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In Singapore, an ageing population with increasing chronic disease burden and complex social circumstances have strained the healthcare system. For the health system to run more efficiently, patients should be appropriately sited according to their medical needs. In Singapore, community hospitals serve as an intermediate inpatient facility managing patients with sub-acute and rehabilitation care needs. Our policy brief uncovers the gaps in transforming community hospital care models and offers actionable steps to unlock the community hospital chokepoints in Singapore's health system. The future community hospitals can accommodate higher acuity but medically stable patients, while patients who do not require inpatient rehabilitation care can be appropriately sited to community partners, if policy, resourcing and technology factors are addressed. An evidence-based, stepwise approach involving all stakeholders will be required to pilot and evaluate new models before large-scale change. [ABSTRACT FROM AUTHOR]

Introduction: Hospital-based practices today remain predominantly disease-oriented, focusing on individual clinical specialties with less visibility on a comprehensive picture of each patient's health needs. To tackle the challenge of growing multimorbidity worldwide, practices without disease-specific focus have shown better integration of services. However, as we move away from the familiar disease-specific approaches of care delivery, many of us are still learning how to implement generalist care in a cost-effective manner. Methods: This mixed-method case study, which centred on a specialist-led General Medicine model implemented at an acute hospital in Singapore, aimed to (1) quantitatively summarise its clinical outcomes, and (2) qualitatively describe the challenges and lessons gathered from the pragmatic implementation of the care model. Quantitative hospital data were extracted from databases and summarised. Qualitative staff-reported experiences and insights were gathered through semi-structured interviews and analysed using thematic analysis. Results: Quantitative findings revealed that the generalist care model was implemented with high fidelity, where more than 75% of patients admitted were placed under General Medicine's or General Surgery's care. The mean length of stay was 2.6 days, and the 30-day post-discharge readmission rate was 15%. Inpatient mortality rate was found to be 2.8%, and the average gross hospitalisation bill amounted to SGD3,085.30. For qualitative findings, themes concerning feasibility and operational aspects of the implementation were grouped into categories- (1) Feasibility of 'One Care Team' approach, (2) Enablers required for meaningful generalist care, (3) Challenges surrounding information sharing, (4) Lack of integration with the community to facilitate care transition, and (5) Evolving roles of self-management. The findings were rich, with some being identified as barriers that could benefit from system-level de-constraining. Discussion: This case study was an illustration of our pursuit for an integrated solution to rising prevalence of multimorbidity. While quantitative findings indicated that a pivot towards General Medicine might be possible, data also revealed gaps in clinical outcomes, especially in readmission rates. These findings corroborated with much of the lessons and challenges gathered from qualitative interviews, specifically surrounding the lack of receptacles in the community to facilitate care transition, training, and competency of generalists in holistic management of complex multimorbid cases, as well as inadequate infrastructure to allow information sharing between providers. Thus, a multi-pronged approach might be required to develop a new and sustainable care model for patients with multimorbidity in the long run. In the short to medium transitional period, nonetheless, the specialist-led General Medicine care model demonstrated might be a viable interim approach, especially in circumstances where trained medical generalists remained limited. [ABSTRACT FROM AUTHOR]

Introduction: Road traffic injuries and fatalities represent a significant public health problem. In Singapore, compliance with appropriate child car restraints (CCRs) is poor. We aimed to understand parental knowledge, beliefs and barriers regarding the use of CCRs.Methods: In this qualitative study, we conducted five focus group discussions with parents who drive with their children in private cars. Participants were recruited using the KK Women's and Children's Hospital's social media page. Guiding questions were derived by consensus following literature review and adaptation to the Singapore context, exploring parental perceptions of CCR use. Focus group interviews were then transcribed and analysed.Results: 33 participants were recruited, with an age range of 28‒46 (mean age 35.5) years. They had a total of 46 children with ages ranging from 2.5 months to 14 years (mean age 4.2 years). Three key themes were identified: parental knowledge regarding CCRs, barriers to CCR use, and suggestions to increase CCR compliance. Barriers to compliance included lack of knowledge, difficult child behaviour and cultural norms. A multipronged approach was proposed to increase CCR use, including educating the public, reinforcing positive behaviour, legal enforcement as a deterrent to non-compliance, increasing CCR installation services, providing CCRs for taxi users and offering financial incentives.Conclusion: Non-compliance to CCR use is multidimensional, including multiple potentially modifiable factors. This study could inform ongoing collaborative injury prevention efforts among healthcare professionals, industry partners and the traffic police, using public education and outreach to reduce the burden of road traffic injuries. [ABSTRACT FROM AUTHOR]

