Our Programmes

Future Primary Care

The FPC programme aims to enable patients to effectively self-manage their chronic diseases in partnership with their primary care providers. This involves the development of a national telehealth platform and the purposeful incorporation of technologies that enable effective and sustainable home management.

 

Various pilots are ongoing. The Primary Technology Enhanced Care (PTEC) project, in partnership with National Healthcare Group Polyclinics, trials the use of a home monitoring kit for hypertensive patients, within an integrated care delivery system that brings about better management and outcomes. Patients are empowered to manage their conditions independently, while building a trusted relationship with their care team. The pilot will be extended to diabetes and the testing of a home HbA1c diagnostic kit. Pilots with Singhealth Polyclinics will commence in 2019 to assess a diabetes coaching solution and better linkages between primary care and community-based services.   

 

MOHT’s plan is to bring together the successful elements from the pilots, build enablers for system-level scaling, and replicate the integrated programme within the public health system. 

 

Partners:

  • National Healthcare Group Polyclinics

 

Current Initiatives:

  • Tele-health pilot at Ang Mo Kio Polyclinic

Integrated General Hospital

Patients with two or more chronic conditions typically use hospital and social services more intensively. When they are managed by multiple specialists in the acute hospital, this often results in care fragmentation and raises costs.  A new care model is required that addresses the needs of each patient more holistically, and enables hospitals to better cope with the rapidly growing  number of such patients due to  population ageing and the rising prevalence of chronic diseases.

 

MOHT has therefore partnered Alexandra Hospital to develop the Integrated General Hospital (IGH) programme. Patients at the IGH are cared for by a single care team which manages their medical, functional and social problems comprehensively, and facilitates their transition back to the community. The goal is holistic care of patients that enables good functional recovery and outcomes,  while blunting the growth in usage of acute hospital beds.

 

The IGH model will extend to pilot approaches aimed at helping patients to stay well in the community post discharge and reduce avoidable readmissions. Work has also started on how the IGH model could be adapted for other hospitals in the public health system.

 

Partners:

  • Alexandra Hospital

 

Current Initiatives:

  • Continually enhance an application prototype that streamlines nursing documentation and enables additional analytics at the wards at Alexandra Hospital

  • Review and redesign discharge related workflows at Alexandra Hospital

  • Co-create future-ready spaces at Alexandra Hospital that could better enable recovery and encourage productive conversations

  • Enable a community-based activation movement around Queenstown, involving patient and families as co-creators of care

Integrated Health Promotion

The Integrated Health Promotion (InHealth) programme focuses on novel strategies to improve the health of the population and prevent the onset and progression of disease.

 

The goal is to work with communities to help shift community norms towards a conscious emphasis on health, leading to long-term and sustained behavioral change. The InHealth team works closely with government bodies, community leaders and private partners to embed ‘health in all policies’.

 

MOHT is developing a healthy precinct framework which advocates the coordinated implementation of a comprehensive set of health promoting interventions, together with active participation of the community. We are also creating a healthy precinct toolkit as a practical way for neighbourhoods to assess and prioritise their health promotion needs, engage the community and implement specific interventions.

 

InHealth will be piloting the framework and toolkit with a number of partners in 2019, with a view to refining them. These can then be used to replicate these efforts in precincts across Singapore.

 

Partners:

  • National University of Singapore (NUS)

  • Nanyang Technological University (NTU)

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Current Initiatives:

  • Creation of solutions that will nudge healthy behaviours

  • Development of methodologies and toolkits to enable scaling of efforts

© 2019 MOH Office for Healthcare Transformation

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