Roles and recommendations from primary care physicians towards managing low-risk breast cancer survivors in a shared-care model with specialists in Singapore-a qualitative study.

BACKGROUND: Breast cancer is prevalent and has high cure rates. The resultant increase in numbers of breast cancer survivors (BCS) may overwhelm the current oncology workforce in years to come. We postulate that primary care physicians (PCPs) could play an expanded role in comanaging survivors, provided they are given the appropriate tools and training to do so. OBJECTIVE: To explore the perspectives of PCPs towards managing BCS in a community-based shared-care programme with oncologists. METHODS: Eleven focus groups and six in-depth interviews were conducted with seventy PCPs recruited by purposive sampling. All sessions were audio-recorded, transcribed verbatim and coded by three independent investigators. Thematic data analysis was performed and the coding process facilitated by NVivo 12. RESULTS: Majority of PCPs reported currently limited roles in managing acute and non-cancer issues, optimizing comorbidities and preventive care. PCPs aspired to expand their role to include cancer surveillance, risk assessment and addressing unmet psychosocial needs. PCPs preferred to harmonize cancer survivorship management of their primary care patients who are also BCS, with defined role distinct from oncologists. Training to understand the care protocol, enhancement of communication skills, confidence and trust were deemed necessary. PCPs proposed selection criteria of BCS and adequacy of their medical information; increased consultation time; contact details and timely access to oncologists (if needed) in the shared-care programme. CONCLUSIONS: PCPs were willing to share the care of BCS with oncologists but recommended role definition, training, clinical protocol, resources and access to oncologist's consultation to optimize the programme implementation.

Doctor, do I really need treatment for my current blood pressure?

Hypertension is the most common chronic condition seen in primary care. It is a potentially modifiable risk factor for cardiovascular and renal complications. The latest Joint National Committee recommendations in 2014 address common clinical questions from the best available science with regard to managing patients with hypertension. We review some of these recommendations and discuss how they may be applied in our practice.

PILL series. Managing urinary incontinence in the community.

Urinary incontinence is the involuntary loss of urine. There are many types of incontinence and different management options available, ranging from lifestyle modifications, medication to surgical intervention. Untreated urinary incontinence can result in a myriad of problems, including skin irritations, infections, social phobia, major depression and premature institutionalisation of elderly family members. Common barriers to optimal management include the socially embarrassing nature of the condition, which impedes open discussion, as well as the misperceptions that management must be invasive and the condition cannot be adequately managed within the community. We discuss the common types of incontinence encountered in the community and their management in the primary care setting.

The discriminative power of the EuroQol visual analog scale is sensitive to survey language in Singapore.

BACKGROUND: Existing evidence for validity of the visual analog scale of the EQ-5D-3L questionnaire (EQ-VAS) is weak in Chinese-speaking respondents in Singapore. We therefore investigated the validity of the Chinese (Singapore) version of EQ-VAS in patients with diabetes. METHODS: In a cross-sectional survey, patients with type 2 diabetes seen in a primary care facility completed an identical Chinese or English questionnaire containing the EQ-5D-3L and questions assessing other health and disease-related characteristics. Convergent and known-groups validity of the EQ-VAS was examined for Chinese- and English-speaking respondents separately. RESULTS: The EQ-VAS was correlated with the EQ-5D-3L health index and a 5-point Likert-type scale for assessing global health in both Chinese-speaking (N = 335) and English-speaking respondents (N = 298), suggesting convergent validity. The mean EQ-VAS scores differed between English-speaking patients with differing duration of diabetes (< 10 years versus ≥ 10 years), comorbidity status (absence versus presence), and complications of diabetes (absence versus presence), providing evidence for known-groups validity. However, the EQ-VAS scores for Chinese-speaking respondents known to differ in these characteristics were similar, even among subgroups of relatively younger patients or those with formal school education. CONCLUSIONS: Chinese- and English-speaking Singaporeans respond differently to the EQ-VAS. The Chinese version of EQ-VAS appears less sensitive than its English version for measuring global health in patient populations in Singapore.