Asthma Management and Right Siting to Primary Care

Asthma is a global problem, with more than 300 million sufferers and a growing global burden to health care systems.

 

In Singapore, it isestimat ed that 140 000 individuals have asthma.

Asthma is a chronic condition. The ultimate aim is to control asthma and allow patients to continue their treatment in the community once it is stable. With the advent in knowledge and treatment, there was a paradigm shift of focus of care from acute institutions, such as hospitals, to primary heath care providers (PCP) (e.g. polyclinics and general practitioners (GPs) in the last decade. PCP ensures the disease is controlled with maintenance therapy and provides regular reviews, which are recommended by the national asthma education and prevention program expert panel.

The asthma team at Tan Tock Seng Hospital (TTSH) works closely with patients and collaborates with the PCP in the heartlands of Singapore.

Previous studies reported a high default rate of primary care follow ups for asthma patients discharged from acute health care services. The postulated reason was patients who were discharged from an acute setting were not linked to the PCP to follow-up on their care. Patients were given referral letters to PCP but were told to make their own follow-up arrangements. This resulted a high default rate in follow-up at the PCP, leading to poor asthma control and increases in usage of acute health care systems (e.g. Emergency Department). There was an urgent need to enhance and close the gaps on follow-up care with the PCP.

The asthma team at TTSH has a dedicated right-siting officer. The role of the officer is to link patients to the PCP and provide assistance to the patients on making follow-up appointments at the PCP closest to where the patients reside. The right siting officer will call and remind the patients of their appointment with the PCP. This model of care increases the attendance rate with PCP, facilitating the link between the acute health care service and the PCP, by providing a convenient and personalised service. It reinforces patients’ behavior in self-management and cost effective healthcare.

 

The right-siting asthma service was introduced in 2012. Asthma patients discharged from the asthma specialist outpatient clinic, ward and Emergency Department have benefited from the service, with a success rate of more than 90% recorded for patients discharged to PCP.


 

By Dr Albert Lim
Senior Consultant
Department of Respiratory and Critical Care Medicine
Tan Tock Seng Hospital