What are the measures taken to prevent COVID-19 infection among healthcare workers? A retrospective study in a cluster of primary care clinics in Singapore.

OBJECTIVE: To examine factors contributing to the low COVID-19 infectivity rate among healthcare workers in SingHealth Polyclinics (SHP), Singapore, from February to July 2020. DESIGN: Retrospective description, analysis and discussion of the factors and their contribution. SETTING: Single-institution study. METHODS: We describe and discuss the healthcare policies, infrastructure, people and processes contributing to the low COVID-19 infectivity rate in SHP.There were 1212 full-time and 198 contract staff. Of these, 171 SHP employees also supported the work in dormitories, isolation and community care facilities. During the review period, healthcare workers (HCWs) in SHP managed about 867 076 patient attendances, including 63 503 for upper respiratory tract infections, across its cluster of eight polyclinics. 29 642 swabs for COVID-19 were performed in SHP, with 126 positive results. 395 swabs were carried out in the dormitories and 59 were positive. Despite the high exposure, only two SHP staff were infected with COVID-19. Both have recovered well. RESULTS: Provision of adequate personal protection equipment, zonal segregation of high-risk patients, reduction in physical patient visits, effective staff communication, implementation of self-declared temperature monitoring and the maintenance of sustainable workload and work hours of HCWs contributed to the mitigation of COVID-19 infection risk among our staff. CONCLUSIONS: Until the widespread uptake of safe and effective vaccines against COVID-19, these measures are important in protecting HCWs. They are also important when managing future pandemics of similar nature to COVID-19.

Evaluation of a training programme to induct medical students in delivering public health talks.

INTRODUCTION: It is uncommon for medical students to deliver public health talks as part of their medical education curriculum. This study evaluated the effectiveness of a novel training programme that required medical students to deliver public health talks during their family medicine (FM) clerkship in a Singapore primary care institution. METHODS: The FM faculty staff guided teams of third-year medical students to select appropriate topics for health talks that were to be conducted at designated polyclinics. The talks were video-recorded and appraised for clarity, content and delivery. The appraisal was done by the student's peers and assigned faculty staff. The audience was surveyed to determine their satisfaction level and understanding of the talks. The students also self-rated the effectiveness of this new teaching activity. RESULTS: A total of 120 medical students completed a questionnaire to rate the effectiveness of the new teaching activity. 85.8% of the students felt confident about the delivery of their talks, 95.8% reported having learnt how to deliver talks and 92.5% perceived this new training modality as useful in their medical education. Based on the results of the audience survey, the speakers were perceived as knowledgeable (53.1%), confident (51.3%) and professional (39.0%). Assessment of 15 video-recorded talks showed satisfactory delivery of the talks by the students. CONCLUSION: The majority of the students reported a favourable overall learning experience under this new training programme. This finding is supported by the positive feedback garnered from the audience, peers of the medical students and the faculty staff.

Cross-cultural measurement equivalence of the 5-level EQ-5D (EQ-5D-5L) in patients with type 2 diabetes mellitus in Singapore.

BACKGROUND: This study aimed to assess the measurement equivalence of the 5-level EQ-5D (EQ-5D-5L) among the English, Chinese, and Malay versions. METHODS: A convenience sample of patients with type 2 diabetes mellitus were enrolled from a public primary health care institution in Singapore. The survey questionnaire comprised the EQ-5D-5L and questions assessing participants' socio-demographic and clinical characteristics. Multiple linear regression models were used to assess the difference in EQ-5D-5L index (calculated using an interim algorithm) and EQ-visual analog scale (EQ-VAS) scores across survey language (Chinese vs. English, Malay vs. English, and Malay vs. Chinese). Measurement equivalence was examined by comparing the 90% confidence interval of difference in the EQ-5D-5L index and EQ-VAS scores with a pre-determined equivalence margin. Multiple logistic regression models were used to assess the response patterns of the 5 Likert-type items of the EQ-5D-5L across survey language. RESULTS: Equivalence was demonstrated between the Chinese and English versions and between the Malay and English versions of the EQ-5D-5L index scores. Equivalence was also demonstrated between the Chinese and English versions and between the Malay and Chinese versions of the EQ-VAS scores. Equivalence could not be determined between the Malay and Chinese versions of the EQ-5D-5L index score and between the Malay and English versions of the EQ-VAS score. No significant difference was found in responses to EQ-5D-5L items between any languages, except that patients who chose to complete the Chinese version were more likely to report "no problems" in mobility compared to those who completed the Malay version of the questionnaire. CONCLUSIONS: This study provided evidence for the measurement equivalence of the different language versions of EQ-5D-5L in Singapore.

