's
pharmacist-managed anticoagulation service targets warfarin patients in
view of the close monitoring required and extensive counselling needed with the
aim of improving compliance rate through its safe use.
