A “GP” for the President’S Forum COMMUNITY HOSPITAL
Total Page：16
File Type：pdf, Size：1020Kb
A “GP” for the president’s forum COMMUNITY HOSPITAL Text by Dr Wong Tien Hua Singapore’s population is ageing rapidly, hospital, to recuperate before being health provision up and down the with the number of people aged 65 discharged. Elderly patients with chronic healthcare continuum. It could also years and older set to double to 900,000 medical conditions, such as dementia or mean integration across different by 2030. There will be a tremendous stroke, who need daily nursing care as sectors such as allied health, social strain on healthcare services, stretching they do not have families or caregivers, services and health promotion. the capacity of tertiary hospitals and can be looked after in nursing homes Transitional care specifically specialist centres. The Ministry of over the long term. Terminally ill patients addresses the coordination and Health (MOH) has been planning to who require palliative care can be continuity of care as patients are boost primary care and keep healthcare admitted to the hospices. transferred from one healthcare facility closer to the community. In their 2017 to another, or even between different Committee of Supply Budget Statement, Integrated care, transitional care care teams within the same location. MOH listed three key shifts for a future- ready healthcare system, one of which It can be seen that healthcare delivery was moving “beyond hospital to can no longer be defined by the primary New healthcare settings community”. They stated that “there is care/tertiary care model that we have Community hospitals have been a need to shift our healthcare delivery grown accustomed to. Patients seek and receiving much attention in the past model from one built around the hospital utilise healthcare services based on their few years. They started in the 1990s to one that can meet the needs of more medical condition, stage of the illness, as facilities for step-down care to help Singaporeans closer to their homes, at social needs and the accessibility of lower healthcare costs, and were run by primary and community care settings”. support services in the community. voluntary welfare organisations, with The ideal care for elderly patients some funded by charities or religious Primary care’s would be delivered by family members groups along with funding assistance changing landscape within their homes, with the right from the Government. Such community support from visiting healthcare hospitals include St Luke’s Hospital, Primary care in Singapore is changing services. This will avoid the need for Bright Vision Hospital, Ren Ci Hospital and moving away from the provision of expensive hospitalisation and the and Ang Mo Kio - Thye Hua Kwan healthcare services at traditional point- risk of hospital-acquired infections. Hospital, just to name a few. of-care locations, such as the polyclinics Unfortunately, this cannot be the case In line with the concept of care in the public sector and GP clinics in the for everyone, and patients today find private sector. integration and better transitional themselves being shifted around the care, we are now witnessing the A spectrum of healthcare services various facilities and services depending development of community hospitals now exists in the spaces among large on their situation and requirements. co-located with general hospitals tertiary hospitals, primary care facilities Because patients are transitioning – a logical choice especially when and the community. Intermediate between different facilities – from one community hospitals are part of the and long term care (ILTC) services are healthcare provider to another – they planning in the design of these new available for patients who need care become vulnerable to problems with general hospitals. Examples include the beyond hospital stays, as well as for frail care coordination, such as lapses in Jurong Community Hospital (400 beds) and at-risk seniors in the community communication when one medical team integrated with Ng Teng Fong General who need assistance with daily activities. hands over the case to another. Hospital, which started operations in Such ILTC services include home care, Integrated care is a much talked 2015; Sengkang Community Hospital day care centres, community hospitals, about concept to streamline care (400 beds) integrated with Sengkang nursing homes and hospices. delivery, and is used to address the General Hospital, slated to open in 2018; Patients who are admitted to problem of fragmented care. Integrated and Outram Community Hospital (550 acute hospitals can be warded in an care could mean vertical integration beds) to be located within the Singapore intermediary facility, such as a community where patients experience seamless General Hospital campus by 2020. 08 apr 2017 SMA News With the addition of bed capacity in physicians. At the end of 2015, there family physician to be well positioned community hospitals, it is evident that were 1,659 family physicians out of more as the “generalist physician”, such as they will in time reshape the system than 8,200 non-specialists, the majority having the ability to take account of the of patient care delivery in Singapore. of whom were GPs. In his speech at patient’s illness in the context of the Patients will find themselves spending the National University Health System patient’s life circumstances, working less time in acute hospitals after a Division of Family Medicine’s 30th in multidisciplinary teams and making procedure, or after an acute event such anniversary dinner, Permanent Secretary efficient use of resources, having good as a stroke, and will be transferred Mr Chan Heng Kee said that he envisions communication skills, and being able very early to a community hospital for doubling of these 1,700 family physicians to bridge the gap between the hospital recovery and rehabilitation. to 3,500 over the next ten years. Most and the community with their intimate of these family physicians would be knowledge of the services available, The generalist physician serving in primary care such as in the among others. Since community hospitals are a relatively polyclinics and private GP clinics, but Community hospitals will ultimately new entity in the healthcare scene, they would also have a choice to work in be staffed by doctors who are interested the role of the physician in community the community hospital as a “GP”. in practising in a hospital environment, hospitals needs to be defined. There is Whether trained family physicians and like to be involved in transitional no “specialty in community medicine”, are best placed to look after patients care, whether they come from internists, so to speak, and the requirements of a in community hospitals is a question geriatrics or family medicine backgrounds. community hospital involve elements worth exploring. Our current system The requirements of such a role in of rehabilitation medicine, geriatric of family medicine residency and transitional care need to be clearly medicine, palliative medicine, internal training is a very rigorous programme defined and training modules for medicine and psychiatry. However there that prepares doctors for careers as competency in this area can be introduced are also areas such as care integration, family physicians. Family medicine is in the various training programmes, to working with multidisciplinary teams, a specific field and has characteristics prepare doctors for a unique role in the risk assessment and prevention, care such as being the first point of contact healthcare delivery system. planning and communication, and in the healthcare system, dealing with comprehensive care that require training all health problems regardless of age, 1 References and clinical exposure. looking after the patient longitudinally 1. Lee KH. Transitional Care: Origins, Concept and It seems that the needs of community over an extended period of time and Practice. Singapore Family Physician 2015; 41(1):5- hospitals are best served by doctors managing undifferentiated illnesses.3 10. Available at: http://cfps.org.sg/publications/ who have a broad base of knowledge These skills will not be applicable the-singapore-family-physician/article/903_pdf. to provide comprehensive care, instead in a hospital environment where 2. Push for more doctors in community care: of being focused on one particular recuperating patients typically stay for Gan Kim Yong. The Straits Times 2017 6 March. specialty, akin to a “generalist physician”. three to four weeks. Moreover, the term Available at: http://www.straitstimes.com/ singapore/health/push-for-more-docs-in- “family physician” does not evoke an community-care. Role of the family physician image of a doctor practising in a hospital 3. WONCA Europe. The European Definition environment, but this is only a matter of Minister of Health Mr Gan Kim Yong said of General Practice/Family Medicine. WONCA 2 awkward terminology. Europe 2011 Edition. Available at: http://www. in his interview with the Straits Times woncaeurope.org/sites/default/files/documents/ that he plans to encourage more primary There are, of course, areas in family Definition%203rd%20ed%202011%20with%20 care physicians to be trained as family medicine training that enable the revised%20wonca%20tree.pdf. Dr Wong Tien Hua is President of the 57th SMA Council. He is a family medicine physician practising in Sengkang. Dr Wong has an interest in primary care, patient communication and medical ethics. Illustration: Dr Kevin Loy apr 2017 SMA News 09.