Older people with chronic conditions often suffer from multiple illnesses and it is very confusing and taxing for them to see different specialists at different times. Its also very hard for them and their family caregivers to follow different instructions from different clinics and doctors. So this is definitely a great initiative by TTSH to simplify one aspect of care for the elderly
Struggling with multiple illnesses including diabetes, high blood pressure, gout attacks and chronic kidney disease for the past 20 years, Mr Loy Wen Ann, 80, had to make trips to Tan Tock Seng Hospital (TTSH) every month — sometimes even a few times a month — for follow-up appointments with different doctors for each of his conditions. His wife and main caregiver, Mdm Ho Leong Pong, 78, told TODAY that they had a hard time keeping track of all the different appointments and would sometimes miss a few. But under a new initiative piloted by TTSH, which allows her husband to be treated by a single general medicine (GM) doctor, the couple has been able to save time and money with fewer hospital appointments. Patients like Mr Loy are exactly who TTSH wants to help with their General Medicine Complex Care Clinic (GMCC) programme. This month, the clinic is also starting a medication reconciliation service under the initiative, for pharmacists to advise patients on complex medication regimes, which have at least five different types of medication. Associate Professor Tan Thai Lian, divisional chairman of medicine at TTSH, said current care models see patients with multiple conditions — what doctors refer to as comorbidities — having to go to different clinics for each condition. “We can imagine in a frail, older person, it becomes very difficult when you have to attend many clinics and listen to many separate instructions from different clinics,” said Assoc Prof Tan. “That can get very confusing and it becomes an issue with regards to patients’ management of multiple chronic illnesses.”
However, not all patients can be treated by a single GM doctor. Patients with complex cases will be co-managed by a GM doctor with other specialists and alternate appointments among themselves. For instance, Dr Teong, who is in charge of Mr Loy’s care, manages his conditions such as his diabetes, blood pressure, poorly controlled gout while alternating appointments with a kidney specialist. Dr Teong also noted that involving pharmacists in the initiative will help coordinate medicine more clearly, especially in cases where there are overlaps in prescription or patients confuse adjusted medication with previous prescriptions. The GMCC programme also helps cut down more than a week’s worth of appointments for patients, and save on hospital resources such as the unnecessary repetition of blood tests, noted Dr Teong. See more