Interpretation and use of the 5-level EQ-5D response labels varied with survey language among Asians in Singapore.

OBJECTIVES: This study aimed to investigate the comparability of the English, Chinese, and Malay versions of the 5-level EQ-5D (EQ-5D-5L) response labels in Singapore. STUDY DESIGN AND SETTING: Visitors to a primary care institution in Singapore (n = 743) were asked to complete two exercises: (1) rating the severity of the EQ-5D-5L response labels presented in English, Chinese, or Malay using a 0-100 numeric rating scale and (2) using the labels to describe various hypothetical health problems. Label ratings and choices between language versions were compared using regression analysis. RESULTS: Perceived severity of the English and Chinese labels was similar. Compared with their English counterparts, the Malay label "slight(ly)" was rated as more severe (adjusted mean difference: 10.5 to 14.5) and "unable"/"extreme(ly)" as less severe (adjusted mean difference: -13.3 to -11.0) (P < 0.001 for all). The Malay labels "no(t)" and "unable"/"extreme(ly)" and the less severe Chinese labels were more frequently used to describe hypothetical health problems than their English counterparts. CONCLUSION: Interpretation and use of the EQ-5D-5L response labels vary among Singaporeans using different language versions of the instrument. Future studies need to investigate ways to reduce the variations and increase the cross-cultural measurement equivalence of the instrument.

Younger adult type 2 diabetic patients have poorer glycaemic control: a cross-sectional study in a primary care setting in Singapore.

BACKGROUND: The aim was to study the glycaemic control of type 2 diabetic patients, and to identify factors associated with unacceptable glycaemic control (defined as HbA1c >8.0%). METHODS: Analysis of data collected in a cross-sectional survey of type 2 diabetic patients in eight SingHealth Polyclinics in January 2009. HbA1c value was measured on the day of the survey, while information on patient and diabetic characteristics was obtained through a questionnaire. Odds ratio of having unacceptable glycaemic control was estimated for selected variables using multiple logistic regression models. RESULTS: A total of 688 patients were included in the analysis. The mean (± standard deviation) and median (range) HbA1c levels were 7.6% (± 1.35) and 7.3% (5.0% to 14.0%), respectively. 25.4% of the patients had an unacceptable HbA1c level of >8.0% and the odds of this were higher (p < 0.05) in patients with the following characteristics: younger age, longer diabetes duration, presence of insulin treatment, and poorer compliance to medication. CONCLUSION: Younger adult patients were found to have poorer glycaemic control, and hence targeted educational and behaviour modification programmes would be required to effectively manage this group of patients.

Postgraduate family medicine training in Singapore--a new way forward.

Postgraduate Family Medicine (FM) training is important to train future primary care doctors to provide accessible and cost effective healthcare. In Singapore, a structured postgraduate FM training programme has been available for 20 years. This programme is characterised by involvement of both FM and non-FM doctors, well written modules and a rigorous assessment process. However, challenges faced by both the current healthcare system and training structure underlie the need to review the training structure to ensure its relevancy for future Family Physicians (FPs) to manage the needs of their patients. A workgroup was formed to review the current FM postgraduate programme and to explore the possibility of using the Accreditation Council for Graduate Medical Education (ACGME) framework to enhance our current system. The workgroup felt that broad-based training and comprehensive coverage of topics are areas that are important to retain in any new FM residency programme. Weaknesses identified included a lack of early FM exposure and the need to strengthen formative assessments. New organisational structures such as Family Medicine Centres (FMC) need to be established and the involvement of the private sector in any FM residency progammes could be enhanced. The implementation of the FM Residency Programme in 2011 presented a unique opportunity to realign FM postgraduate education in line with the national objectives and to equip FPs with the necessary knowledge and skills for managing the future healthcare needs of Singaporeans.

The discriminative power of the EuroQol visual analog scale is sensitive to survey language in Singapore.

