Chronic Disease Management with Your Family Doctor

More Singaporeans are suffering from chronic illnesses, which are defined as diseases or conditions that usually last for 3 months or longer, and may worsen over time.

The proportion of older adults with 3 or more chronic diseases has nearly doubled from 2009 to 2017. Some of the most commonly experienced chronic health conditions are high blood pressure, high blood cholesterol, diabetes, joint pain and arthritis.

Chronic disease can be effectively managed through regular checks with a family doctor. Such regular visits allow the doctor to better understand the patient's condition and preferences, and will go a long way in helping to tailor a patient's treatment, and in offering health advice that can improve their overall health.

Common chronic conditions

Here are some common chronic conditions under the Chronic Disease Management Programme (CDMP) that your family doctor can help manage. The CDMP is a national programme available at primary care clinics such as the general practice clinics by Parkway Shenton.

• Diabetes mellitus / pre-diabetes
• Hypertension
• Hyperlipidemia (lipid disorders)
• Osteoarthritis
• Gout
• Allergic rhinitis
• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Chronic hepatitis B
• Anxiety
• Schizophrenia
• Major depression
• Bipolar disorder
• Dementia

The CDMP allows patients to use their MediSave for treatment of their chronic conditions. Patients with CHAS (Community Health Assist Scheme) cards, or who are Pioneer and Merdeka Generation cardholders, are also able to receive subsidies for medical care participating clinics such as those operated by Parkway Shenton.

Services for chronic disease patients at Parkway Shenton

Parkway Shenton has a variety of services to help in the optimal and effective management of chronic disease patients.

These include specific screening services for patients with diabetes (e.g. eye and feet screening tests) and heart disease (e.g. ambulatory blood pressure monitoring), health education, dietary and nutrition advice, device assessment and instruction, and smoking cessation programmes.

Here's a closer look at some specific services for patients:

Health education

Being newly diagnosed with a chronic illness can be overwhelming, especially with so much information to take in and not much known about how or where to start to better control the condition.

Education by our team of doctors and nurses at Parkway Shenton can help patients better understand their conditions, especially for common ones such as diabetes, hypertension, gout or cholesterol conditions. These can be done via a face-to-face session at a Parkway Shenton clinic or via a teleconsultation.

Dietary and nutrition advice

Eating the right foods is often the most important first step in controlling chronic illnesses such as diabetes, high blood pressure, and high cholesterol. Diet counselling can help guide patients in spotting common mistakes in their diet and pick up tips and advice on the right foods to take.

Health device assessment and education

Newly diagnosed with diabetes but unsure about how to check your own blood sugar?

Having a session with a nurse counsellor can help patients learn the skills that can empower them to manage their condition. The nurse can teach them how to use a home glucometer to check their blood sugar, how to administer insulin injections, and how to accurately check their blood pressure on their own at home. They will also learn how to ensure that their blood pressure monitors are calibrated and working well.

Smoking cessation

Quitting smoking is one of the most important lifestyle changes patients with chronic illnesses can do for themselves. Patients on a dedicated counselling programme for smoking cessation have doubled the success rate of quitting compared to patients who try to quit on their own. They are more likely to quit smoking successfully with the help of their doctor and with counselling intervention.

Screening tests

Screening is one of the most effective ways to monitor the status or progression of a chronic illness. Here are some examples.

Diabetes eyes and feet tests

Diabetic eye disease (retinopathy) is one of the most common complications of diabetes and is a leading cause of blindness among working adults. Did you know that one-third of diabetic patients have eye disease, and 1 in 10 have vision-threatening levels of retinopathy?

Diabetic eye screening, done annually, is essential to find out if the patient is at risk of developing diabetic eye complications. This test takes about 30 minutes, and the nurse will photograph an image of the retina to check for any early eye diseases from diabetes. Sometimes eye drops may be instilled into the patient's eyes to help dilate the pupils and facilitate this process.

Singapore also has one of the highest rates of lower extremity amputations in the world, and diabetes is an important risk factor. The lifetime risk of developing a foot ulcer is 15%, while in diabetics, this incidence may be as high as 25%. In diabetics, 84% of non-traumatic limb amputations are preceded by foot ulcers, and the risk is 25 times more as compared to patients without diabetes.

An annual foot screening can help to detect early foot problems in diabetic patients. This test takes about 30 minutes, and includes visual inspection of the patient's feet to look for early signs of blood supply problems, wounds and ulcers. The nurse may give tips on feet care and how to trim the toenails correctly to prevent skin infections around the nail. The nurse will also check on feet pulses and use a thin filament to check for numbness.

Ambulatory blood pressure monitoring

A doctor may order ambulatory blood pressure tests for patients with white coat hypertension or blood pressure that is difficult to control.

The benefits of such regular tests are useful in the following circumstances:

• There are wide differences between home and clinic blood pressure
• To aid diagnosis in borderline hypertension
• Blood pressure that is difficult to control
• To check for nocturnal hypertension (for patients with higher cardiovascular risk)

As part of the test, a wrist monitor is strapped to the wrist for 24 hours. At regular intervals, the patient's blood pressure will be automatically measured and recorded in the device. This device is then returned to the nurse at the end of the 24-hour period so the doctor can then interpret the readings.

This 24-hour blood pressure readings offer valuable insight into the patient's condition as they go about daily activities and while asleep.

Prevention is better than cure

Building a relationship with your primary care doctor can be a good thing. It will allow your doctor to better understand your health risks and prescribe preventive solutions to help. These may be as simple as regular health screenings or vaccinations to prevent disease. This helps to save money in the long run by preventing the development of complications due to late or untreated illnesses.

Examples of some health screening tests which may be ordered by your doctor include:

• Mammogram to screen for breast cancer
• Pap smear to screen for cervical cancer
• Stool test to screen for colon cancer

Speak to your doctor and locate the nearest Parkway Shenton clinic to you here and make an appointment for a medical evaluation.