Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Ann Acad Med Singap. 2021 Feb;50(2):149-158. doi: 10.47102/annals-acadmedsg.2020216.
Primary healthcare providers play a crucial role in educating their patients on chronic disease self-management (CDSM). This study aims to evaluate CDSM competency and satisfaction in patients receiving their healthcare from public or private healthcare providers.
A cross-sectional household study was conducted in a public housing estate using a standardised questionnaire to interview Singaporeans and permanent residents aged 40 years and above, who were diagnosed with at least 1 of these chronic diseases: hyperlipidaemia, hypertension or diabetes mellitus. CDSM competency was evaluated with the Partners In Health (PIH) scale and a knowledge based questionnaire. Satisfaction was evaluated using a satisfaction scale.
In general, the 420 respondents demonstrated good CDSM competency, with 314 followed up at polyclinics and 106 by general practitioners (GPs). There was no significant difference between patients of polyclinics and GPs in CDSM competency scores (mean PIH score 72.9 vs 75.1, P=0.563), hypertension knowledge scores (90.9 vs 85.4, P=0.16) and diabetes knowledge scores (84.3 vs 79.5, P=0.417), except for hyperlipidaemia knowledge scores (78.6 vs 84.7, P=0.043). However, respondents followed up by GPs had higher satisfaction rates than did those followed up at polyclinics (odds ratio 3.6, confidence interval 2.28-5.78). Favourable personality of the doctors and ideal consultation duration led to higher satisfaction in the GP setting. A longer waiting time led to lower satisfaction in the polyclinic group.
Polyclinics and GPs provide quality primary care as evidenced by high and comparable levels of CDSM competency. Redistribution of patients from public to private clinics may result in improvements in healthcare service quality.
初级保健提供者在教育慢性病自我管理（CDSM）患者方面发挥着至关重要的作用。本研究旨在评估从公共或私人医疗保健提供者处获得医疗服务的患者的 CDSM 能力和满意度。
在一个公共住房区进行了一项横断面家庭研究，使用标准化问卷采访了年龄在 40 岁及以上、至少患有以下一种慢性疾病的新加坡人和永久居民：高脂血症、高血压或糖尿病。使用合作伙伴健康（PIH）量表和基于知识的问卷评估 CDSM 能力。使用满意度量表评估满意度。
总体而言，420 名受访者表现出良好的 CDSM 能力，其中 314 名在综合诊疗所接受随访，106 名在全科医生（GP）处接受随访。在 CDSM 能力评分（平均 PIH 评分 72.9 与 75.1，P=0.563）、高血压知识评分（90.9 与 85.4，P=0.16）和糖尿病知识评分（84.3 与 79.5，P=0.417）方面，综合诊疗所和全科医生处的患者没有显著差异，除了高脂血症知识评分（78.6 与 84.7，P=0.043）。然而，在全科医生处接受随访的受访者的满意度率高于在综合诊疗所接受随访的受访者（优势比 3.6，置信区间 2.28-5.78）。医生良好的个性和理想的咨询时间导致在 GP 环境中更高的满意度。在综合诊疗所，较长的等待时间导致较低的满意度。
综合诊疗所和全科医生提供高质量的初级保健，这体现在高水平且相当的 CDSM 能力上。将患者从公共诊所重新分配到私人诊所可能会提高医疗服务质量。