BACKGROUND: Existing evidence for validity of the visual analog scale of the EQ-5D-3L questionnaire (EQ-VAS) is weak in Chinese-speaking respondents in Singapore. We therefore investigated the validity of the Chinese (Singapore) version of EQ-VAS in patients with diabetes. METHODS: In a cross-sectional survey, patients with type 2 diabetes seen in a primary care facility completed an identical Chinese or English questionnaire containing the EQ-5D-3L and questions assessing other health and disease-related characteristics. Convergent and known-groups validity of the EQ-VAS was examined for Chinese- and English-speaking respondents separately. RESULTS: The EQ-VAS was correlated with the EQ-5D-3L health index and a 5-point Likert-type scale for assessing global health in both Chinese-speaking (N = 335) and English-speaking respondents (N = 298), suggesting convergent validity. The mean EQ-VAS scores differed between English-speaking patients with differing duration of diabetes (< 10 years versus ≥ 10 years), comorbidity status (absence versus presence), and complications of diabetes (absence versus presence), providing evidence for known-groups validity. However, the EQ-VAS scores for Chinese-speaking respondents known to differ in these characteristics were similar, even among subgroups of relatively younger patients or those with formal school education. CONCLUSIONS: Chinese- and English-speaking Singaporeans respond differently to the EQ-VAS. The Chinese version of EQ-VAS appears less sensitive than its English version for measuring global health in patient populations in Singapore.

Health-related quality of life is associated with diabetic complications, but not with short-term diabetic control in primary care.

INTRODUCTION: Type 2 diabetes mellitus is of increasing healthcare concern worldwide, with incidence rising, complications leading to significant morbidity and mortality, posing strain on public healthcare funding. Health-related quality of life of diabetic patients is increasingly being recognised as "the ultimate goal of all health interventions". The aim of our study was to identify the quality of life predictors of diabetic patients in primary care. This study was conducted in 8 public primary care polyclinics from SingHealth Polyclinics. MATERIALS AND METHODS: We carried out a cross-sectional, questionnaire-based survey on 699 diabetic patients, administered by medical students on a systematic sample of patients during their routine visit. Multiple regression analysis was used to investigate the socio-demographic and clinical characteristics as predictors of quality of life, measured by the Short Form 36 Health Survey (SF-36) and the EQ-5D self-report questionnaire. RESULTS: Higher quality of life in diabetic patients is associated with younger age, male gender, employed status, higher educational level and exercise. Lower quality of life is associated with comorbidities and diabetic complications. Short-term glycaemic control as measured by HbA1c did not correlate with quality of life. Most interestingly, confidence in doctor and satisfaction in clinic were related to better quality of life. CONCLUSION: Health-related quality of life is adversely associated with symptomatic complications of diabetes mellitus, but not with short-term diabetic control. This suggests that the diabetic patient may not appreciate the impact of good diabetic control immediately on his or her health-related quality of life. More effort should be invested into patient education of the importance of glycaemic control to prevent these long-term complications.

Acceptance of information and communication technologies for healthcare delivery: a SingHealth Polyclinics study.

OBJECTIVE: This study aimed to determine the prevalence of short message system (SMS) and internet usage in patients visiting the SingHealth Polyclinics and to measure patients' acceptance of using these technologies in healthcare delivery. MATERIALS AND METHODS: A representative sample of patients visiting the 9 SingHealth Polyclinics were interviewed in-person by trained medical students. Collected information included demographic characteristics, access to and usage of mobile phone/SMS and internet, as well as acceptance and concerns on using these technologies in primary healthcare delivery. RESULTS: Among 705 patients surveyed (mean age: 54.6 years, female: 50.6%, response rate: 92%), 407 (57.7%) were SMS users and 158 (22.4%) were internet users. Two hundred and eighty-four of 412 SMS and/or internet users (40.3% of the entire sample) were comfortable with the use of these technologies in healthcare delivery. Malay or Indian ethnicity, better education, and visiting the clinic for acute symptoms or screening were factors positively associated with willingness to use such technologies. The main concerns associated with the use of SMS and internet in healthcare delivery were preference for in-person consultation with a doctor (23.5%), reduced patient-doctor interaction (23.0%), and increased healthcare cost (20.8%). CONCLUSION: The present prevalence of SMS and internet usage among patients visiting the SingHealth Polyclinics and their concerns towards use of these technologies in healthcare delivery do not support current widespread implementation of services entailing SMS and internet in the study sites.