Chronic Disease Management Programme: Is it for You?

Many Singaporeans suffer from chronic diseases, which are defined as diseases or conditions that usually last for 3 months or longer, and may worsen over time. Common chronic diseases in Singaporeans between the period of 2021 to 2022, among individuals aged 18 to 74 years old, included hypertension (high blood pressure), diabetes, and hyperlipidaemia (high blood cholesterol). These conditions affected 37%, 9.5%, and 31.9% of the population, respectively.

Chronic disease can be effectively managed through regular checks with a family doctor, which allow your doctor to better understand your condition, lifestyle and preferences. This will go a long way in helping your doctor tailor your treatment and offer health advice that can improve your overall health.

Common chronic diseases

Here are some common chronic conditions under the Chronic Disease Management Programme (CDMP) that your family doctor can help manage. The CDMP is a national programme available at primary care clinics such as the general practice clinics by Parkway Shenton.

• Diabetes mellitus / pre-diabetes
• Hypertension
• Hyperlipidemia (lipid disorders)
• Osteoarthritis
• Gout
• Allergic rhinitis
• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Chronic hepatitis B
• Anxiety
• Schizophrenia
• Major depression
• Bipolar disorder
• Dementia

From 1 Jan 2021, under the CDMP, patients may claim up to $500 yearly from MediSave for treatment of these conditions, and those with complex chronic conditions may claim up to $700 yearly. However, each MediSave claim is subject to a 15% co-payment in cash.

Through the CDMP, Community Health Assist Scheme (CHAS) cardholders with chronic conditions can access government subsidies of up to $500 per year, making it more affordable to receive medical care at participating clinics, including those operated by Parkway Shenton. Additionally, special subsidies of up to $540 per year are also available for Pioneer Generation or Merdeka Generation cardholders.

Services for chronic disease patients at Parkway Shenton

Parkway Shenton has a variety of services to help in the optimal and effective management of chronic disease patients.

These include specific screening services for patients with diabetes, such as eye and feet screening tests, and heart disease such as ambulatory blood pressure monitoring, as well as health education, dietary and nutrition advice, device assessment and instruction, and smoking cessation programmes.

Here's a closer look at some specific services for patients:

Health education

Being newly diagnosed with a chronic illness can be overwhelming, especially with so much information to take in and not knowing much about how or where to start.

Health education by our team of doctors and nurses at Parkway Shenton can help you better understand your condition or conditions. These can be done via a face-to-face session at a Parkway Shenton clinic or via a teleconsultation.

Dietary and nutrition advice

Eating the right foods is often the most important first step in controlling chronic illnesses such as diabetes, high blood pressure, and high cholesterol. Diet counselling can guide patients to spot areas in their diet that need improvement and provide tips and advice on making effective dietary changes.

Health device assessment and education

Newly diagnosed with diabetes but unsure about how to check your own blood sugar? A session with a nurse counsellor can help you learn the necessary skills to manage your condition. This includes teaching you how to use a home glucometer to check your blood sugar, how to administer insulin injections, and how to accurately check your blood pressure independently, using a home blood pressure monitor.

Smoking cessation

Quitting smoking is one of the most important lifestyle changes patients with chronic illnesses can do for themselves. Patients on a dedicated counselling programme for smoking cessation are twice as likely to quit smoking successfully, compared to those who try to quit on their own.

Screening tests

Health screening is one of the most effective ways to monitor the status or progression of a chronic illness. Here are some examples:

Diabetes eyes and feet tests

Diabetes can lead to complications involving the eyes and feet. To allow early detection and prevent damage, annual tests are recommended.

Diabetic eye disease, known as retinopathy is one of the most common complications of diabetes and a leading cause of blindness among working adults. Overall, one-third of diabetic patients have eye disease, and 1 in 10 have vision-threatening levels of retinopathy.

Diabetic eye screening is essential to find out if the patient is at risk of developing diabetic eye complications. This test takes about 30 minutes, during which a nurse will photograph an image of your retina to check for any early signs of eye disease. Eye drops may be used to help dilate the pupils and facilitate this process.

Singapore also has one of the highest rates of lower extremity amputations in the world, and diabetes is an important risk factor. The lifetime risk of developing a foot ulcer is 15%, but for those with diabetes, this incidence may be as high as 25%. The presence of foot ulcers in patients with diabetes is also risk factor for amputation as 84% of non-traumatic limb amputations are preceded by foot ulcers, and the risk is 25 times more as compared to patients without diabetes.

To help prevent this, annual foot screening can help to detect early foot problems. This test takes about 30 minutes, and includes visual inspection of the patient's feet to check for numbness and look for early signs of blood supply problems, wounds and ulcers. The nurse may give tips on feet care and how to trim toenails correctly to prevent skin infections around the nail.

Ambulatory blood pressure monitoring

As high blood pressure affects a significant portion of the population, a doctor may order ambulatory blood pressure tests for those with white coat hypertension or blood pressure that is difficult to control.

This is done by strapping a monitor to the wrist for 24 hours. At regular intervals, the patient's blood pressure will be automatically measured and recorded in the device. This device is then returned to the nurse at the end of the 24-hour period so the doctor can then interpret the readings.

The 24-hour blood pressure readings offer valuable insight into the patient's condition as they go about daily activities and while asleep, and can reveal many things about your condition such as:

• Difference between blood pressure measurements performed at home and at the clinic
• Detect borderline hypertension
• Blood pressure that is difficult to control
• Identify nocturnal hypertension (for patients with higher cardiovascular risk)

Prevention is better than cure

Building a relationship with your primary care doctor allows your doctor to better understand your health risks and prescribe preventive solutions to help. These may be as simple as regular health screenings or vaccinations to prevent disease. Over time, this preventative care can help to save money by reducing the risk of complications due to late treatment or untreated illnesses.

Examples of some health screening tests which may be ordered by your doctor include:

• Mammogram to screen for breast cancer
• Pap smear to screen for cervical cancer
• Stool test to screen for colon cancer

Speak to your doctor and locate the nearest Parkway Shenton clinic to you here and make an appointment for a medical evaluation.