Background

1. GENERAL PRACTITIONER LANDSCAPE SURVEY 2011 Harold Lim, Wayne Freeman Chong, Kirk Chuan Wong Agency for Integrated Care, Singapore Background Methodology Results The number of elderly aged 65 years and above is expected to *triple from 100,000 in 2010 to 900,000 in 2030. With this increase in elderly population, a higher prevalence of chronic diseases (CD) will ensue. Hence, chronic disease management (CDM) is becoming a cornerstone of Singapore’s healthcare landscape. In view of the increasing importance of chronic care, the Agency for Integrated Care (AIC) conducted a survey to find out the specific areas of need in which the agency could work with General Practitioners (GPs) to enhance CDM in Singapore’s primary care sector. Besides being part of AIC’s engagement strategies, this is in conjunction with the finding from the Primary Care Survey 2010  which notes the decrease in GP share of chronic care. *Based on projections by the Ministry of Health, Singapore. An interviewer-administered questionnaire was carefully constructed through consultations with the various healthcare agencies and institutions, including the Ministry of Health (MOH), Health Promotion Board (HPB) and Restructured Hospitals (RHs). A pilot study was first rolled out to four GPs to ascertain the questionnaire’s clarity and viability. Thereafter, the survey was administered to 500 GPs randomly-sampled from within two clinic types (group and non-group) and four geographical districts (Central, North, East and West) of Singapore. It was conducted between July to August 2011. The domains covered in the questionnaire included clinic patient profile and participation in national healthcare programmes. • Other findings include: • Seven in 10 GPs seemental health patients, with Anxiety being the most commonly attended mental ailment. • Those who do not attend to mental health patients cite the lack of drugs and facilities in their clinics as well as unfamiliarity with mental health patient management as main reasons. • Diabetic Retinal Photography (DRP), Diabetic Foot Screening (DFS), X-ray, and podiatry are services which GPs most commonly refer their patients to. • One in four GPs do not use computers in their clinics, largely because they or their clinic assistants are used to writing notes or are unfamiliar with using computers. Figure 1. 69% of GPs have 20% or less CD patients on their monthly patient load. Figure 2. Access to #group purchase order (GPO) drugs and ability to refer patients to RHs as subsidised status are main factors that encourage GPs to see more CD patients. Figure 4. A simpler claims process is the topmost consideration for GPs to participate in the Chronic Disease Management Programme (CDMP) and Primary Care Partnership Scheme (PCPS), nowknown as the Community Health Assist Scheme (CHAS). Figure 3. 43% of GPs believe having comparable subsidies for patients between private clinics and polyclinics will increase the number of CD and mental health patients at their clinics. #GPO drugs: drugs bought in bulk and thus at lower costs. Conclusion The views of GPs gathered in this survey render insights into how chronic care in Singapore can be enhanced. With the increase in elderly population, access to GPO drugs (Fig. 2), the ability to refer patients to RHs at subsidised rates (Fig. 2), the provision of support services (Figs. 2 and 3) and improvements in CDMP and PCPS/CHAS (Fig. 4) can help policymakers and healthcare providers to better meet the growing needs of the primary care sector and the changing healthcare demands.