Research Projects

Principal Investigator
Helen Smith (Email: h.e.smith@ntu.edu.sg)

Amount awarded
$50,000

Duration
1 year

Summary
Skin problems present frequently in family medicine and attendances for dermatology-related problems are increasing year on year. Since the introduction of telemedicine, the total number of dermatology referrrals to NSC have remained stable on a background of increasing dermatology attendances in primary care.

To date, the impacts of this innovation ('store and forward teledermatology') on patient wellbeing, workload and costs have not been evaluated rigorously. To ensure the quality and safety of the care provided it is necessary to go beyond the analysis of the number of patients referred, to calculate outcomes such as appropriateness of referrals, diagnostic accuracy and resultant changes in medication.

This research proposal will evaluate the impact of the introduction of a teledermatology intervention on polyclinic care for patients with skin problems. The study will be a 'before-and-after' design, combined with experienced based design methodology. These data will enable us to highlight modifications that need to be made to the existing intervention, and to design a pragmatic randomised controlled trial, including an economic evaluation, of store and forward dermatology. The seedcorn funding available will not cover the costs of the definitive trial, but it will enable us to provide strong supporting evidence of preliminary research, and the need for formal evaluation of 'store and forward'teledermatology, in an external funding proposal (for example, to MOH or NMRC) which we plan to submit in latter half of 2018.


 

Principal Investigator
Julia Zhu (Email: julia_zhu@ntu.edu.sg)

Amount awarded
$50,000

Duration
1 year

Summary
Diabetic foot amputation, affects one’s quality of life, and increases morbidity and mortality. It in turn results in higher healthcare expenses and poorer patient outcomes. Statistics tells us that there is an increase in numbers of such cases, but we know little about those patients’ experiences with diabetic foot amputation in Singaporean context. Therefore, this study aims to explore the lived experiences of patients within 6 months of post operation with a foot or partial foot amputation in primary healthcare. The study adopts qualitative design to enable those patients with amputations to share individual experiences of their daily life in the initial post-discharge period which will contribute to the understanding how an individual copes with life changes related to diabetic foot amputations. Research findings will inform the type and level of assistance and support to be offered to patients during the initial postoperative period by healthcare professionals in primary healthcare setting which will ultimately promote both patients’ wound healing and emotional healing. The findings of this study will also contribute to enhancement of existing services which would better meet the holistic needs of the studied population and build care pathways to treat the “whole” patient considering the bio-psycho-social factors, not just leaving the patients with the “hole” that they have to deal with after their amputation.

Principal Investigator
Lorainne Tudor-Car (lorraine.tudor.car@ntu.edu.sg​)

Amount awarded
$50,000

Duration
1 year

Summary
Primary care providers make thousands of clinical decisions each year related to diagnosis, prognosis, treatment and patient management in general. With the widespread propensity towards evidence-based healthcare, these clinical decisions need to be informed by the best available healthcare evidence. There is a range of healthcare-related information and evidence sources currently available to healthcare professionals encompassing clinical practice guidelines, care guides, journal articles, medical literature databases etc. Yet, research shows a wide variation in the evidence adoption in healthcare which may be associated with poorer primary care outcomes and healthcare quality.

Our aim is to explore and report on information seeking behaviour of primary care physicians and nurses in Singapore. There is a range of healthcare-related information and evidence sources currently available to healthcare professionals encompassing clinical practice guidelines, care guides, journal articles, online webpages, blogs and medical literature databases. However, research shows there is a wide variation in the adoption of evidence across healthcare disciplines, which could lead to poorer primary care outcomes such as patient healthcare quality, satisfaction and adverse outcomes. Besides the difference in evidence adoption, primary care physicians and nurses also differ in their information seeking behaviour. These healthcare professionals differ in their training, working practices and responsibilities, all of which are factors that can influence their information seeking behaviour. There is evidence on information seeking behaviour in primary care settings in various countries but reports of information seeking behaviours in Singapore is limited. The widespread inclination towards evidence-based healthcare, coupled with the constant growth in medical knowledge and increasing complexity of patient care, it is therefore essential to identify relevant information needs, and information seeking behaviour for primary care providers in Singapore. We will recruit physicians and nurses involved in provision of primary care within NHGP. We intend to use surveys and interviews for collection of data.​

Principal Investigator
Lee Eng Sing (eng_sing_lee@nhgp.com.sg)

Amount awarded
$50,000

Duration
1 year

Summary
An earlier in-house pilot study has suggested that the pharmacist-led pre-consultation medication reconciliation service (MRS) is able to reduce post-consultation unintentional medication discrepancies for patients who are transferred from tertiary care to primary care setting. Commonly detected discrepancies such as drug omission or dosing regimen errors can be flagged out prior to consultation and highlighted to the prescribers.