Background: Integrated care has been well-recognized as a solution to improve quality of care for patients with complex needs. As Singapore increasingly develops and promotes integrated models of care, it is unclear if providers, patients, and caregivers share similar understanding of changes in the healthcare system. Objectives: This study aims at exploring three dimensions of care integration: a) understanding of integration; b) challenges and c) changes perceived as essential among three distinct stakeholder groups: providers, patients and caregivers. Methods: This qualitative study was conducted among 41 care providers (clinicians and administrators) and care consumers (patients and caregivers) in Singapore utilizing 29 semi-structured interviews and 2 focus group discussions. Study participants were selected by purposive, snowball sampling from various clinical settings. Data were transcribed, familiarized, coded and analyzed using a conceptual framework. Results: Understanding of care integration was generally lacking among patient and caregivers. Most of them focused on healthcare costs and accessibility of services. Providers characterized care integration in clinical process terms and had a more systems view of the concept. Most participants viewed resource constraints as a key challenge in integrating care. Additionally, providers expressed the need for patients and their families to play a greater role in managing their health. Individuals and the community are key components of an integrated care system in the future. Reliance on the healthcare system alone is not sustainable. Conclusions: Patients, caregivers and providers have varying degrees of understanding towards care integration. The success of engaging stakeholders on the ground to be active participants in the healthcare system integration process requires policymakers and healthcare leaders to increase patient engagement efforts and to better appreciate the challenges faced by the healthcare workers in the rapidly changing national and global healthcare landscape. [ABSTRACT FROM AUTHOR]

Introduction: Hospital-at-home programmes are well described in the literature but not in Asia. We describe a home-based inpatient substitutive care programme in Singapore, with clinical and patient-reported outcomes., Methods: We conducted a retrospective cohort study of patients admitted to a hospital-at-home programme from September 2020 to September 2021. Suitable patients, who otherwise required hospitalisation, were admitted to the programme. They were from inpatient wards, emergency department and community nursing teams in the western part of Singapore, where a multidisciplinary team provided hospital-level care at home. Electronic health record data were extracted from all patients admitted to the programme. Patient satisfaction surveys were conducted post-discharge., Results: A total of 108 patients enrolled. Mean age was 67.9 (standard deviation 16.7) years, and 46% were male. The main diagnoses were skin and soft tissue infections (35%), urinary tract infections (29%) and fluid overload (18%). Median length of stay was 4 (interquartile range 3-7) days. Seven patients were escalated back to the hospital, of whom 2 died after escalation. One patient died at home. There was 1 case of adverse drug reaction and 1 fall at home, and no cases of hospital-acquired infections. Patient satisfaction rates were high and 94% of contactable patients would choose to participate again., Conclusion: Hospital-at-home programmes appear to be safe and feasible alternatives to inpatient care in Singapore. Further studies are warranted to compare clinical outcomes and cost to conventional inpatient care.

