Integrating rheumatology care in the community: can shared care work?
<p><strong>Introduction: </strong>Singapore's rapidly ageing population and chronic disease burden at public hospital specialist clinics herald a silver tsunami. In Singapore, “right siting” aims to manage stable chronic disease in primary care at a lower cost. To improve the...
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doaj-75923a5a0f7c4360b8d3592bfff0bc0c2020-11-24T23:06:23ZengUbiquity PressInternational Journal of Integrated Care1568-41562015-08-011531897Integrating rheumatology care in the community: can shared care work?Anita YN Lim0Chuen-Seng Tan1Bernadette PL Low2Tang-Ching Lau3Tze- Lee Tan4Lee-Gan Goh5Gim-Gee Teng6Assistant Professor, Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, SingaporeBSc, MSc, PhD, Assistant Professor, Saw Swee Hock School of Public Health, National University of Singapore, SingaporeCare coordinator, Care Integration and Alliances, National University Health SystemAssociate Professor, Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, SingaporeAdjunct Assistant Professor , Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Division of Family Medicine, University Medicine Cluster, National University Health System, Institute of Family Medicine, College of Family Physicians, SingaporeMBBS, FCFP, FRCGP, Associate Professor ,Yong Loo Lin School of Medicine, National University of Singapore; Institute of Family Medicine, College of Family Physicians, SingaporeMBBS, Assistant Professor, Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore<p><strong>Introduction: </strong>Singapore's rapidly ageing population and chronic disease burden at public hospital specialist clinics herald a silver tsunami. In Singapore, “right siting” aims to manage stable chronic disease in primary care at a lower cost. To improve the quality of rheumatology care, we created shared care between rheumatologist and family physician to reduce hospital visits.</p><p><br /><strong>Methods: </strong>Clinical practice improvement methodology was used to structure shared care of stable patients between hospital rheumatologists and eleven community family physicians; one ran a hospital clinic. A case manager coordinated the workflow.</p><p><br /><strong>Results: </strong>About 220 patients entered shared care over 29 months. Patients without hospital subsidies (private patients) and private family physicians independently predicted successful shared care, defined as one cycle of alternating care.</p><p><br /><strong>Discussion: </strong>Our shared care model incorporated a case manager, systematic workflows, patient selection criteria, willing family physician partners and rheumatologists in the absence of organizational integration. Health care affordability impacts successful shared care. Government subsidy hindered right siting to private primary care.</p><p><br /><strong>Conclusions: </strong>Financing systems in Singapore, at health policy level, must allow transfer of hospital subsidies to primary care, both private and public, to make it more affordable than hospital care. Structural integration will create a seamless continuum between hospital and primary care.</p>http://www.ijic.org/index.php/ijic/article/view/1990musculoskeletal diseasesrheumatologyfamily physicianintegrated carefinancingSingapore |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Anita YN Lim Chuen-Seng Tan Bernadette PL Low Tang-Ching Lau Tze- Lee Tan Lee-Gan Goh Gim-Gee Teng |
spellingShingle |
Anita YN Lim Chuen-Seng Tan Bernadette PL Low Tang-Ching Lau Tze- Lee Tan Lee-Gan Goh Gim-Gee Teng Integrating rheumatology care in the community: can shared care work? International Journal of Integrated Care musculoskeletal diseases rheumatology family physician integrated care financing Singapore |
author_facet |
Anita YN Lim Chuen-Seng Tan Bernadette PL Low Tang-Ching Lau Tze- Lee Tan Lee-Gan Goh Gim-Gee Teng |
author_sort |
Anita YN Lim |
title |
Integrating rheumatology care in the community: can shared care work? |
title_short |
Integrating rheumatology care in the community: can shared care work? |
title_full |
Integrating rheumatology care in the community: can shared care work? |
title_fullStr |
Integrating rheumatology care in the community: can shared care work? |
title_full_unstemmed |
Integrating rheumatology care in the community: can shared care work? |
title_sort |
integrating rheumatology care in the community: can shared care work? |
publisher |
Ubiquity Press |
series |
International Journal of Integrated Care |
issn |
1568-4156 |
publishDate |
2015-08-01 |
description |
<p><strong>Introduction: </strong>Singapore's rapidly ageing population and chronic disease burden at public hospital specialist clinics herald a silver tsunami. In Singapore, “right siting” aims to manage stable chronic disease in primary care at a lower cost. To improve the quality of rheumatology care, we created shared care between rheumatologist and family physician to reduce hospital visits.</p><p><br /><strong>Methods: </strong>Clinical practice improvement methodology was used to structure shared care of stable patients between hospital rheumatologists and eleven community family physicians; one ran a hospital clinic. A case manager coordinated the workflow.</p><p><br /><strong>Results: </strong>About 220 patients entered shared care over 29 months. Patients without hospital subsidies (private patients) and private family physicians independently predicted successful shared care, defined as one cycle of alternating care.</p><p><br /><strong>Discussion: </strong>Our shared care model incorporated a case manager, systematic workflows, patient selection criteria, willing family physician partners and rheumatologists in the absence of organizational integration. Health care affordability impacts successful shared care. Government subsidy hindered right siting to private primary care.</p><p><br /><strong>Conclusions: </strong>Financing systems in Singapore, at health policy level, must allow transfer of hospital subsidies to primary care, both private and public, to make it more affordable than hospital care. Structural integration will create a seamless continuum between hospital and primary care.</p> |
topic |
musculoskeletal diseases rheumatology family physician integrated care financing Singapore |
url |
http://www.ijic.org/index.php/ijic/article/view/1990 |
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