Doctors involve patients in clinical process to spur lifestyle changes
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National University Hospital endocrinologist Yew Tong Wei seeing his patient, Madam Evelyn Yeung, to discuss her diabetes condition. She received her test results before the consultation appointment, which gave her time to study the results before meeting her doctor.
PHOTO: NATIONAL UNIVERSITY HEALTH SERVICES
Jolene Ang
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Treating diabetes is not as simple as advising a patient to cut down on his sugar intake.
Dr Yew Tong Wei, an endocrinologist at the National University Hospital (NUH), knows this all too well.
One of his patients is a Malay Muslim woman who enjoys hosting parties with an array of sugary treats - not the most ideal for someone with diabetes.
"My solution for her could be just to serve salads with olive oil instead of the Malay delicacies - but that doesn't align with her customs or culture," Dr Yew said.
He is one of nine doctors in a pilot programme at NUH who are trying a new approach - involving patients in the clinical process.
Patients receive various test results - before their medical appointments - in a format that is easy to understand. These help them identify areas where they are at higher or lower risk, such as kidney function or cholesterol levels, and enable them to make changes to their lifestyles or eating habits.
A year into the pilot programme, the patients' conditions were found to have generally improved. For example, the proportion who achieved an ideal target for their glucose control increased by 21/2 times.
Sharing the findings at a media briefing last week, Dr Yew said the programme has enabled patients to take control of their lifestyle habits and choices, as they can study their test results before they meet their doctors.
The results were also shared at a symposium for general practitioners (GPs) as part of an event organised by Diabetes Singapore and the National University Health System (NUHS) yesterday.
In the case of Dr Yew's Malay Muslim patient, she was able to come up with a solution herself - going on a religious fast on days when she hosts parties, something he said he would never have thought of himself. "We doctors are the medical experts, but the patients are the experts on their own lives."
Professor Tai E Shyong, a senior consultant at NUH's endocrinology division, noted: "Living well with diabetes requires the active participation of patients."
The pilot has since been expanded to two polyclinics under National University Polyclinics (NUP). It will be reviewed before a possible expansion to all six NUP polyclinics.
NUHS has also introduced a programme that allows GP clinics, which usually operate in silos, to keep track of patients' progress and compare the data with other clinics. This data sharing is not just for people with diabetes, but also for those with other chronic conditions such as hypertension.
A one-year pilot was conducted with four GPs in Choa Chu Kang. Among other results, it uncovered problems GPs face, such as patients refusing to start medication because of concerns over side effects.
Meanwhile, the National Kidney Foundation (NKF) announced a new haemodiafiltration programme yesterday at the opening of its Foo Hai-NKF Dialysis Centre in Ubi Avenue 1.
Haemodiafiltration is similar to the more common haemodialysis process, but is said to be more effective as it can remove smaller-and bigger-sized toxins from blood.
But as haemodiafiltration involves an infusion of a large volume of fluid, there is a potential risk of infection if the fluid is not ultrapure. Nevertheless, studies show this is not a big concern if the process is carried out based on recommended guidelines.
NKF has piloted this programme at two dialysis centres in Bedok and Serangoon since March with 20 patients.