Objective: Hospital at Home (HaH) programs have been shown to improve quality of care and patient satisfaction, and reduce bed occupancy rate in hospitals. Despite the prevalence of HaH in Western countries, studies in Asia are limited and the perception of HaH remains underexplored in Asian context. Understanding the perceptions of stakeholders is vital before implementing HaH in any new settings. Thus, the aim of this study is to explore the perceptions of referring physicians, care providers, patients, and caregivers on HaH programs in a multiracial country such as in Singapore., Methods: This study used a descriptive qualitative design. Participants from 2 tertiary hospitals in Singapore, including 13 referring physicians, 10 care providers, 15 patients, and 3 caregivers, were interviewed between June 2020 and September 2020. Data were analyzed using inductive thematic analysis., Results: The overarching theme titled "The stakeholders' perception on HaH" was pillared by 4 main themes: (1) patients suitable for HaH; (2) perceived advantages and benefits of HaH; (3) perceived risks, anxiety, and concerns about HaH; and (4) potential enablers of HaH. Overall, the findings reported that most of the stakeholders embraced HaH. Timely medical interventions and support from care providers were reportedly important factors to maintain patient safety and quality of care. The importance of having adequate resources and sound financing mechanisms to develop a successful HaH program was also highlighted., Conclusions: This study offered insights into HaH from the perspectives of stakeholders in Singapore and facilitate the planning of future HaH pilot programs in multiracial Singapore and other Asian countries., Competing Interests: A Ministry of Health Office for Healthcare Transformation (Y.F.L.) employee was involved in the study as a research collaborator. He provided input in the design of the study as well as the writing of this article in his capacity as an associate at Alexandra Hospital, National University Health System, Singapore. The other authors disclose no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Smart Nation is a key initiative of Singapore to move toward digitalization of its industries including healthcare. The complex negotiations of aging amid Smart Nation are addressed in this paper, where we study the challenges faced to adapt the elderly for the digital revolution while ensuring dignified aging. While the healthcare industry accelerates its study and use of health technologies to improve diagnostics, treatment, and the quality of life of those in the aging category, the elderly socially construct these technological insertions that challenge the dominant understandings of what these technologies can do for their health outcomes. The study reveals re-constructions of these technological insertions through the voice of the elderly in their negotiations with health technologies in their everyday lives. Here, narratives reveal key themes that proliferate technology negotiation as barriers to everyday lived experiences., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Low, Sakhardande, Lai, Long and Kaur-Gill.)

Background: Over the past decades, the pharmacist's role has changed from being 'compounders and dispensers' to one of 'medication therapy manager' providing pharmaceutical care (PC). The transformation of pharmacy practice and its benefits, however, seem to be poorly understood by patients and caregivers (consumers) even in advanced health systems., Objective: This study aims to assess the comprehension of consumers in Singapore towards PC and expectations on the scope of pharmacy services today., Methods: This qualitative study was conducted among 51 consumers and pharmacy staff (pharmacy providers) in a tertiary acute care hospital in Singapore through 45 semi-structured interviews. Participants were sampled from inpatient and outpatient settings. Data were transcribed, coded and analysed by thematic analysis., Results: Thirteen pharmacy technicians, 14 pharmacists and 14 out of 24 patients and caregivers, agreed to be interviewed. Reasons such as minimal English and unsure of pharmacy services were cited for declining interviews. From the interviews, the majority of the consumers did not understand the differences in roles between pharmacists and doctors beyond the basics of doctors diagnosing and pharmacists dispensing. Eighteen (75%) consumers remain unaware that pharmacists are trained to provide additional services such as medication enquiry services and optimisation of drug therapy. In addition, consumer expectations have expanded beyond transactional encounters, with 15 (63%) consumers expecting personalised services. Five (19%) pharmacy providers also expect the use of automation to boost efficiency and improve patients' convenience. Seven (15%) of the participants hope to see better prediction with analytics and, therefore, pre-emptive management of medication errors., Conclusions: There is an incomplete understanding regarding PC and the roles of pharmacy providers among healthcare consumers today. Beyond basic service provisions, expectations of pharmacy practice have become more experience-oriented. Policy changes that expand pharmacists' roles must be matched with corresponding publicity and education efforts to encourage service utilisation., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2020. No commercial re-use. See rights and permissions. Published by BMJ.)