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Preprint in English | EuropePMC | ID: ppcovidwho-328578


Background: Patients with complex needs require greater biopsychosocial support. Fragmented services often result in gaps, duplication or incompatibility in treatments, leading to poorer health outcomes and higher utilization of costly hospital-based healthcare services. Patient-Centred Medical Home (PCMH) is a primary care model reform advocated as more appropriate for patients with complex needs. This analysis assessed the impact of a PCMH demonstration on healthcare utilization for patients with complex needs in Singapore. Methods: : This study assessed the Community for Successful Ageing (ComSA)-PCMH in Singapore that was launched in Nov’2016. ComSA-PCMH serves adults aged 40 and above with complex needs, delivering care integrated between its primary care clinic, home-based care management, an acute hospital and other community-based services. This was a matched cohort analysis that used a difference-in-difference approach to compare quarterly healthcare utilization of PCMH study participants and controls. 165 PCMH study participants enrolled between Oct’2017 and Apr’2019 were compared against 5,385 controls selected using Coarsened Exact Matching from a neighbouring geographical precinct. Healthcare utilization data spanning Oct’2014 to Mar’2020 were extracted from a public regional health system, including primary care, specialist outpatient clinic and emergency department utilization, and inpatient admissions. Two-part models were fitted, with controls for socio-demographics, Charlson Comorbidity Index, secular trends including effect of COVID-19, and between-group differences. Statistical inferences were based on cluster-robust standard errors at the individual level. Results: : At ≥4 four quarters post-enrolment, PCMH study participants had sustained reductions of 1.08 polyclinic visits ( p< 0.001), 0.37 SOC visits ( p= 0.047), 0.04 ED visits ( p= 0.013) and 0.02 inpatient admissions ( p= 0.093) per person-quarter, compared to the quarter before enrolment and controls. Conclusions: : ComSA-PCMH study participants reduced healthcare utilization after enrolment into the programme, adding to a growing global body of evidence supporting the benefits of PCMH for patients with complex needs and pointing to its potential in Asia. Trial registration: This analysis is part of the ComSA Patient-Centered Care (COPACC) study, retrospectively registered with in October 2020 (Protocol ID: NCT04594967;

PLoS One ; 16(10): e0258866, 2021.
Article in English | MEDLINE | ID: covidwho-1480457


AIM: The long-term stress, anxiety and job burnout experienced by healthcare workers (HCWs) are important to consider as the novel coronavirus disease (COVID-19) pandemic stresses healthcare systems globally. The primary objective was to examine the changes in the proportion of HCWs reporting stress, anxiety, and job burnout over six months during the peak of the pandemic in Singapore. The secondary objective was to examine the extent that objective job characteristics, HCW-perceived job factors, and HCW personal resources were associated with stress, anxiety, and job burnout. METHOD: A sample of HCWs (doctors, nurses, allied health professionals, administrative and operations staff; N = 2744) was recruited via invitation to participate in an online survey from four tertiary hospitals. Data were gathered between March-August 2020, which included a 2-month lockdown period. HCWs completed monthly web-based self-reported assessments of stress (Perceived Stress Scale-4), anxiety (Generalized Anxiety Disorder-7), and job burnout (Physician Work Life Scale). RESULTS: The majority of the sample consisted of female HCWs (81%) and nurses (60%). Using random-intercept logistic regression models, elevated perceived stress, anxiety and job burnout were reported by 33%, 13%, and 24% of the overall sample at baseline respectively. The proportion of HCWs reporting stress and job burnout increased by approximately 1·0% and 1·2% respectively per month. Anxiety did not significantly increase. Working long hours was associated with higher odds, while teamwork and feeling appreciated at work were associated with lower odds, of stress, anxiety, and job burnout. CONCLUSIONS: Perceived stress and job burnout showed a mild increase over six months, even after exiting the lockdown. Teamwork and feeling appreciated at work were protective and are targets for developing organizational interventions to mitigate expected poor outcomes among frontline HCWs.

Anxiety , Burnout, Professional , COVID-19 , Health Personnel/psychology , Pandemics , SARS-CoV-2 , Adult , Aged , Anxiety/epidemiology , Anxiety/psychology , Burnout, Professional/epidemiology , Burnout, Professional/etiology , COVID-19/epidemiology , COVID-19/psychology , Female , Humans , Male , Middle Aged , Prospective Studies , Singapore/epidemiology