How does the THRUST programme help to manage your hypertension? – A Patient Journey
In January 2020, MOHT invited GPs to submit innovative proposals to answer the following challenge:
“What innovative solutions can help significantly increase the number of chronic patients managed by GP clinics by at least 20% in the next 3 years, with achievement of good chronic disease control, and which are financially sustainable and scalable?”
Project THRUST (Tackling Hypertension Right, Unifying Strengthening Trust) was one of the pilot projects that was selected and awarded by MOHT to support General Practitioner (GP) leaders to pilot their new care models, aimed at addressing the challenge.
Project THRUST is driven by Dr Lee Yik Voon (Lee & Tan Family Clinic and Surgery), supported by MOHT’s Future Primary Care (FPC) team. It involves 10 GP clinics and their Technology and Care Services Partner, Witz-U, to on-board hypertensive patients to the THRUST care programme for up to 12 months to better control high blood pressure. The patients could have concomitant chronic disease(s) such as diabetes.
Hypertension is prevalent and increasing in many developing and developed countries. Uncontrolled hypertension can lead to increased risk of cardiovascular diseases and complications such as stroke, coronary artery disease and heart failure. In 2017, there were 6,292 deaths from cardiovascular diseases in Singapore (30.1% of all deaths). Prevention is key and primary care is poised to play a key role. The pilot THRUST programme provides systematic wellness support to hypertensive patients in a GP clinic that they trust. This is made possible with empowerment of self-management, with in-person and virtual coaching and support by a multi-disciplinary care team consisting of GPs, nutritionists, and health coaches. The aim is to help hypertensive patients understand how their lifestyle choices (especially food choices, exercise and stress management) could help them achieve better controls of their high blood pressure and general health.
Dr Elaine Chua, a GP on the THRUST programme since 2021, referred Andrew* (not his real name) to the programme to help manage his hypertension and diabetes. Andrew wished to share and inspire others through his personal journey of staying healthy through the programme:
“My (hypertensive and diabetic) condition was not well controlled as a result of a combination of factors. I have a hectic work schedule and did not like exercising. My hobby is to binge watch Korean drama. I love good food and cannot resist my favourite dishes like char kway teow, nasi briyani and laksa. I also love sweet desserts like tau suan (mung bean dessert) and ice-cream.” - Andrew, 33 year-old patient that initially weighed 104kg.
With Andrew developing diabetes at the age of 33, Dr Chua advised him that in addition to medications, he also required lifestyle changes to control his hypertension, weight and diabetes to prevent damage to his body.
The THRUST programme utilised a Multi-Disciplinary Team (MDT) approach to help Andrew make small smart daily choices. As a relatively young patient, the MDT found him suitable to participate in a more intensive program. Besides a care coordinator monitoring his blood pressure trends, he received personalised education on exercise strategies from a health coach and on better diet choices from a nutritionist. Through co-management, the MDT tracked his progress and made small changes to his daily choices.
Mobile app provides food logging functions for users to log down their daily food intake as seamless entries.
Video tutorial on how to log food intake in the mobile app
Andrew's initial diet consisted mostly of hawker and occasional home cooked meals. At the time of joining the program, his HbA1c was 8.8%, which was in the unacceptable range (target HbA1c was <7.0%). With the team's guidance, he was able to shift his meal composition towards the ideal “Healthy Plate” proposed by the Health Promotion Board (HPB). He was taught to reduce the sodium content and proportion of carbohydrates in his meals, as well as improve the quality of carbohydrates that he was consuming from simple to complex high-fibre carbohydrates. The team was also able to remotely monitor his blood sugar levels daily during any adjustments, aiming to balance weight loss while preventing episodes of hypoglycemia (excessively low blood sugar). Andrew gradually incorporated more vegetables, fruits and protein in his diet, allowing him to lower the glycemic index of his meals.
- DASH Diet Scoring
Lifelong approach to healthy eating!
DASH is used to guide patients to improve their health and lower the blood pressure.
Our CARE team emphasise the right portion sizes, variety of food and nutrients.
Diet change during a short period of 3 months
DASH Scoring for Andrew’s diet
Empowered by the WitzGO app, he began his daily monitoring, receiving alerts and reminders where appropriate.
Patient self-monitoring via an app: Andrew could readily view the trends of his clinical readings in detail in the WitzGO app.
A precise plan of care
Andrew can easily view his latest tailored care plan from the application’s homepage
Andrew has easy access to the next scheduled review with the CARE team
Andrew was motivated to exercise. The team focused on progressive training, targeting to improve his cardiovascular fitness to help him achieve his weight loss goals. After optimising his cardiovascular fitness, the team progressed to strength training. In just 3 months, he was able to lose 18kg, about 17% of his initial weight. Andrew also reported an improvement in his mood and he was in fact, energised by the program.
Andrew's weight loss journey
Andrew could track his overall health and wellbeing by doing surveys for health professionals to assess his needs better.
Through Andrew’s responses, health professionals gave him feedback and advice during the monthly check-ins.
“Andrew is an example of one of our many patients who was happy they were able to achieve their individual goals. By participating in lifestyle change, Andrew's blood pressure and diabetes control was much improved, and he was able to cut down from 4 to 2 medications when he was off the program without impairing the control of his chronic illnesses.” - Dr Elaine Chua, GP, Bedok Medical Centre
The engagement of the GP sector to drive meaningful and scalable change is an important part of transforming primary care for the future. MOHT is happy to collaborate with like-minded GPs like Dr Lee Yik Voon (Lee & Tan Family Clinic and Surgery) and Dr Elaine Chua (Bedok Medical Centre), together with their Technology and Care Services Partner, Witz-U, on this pilot initiative.
Visit the Witz-U website for more information on the THRUST programme.
Dr Elaine Chua has been a GP since 2009, and was accredited Family Physician status from 2013. She also has Graduate Diplomas in Dermatology (NUS, 2014) and Occupational Medicine (NUS, 2016), before completing her Masters in Medicine in Family Medicine (NUS) in 2019. She is currently the director of Bedok Medical Centre from 2018. Bedok Medical Centre views each patient as unique and worthy of long term holistic care delivered in the context of their interests, their family, their work and their future. Her clinic is one of the first that joined the THRUST programme in 2021 and has been helping patients who are determined to see the change in their life. Dr Chua is now part of the 28th council of the College of Family Physicians.