Leveraging on the success of MRS, this study will seek to improve on MRS by eliciting feedback of stakeholders on current services and their input in expanding MRS to the new Medication Reconciliation Service (nMRS). Before investment into a costly large trial and certainly before consideration for use in clinical care, a feasibility trial is required to establish acceptability and preliminary feasibility of nMRS.

Medication reconciliation can potentially be part of a care model for patients transiting from other institutions to primary care setting, targeted to improve care outcomes such as reducing pill burden and cost, improving medication understanding and adherence in addition to detecting medication discrepancies.

Principal Investigator
Joanne Ngeow (joanne.ngeow@ntu.edu.sg)

Amount awarded
$60,000

Duration
1.5 years

Summary
Advances in genetic technology and understanding, coupled with an increasing patient demand for genetic and genomic investigation, is driving this momentum. The healthcare workforce including primary care physicians (PCP) needs to be empowered to identify the opportunities for genomic medicine and feel confident in their skills to deliver personalised care effectively and compassionately. They will need to have sufficient understanding of genomics to communicate effectively, support their patients and institute appropriate management. This requires an understanding of pathology at a molecular level, which is now made possible by rapid, affordable sequencing of the genetic code (human and microbial / viral). Deciding when to use these tests and how to interpret their results will become important parts of medical practice. Even where PCPs are not using these tests directly, they need to be aware of the implications for patients and their families going through secondary and tertiary care.

We are proposing to conduct a large multi-disciplinary and mixed methods  study  to  understand  the PCPs’ experiences and expectations of personal genomics. We hope to leverage on the Centre of Primary Healthcare Research and Innovation’s expertise and network to identify important gaps in critical thinking that may undermine informed uses of personal genomics in Singapore so as to generate recommendations about educational and public engagement strategies to support the PCP to make well-considered and meaningful decisions, and to advise policy makers regarding how the public might be supported accordingly.

Principal Investigator
Goh Ling Jia ( ling_jia_goh@nhgp.com.sg)

Amount awarded
$59,891

Duration
1.5 years

Summary
Self-wound care is a fairly new concept in Singapore whereby patients perform their own dressing either independently or with the help of their closed ones. This new concept came about with the introduction of new model of care delivery where healthcare leverage on telecommunications to provide convenience to patient to increase patient satisfaction. Tele-wound monitoring service is an initial step towards this concept and there would be more in the near future when remote wound monitoring app and digital video wound monitoring system are developed. This concept of delivery requires patient to manage their own wound in their home setting with the nurse remotely monitoring and providing advice via telecommunications. The new model of delivery not only prevents strain on the healthcare resources where reliance on healthcare providers would shift away to educating patients to manage their own condition but also increases patient autonomy as patient participates more actively in managing their condition. Evaluating patients’ acceptance of self-wound care concept is a vital step towards implementing new models of care delivery and this is in line with the Centre’s objective of promoting innovative ways of delivering care. The results of the study would give an understanding whether the proposed new care of delivery could continue or require further modification and again this is in line with Centre’s objective where implementation of new care model is based on evidence and in this case, the study of patient acceptance.

This study would involve students from Ngee Ann Polytechnic and nurses from the wound care team. The principal investigator, who graduated from University of Manchester with Master in Clinical Research (Distinction), had knowledge in developing and validating the questionnaire. Dr Sathish, our collaborator from LKC, had vast experience in performing statistical operations and is believed that his expertise would provide a lot of support to the study. This study would allow the principal investigator and collaborator from LKC to guide the others in the study team into developing a validated questionnaire thus strengthening the research knowledge and developing the research capacity within the nursing profession.

Principal Investigator
Helen Smith (h.e.smith@ntu.edu.sg)

Amount awarded
$60,000

Duration
1.5 years

Summary
Respiratory diseases constitute a significant and growing health care burden in Singapore; a burden that is exacerbated by over-reliance on secondary and tertiary care. To address the dominance of specialist care the Ministry of Health is developing policies and initiatives to support primary care (both public and private) to expand their roles, but still, there are many unknowns and evidence gaps in this changing health care landscape.

This project aims to map potential ways health care providers in primary care could become more involved in the prevention and management of respiratory problems.