MEDIA RELEASE

​1. A local study conducted by SingHealth Polyclinics (SHP) sheds light on how patients with chronic health conditions in Singapore select their primary care providers. Conducted against the rolled-out Singapore’s Healthier SG initiative, the study aims to enhance understanding of patient preferences on their choice of doctor who would journey with them in improving their health outcomes. 

2. Continuity of care provided for patients with chronic health conditions by the same committed and well-trained primary care physician, has demonstrated enhanced health outcomes. Within Singapore’s primary care framework, patients have the option to consult any primary care provider in public (the polyclinics), or private (General Practitioners/GPs), or between both settings, which may potentially lead to fragmented care.

3. Patients with chronic diseases require long-term care, so having a sustained partnership with their physicians through continuity of care is especially important.¹ They require regular monitoring of their disease status, such as blood pressure, capillary glucose for those with diabetes mellitus, medication adherence, diet and physical activity supervision. Poorly managed chronic conditions can lead to complications and morbidity. 

4. Unfortunately, in many healthcare settings, the focus has often been on providing short-term, acute care that addresses immediate medical issues through brief encounters with different healthcare providers across various settings.² This episodic care approach typically neglects the importance of ongoing relationships for people with long-term medical conditions.³ Relying solely on episodic care may not adequately meet the increasing prevalence of chronic diseases. Inconsistent care received under this system can also lead to greater disease burdens for patients over time.^4,5

5. Singapore’s healthcare system has recently made significant changes to improve the health of its population. A key part of the national Healthier SG programme focuses on continuity of care, by encouraging residents to choose a regular family doctor to be their main point of contact to manage their health needs comprehensively.⁶

6. “The change in choosing a regular family doctor is crucial for healthcare providers and policymakers to understand how patients decide on their family doctors. By understanding these factors, family doctors can adjust how they deliver care and improve their communication skills. This will strengthen their partnership with patients for managing chronic conditions over the long term. In addition, it will help policymakers effectively implement and expand the Healthier SG initiative, ultimately leading to better health outcomes for everyone,” said Dr Abigail Lee, Associate Consultant, SHP-Tampines. Dr Lee is also the main author of this research paper. ⁷ The qualitative study was carried out at SHP-Tampines, with in-depth interviews conducted with 21 patients, examining their preferences and experiences with their primary care providers, both in the polyclinics and private clinics settings. The interviews were conducted in English, Mandarin, and Malay to ensure representation of the diverse voices among Singapore’s multi-ethnic residents, and for capturing the experiences and perspectives of the local population.

8. The study revealed that patients considered the value qualities like empathy, compassion, and showing considerations and care when choosing their family doctors. Building a trusting relationship with their doctor is crucial for ongoing care. Patients prefer doctors who understand their experiences and can communicate effectively, especially when dealing with emotional challenges.⁷

9. Good communication skills are also important to patients. Clear and respectful communication helps patients understand their health better and feel more satisfied with their care. Professionalism is another factor patients look for, although many prioritise their doctor’s personal qualities and the quality of their relationship over technical skills.

10. “The findings highlight the importance of trust and continuity in patient-doctor relationships. Patients who see the same doctor regularly tend to have better health outcomes and higher care satisfaction. The study also recommends that doctors receive training to improve their communication and professionalism. Behavioural economics and system changes could also help encourage doctors to adopt more patient-centered practices,” added Dr Lee.

11. “Programmes like Healthier SG aim to strengthen relationships between doctors and patients in the community, ensuring better health outcomes for everyone. It is important for primary care providers to recognise the factors of how patients commonly select their doctors. By doing so, doctors can effectively establish rapport with their patients to strengthen the overall effectiveness of healthcare delivery,” said Clinical Associate Professor Tan Ngiap Chuan, Director of Research, SHP and Vice-chair, Research, SingHealth-Duke NUS Family Medicine Academic Clinical Programme (FM ACP).

12. “Ultimately, a strong patient-doctor relationship fosters greater adherence to established health plans for patients. When patients trust and feel comfortable with their doctors, they are more likely to follow medical advice, adhere to treatment regimens, and actively participate in managing their own health,” added Prof. Tan.

References:

1 Chen CC, Chen SH. Better continuity of care reduces costs for diabetic patients. Am J Manag Care. 2011 Jun; 17(6):420–7. PMID: 21756012

2 Schwarz D, Hirschhorn LR, Kim JH, Ratcliffe HL, Bitton A. Continuity in primary care: a critical but neglected component for achieving high-quality universal health coverage. BMJ Glob Health. 2019 May 23; 4(3):e001435. https://doi.org/10.1136/bmjgh-2019-001435 PMID: 31263586

3 College of Physicians & Surgeons of Alberta. Episodic Care—Standard of Practice. 2022.

4 Lazar M, Thomas S, Davenport L. Seeking Care at Free Episodic Health Care Clinics in Appalachia. J Appalach Health. 2020; 2(2):67–79. https://doi.org/10.13023/jah.0202.07 PMID: 35769864

5 Lee CM, Lin D, Wong WX. Key Highlights from the National Population Health Survey 2020 [Internet]. 2022 [cited 2023 Mar 12]. Available from: https://www.singstat.gov.sg/-/media/files/publications/society/ssn122-pg10-14.ashx

6 Ministry of Health Singapore. White Paper on Healthier SG [Internet]. 2022 [cited 2023 Jan 12]. Available from: https://file.go.gov.sg/healthiersg-whitepaper-pdf.pdf

7 Lussier MT, Richard C. Should family physicians be empathetic?: YES. Can Fam Physician. 2010 Aug; 56(8):740–2, 744–6; discussion e287, e289. PMID: 20705874