A nudge by mail for diabetics to shape up

Left: A diabetes patient having a consultation with NUH endocrinologist Yew Tong Wei (far left). Below: A sample of the results sent to diabetic patients before their consultations in Britain, under its National Health Service.
A diabetes patient having a consultation with NUH endocrinologist Yew Tong Wei (far left).PHOTOS: NUH, UK NATIONAL HEALTH SERVICE'S YEAR OF CARE PARTNERSHIPS

Test results to be sent to 400 patients a week before doc's appointment under NUH pilot

Starting in September, some 400 diabetic patients will be getting a new type of mail in their mailbox.

About one week before their regular doctor's appointment, they will receive results of the tests for their blood sugar and cholesterol levels, weight, kidney function, as well as eye and foot screenings.

The hope is that this will nudge them into mulling over their condition and becoming more active in discussing possible solutions with family members or researching online, before seeing their doctors.

Currently, most diabetic patients get their test results only when they meet their doctors.

The new approach is part of a pilot by the National University Hospital (NUH), and it could be implemented nationwide for Singapore's more than 400,000 diabetic patients.

Diabetes is the second leading cause of morbidity and mortality in Singapore. Another 430,000 here have pre-diabetes and are at risk of developing diabetes.

NUH is adapting the "collaborative consultation" model from the British National Health Service's successful Year of Care model, which also includes getting doctors to work with patients to plan for their long-term care during consultations. Trials there had found that it helped boost the number of patients who could control their blood sugar, cholesterol and blood pressure levels.


A sample of the results sent to diabetic patients before their consultations in Britain, under its National Health Service.

Dr Yew Tong Wei, an endocrinologist at NUH, said that the model will help to address existing problems.

  • 400k 

    Number of people with diabetes in Singapore.

"From my personal experience with elderly patients, some have had poor control of diabetes for years despite attending all the consultations," he said.

"Family members come with them for the consultations only at a stage (when the condition worsens)... but that involvement could have happened 10 years earlier."

Dr Yew added that patients would be roped into the decision-making process of determining the frequency of the consultations, in place of the previous top-down approach.

On whether it will be rolling out more pilots nationwide, an MOH spokesman said it "is studying overseas efforts to learn from international best practices and will take reference from these examples to develop our local initiatives to empower patients with diabetes to initiate and sustain lifestyle changes, as well as to better manage their condition".

"This includes the UK Year of Care model."

Some 25 healthcare professionals from NUH were trained by a team from Britain who piloted the Year of Care model.

A key part of the model is "recognising that the person has expertise in his life", said healthcare experts involved in the British pilot.

"It can take a little while for patients to get used to working in this way, because they have been quite used to being fairly passive recipients of care delivery, rather than active partners in looking after and thinking through what they can do about their own health," said Ms Lindsay Oliver, national director for Year of Care Partnerships.

A version of this article appeared in the print edition of The Straits Times on July 27, 2017, with the headline 'A nudge by mail for diabetics to shape up'. Print Edition | Subscribe