Chirk Jenn Ng (CJ) is a Clinical Professor of Family Medicine at Duke-NUS Medical School in Singapore. He is also a Senior Consultant Family Physician at SingHealth Polyclinics, where he practises and conducts primary care research. CJ’s research interests are in shared decision making, digital health and implementation science. He leads the EmPaTHy programme which aims to conduct research to empower patients and healthcare professionals to enhance patient centred care through technology, focusing on chronic diseases. He also trains and supports primary care decision makers and providers to design, evaluate and implement health services.
Continuity of care (COC) has been proven to be effective in improving the patient-doctor relationship and patient health outcomes. This study was based on a pilot study that aimed to enhance COC in a Singapore public primary care setting by transforming the clinics from a ‘one patient, one clinic’ to a ‘one patient, one team’ model. The study aimed to identify the barriers and facilitators to implementing this new model of care.
A qualitative study was conducted among 15 doctors, 6 nurses, 6 health pals, 12 management team members and 7 patients in two polyclinics between January and April 2023. A total of 28 in-depth interviews were conducted using interview guides. The interviews were audio-recorded, transcribed verbatim and analysed using a thematic approach. The NVivo software was used to manage the data.
This study found that while patients, healthcare providers and management recognised the importance of COC, incorporating the concept into the existing clinical care pathway was found to be challenging. Three main themes emerged: team size, team stability and information technology (IT) support. Manpower shortages and the provision of concurrent services resulted in difficulties in implementing the initial planned smaller team size and composition of 4 doctors, 2 nurses and 2 care coordinators. Additionally, COC was further impacted by the lack of stability within the care teams, due to the manpower movement across clinics and leaves. Finally, backend IT restructuring required significant time and user familiarisation to proficiently tag patients to a team and displaying it clearly on the electronic records.
Institutional support and prioritization of the new model of care are critical in ensuring its successful implementation, as this requires the institution to address existing systemic challenges, such as IT restructuring as well as increase or
reshuffling of manpower.