Singapore is undergoing an unprecedented shift in population age demographics, caused by a triple whammy – a rapidly ageing population, increased life expectancy, and low fertility rates. This will have major repercussions on society, in terms of the pressure on a shrinking workforce to support the aged, as well as an increase in demand for healthcare services.
In light of this, Singapore’s healthcare leaders have had to relook its population health strategies. “We have a rapidly ageing population, with an increasing old age support ratio and increasing multi-morbidity. Besides working on integrated care for older persons with complex needs, we need to move upstream to preventative health, as well as health promotion, and take a life-course approach to population health,” said Assoc Prof. Low Lian Leng, Director of the Population Health and Integrated Care Office in Singapore General Hospital.
“Therefore, our healthcare financing models have to encourage proactive care, instead of reactive care.”
An integrated care model
Besides his work in population health, Prof Low is also involved in a pilot programme to integrate care for patients under a single care team. Termed “Integrated General Medicine” (IGM), the concept involves the co-management of patients by care team members from both acute and community hospitals, as they chart the patients’ recovery journey and transition back into the community.
Earlier work by the Ministry of Health’s (MOH) Office for Healthcare Transformation (MOHT) had shown better recovery in certain groups of patients cared for under this concept. IGM also holds promise in other areas, as Prof Low explains: “The focus of IGM is in shortening the patient’s length of stay in a timely manner, while considering the intermediate and long term needs of the patient. It also involves right-siting them to the next care provider, and ensuring a good handover, with the hope of reducing readmissions.”
This is an approach in which the focus of hospital care moves beyond the short-term goal of getting patients discharged. Throughout his career, Prof Low has experienced first-hand the “cliff effect” that many patients face after being discharged. This happens when the condition of a patient – despite improving over the duration of their hospital stay – deteriorates when they are back home.
“My family physician training has taught me to provide personalised, comprehensive and coordinated care for my patients,” said Prof Low. “Witnessing the ‘cliff effect’ has inspired me to work on transformative care models that aim to improve care transitions, as well as empower the patient and their caregivers in close partnership with the community providers.”
Prof Low and the SGH team has partnered MOHT and Outram Community Hospital on the pilot programme, which was launched in January 2021. “We hope this pilot programme will balance the limited resources as well as patient and family’s expectations,” he said.
The impact of COVID-19
While one of the programme aims is to integrate patient care to a smaller care team, the COVID-19 pandemic has inevitably impacted their plans.
“COVID-19 has introduced more ward segregation and increased handoffs between teams within the same hospitalisation. For patients with acute respiratory infections (ARI) or fevers, they will spend the first two to three days in an ARI ward before transferring to a general ward. During this transition, our IGM team may lose precious time, and miss the opportunity to review and assist in discharge planning in a timely manner,” Prof Low explained.
In addition, while discharge planning pre-pandemic was usually held with family members face-to-face – which were more meaningful – they now had to be conducted via the phone.
But Prof Low noted that these issues are nothing compared to the impact that the restrictions on arrivals of foreign domestic workers and caregivers has on IGM. The lower number of these workers in Singapore means that some patients have had to undergo longer hospital stays, while resources downstream at nursing homes, as well as interim caregiver service providers, are also strained.
Future of integrated care in Singapore
So, in a post-pandemic era, how would we envision the future of integrated care in Singapore to be like?
To see the concept further take root here, Prof Low pointed to the importance of incorporating the principles of integrated care – linking the health and social aspects of patient care, and providing person-centred care – as critical components in medical education. “If we can inculcate some of these principles early on in their training, and teach them to holistically manage patients, as well encourage inter-professional education, we can hopefully produce a future generation of doctors who are well poised to tackle an aging population, as well as patients who have complex bio-psycho-social needs.”
Prof Low will be one of the speakers at HMA’s annual flagship event, to be held on 14-15 September 2021. The theme of this year’s conference will be centred on “Reimagining healthcare in the new normal through innovations.” Hear from Prof Low as he shares more about how SGH implemented their IGM model, He will also showcase the preliminary results at improving handoffs and post-discharge outcomes for patients, the effect on provider experience, as well as the valuable lessons learnt from the implementation process. Register now for the event at this link.