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Research Projects

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  • Patients’ responses to gout – the journey from symptoms to management: implications for Primary Care in Singapore

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

    Funding Body
    NMRC

    Amount awarded
    $191,630.40

    Duration
    1.5 years

    Summary
    Gout is a common form of arthritis affecting older people. It can cause severe pain and becomes more severe over time, leading to increasing disability. There are effective treatments but many patients do not take their medication or follow dietary advice. There is strong evidence that patients might be reluctant to seek help because they have negative views and/or do not understand the disease. We need to understand these matters better, particularly what stops them getting help, because gout can be cured or controlled if people seek help early. Only one study has researched people’s journeys from first symptoms to when they seek help. That study was conducted in the UK and similar research is needed in Singapore.

    We plan to explore Singaporean patients’ experiences, beliefs and expectations from initial symptoms of gout through to when they are diagnosed. This will identify the sorts of things that held people back from seeking early help, and the sorts of steps that can be taken to support people sooner.

    We will interview around 60 people with gout who did not seek help when they had their first attack and will share our findings with patients and healthcare practitioners.
  • A mixed method descriptive evaluation of the impact of a Telemedicine Dermatology service

    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.
  • Experiences of patients with diabetic foot amputation in the initial postoperative period within 6 months in primary healthcare: Physical healing or emotional healing?

    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.
  • Information seeking behaviour among primary care practitioners in Singapore: finding evidence to support high-quality patient care

    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. ​
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