Lim Angeline Woon Kee, Tan Clive, Yap Jason Chin Huat
Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
National Healthcare Group, Singapore.
Int J Integr Care. 2024 Oct 4;24(4):2. doi: 10.5334/ijic.7747. eCollection 2024 Oct-Dec.
How have we progressed and where are the gaps of integrated care in Singapore? Social-health care provision in the context of an ageing population is critical in the city-state's management of the unprecedented demand as the proportion of seniors with multiple complex medical needs have almost doubled in the past decade.
This study measures the maturity level of Singapore's integrated care, identifies key gaps and discusses their implications using the SCIROCCO Exchange tool, an online self-assessment tool consisting of the 12 dimensions necessary for the provision of integrated care.
A three-step mixed method Delphi study was used to derive expert consensus. Participants across the social-healthcare sector as well as representatives from all three public healthcare delivery networks with at least five years of experience were included. Participants rated each of the twelve dimensions of the SCIROCCO Exchange tool on a six-point ordinal scale and provided justifications for each rating. Criteria from the RAND UCLA appropriateness method and thematic analysis were adopted for the analysis.
All participants completed the study. The study found five dimensions in the "Initial" maturity level and five dimensions in the "Progressing" maturity level. There were two dimensions which were "Uncertain" because of split responses, possibly due to their differing vantage points and conceptualisations of integrated care. The overall medians were plotted on a spider diagram. The absence of a systematic approach for integrated care was the most common subtheme across all dimensions. This is foundational for integrated care as this would enable stakeholders across health and social care to identify with a common goal.
The findings emphasise the imperative to reshape social-health care delivery by focusing on foundational dimensions (such as structure, governance and citizen empowerment) to enable progress in other dimensions. Following the conclusion of this study, Singapore initiated a primary care reform with the launch of Healthier SG in July 2023. Future research may wish to explore the impact of Healthier SG on maturity of integrated care in Singapore.
新加坡在综合医疗方面取得了哪些进展，存在哪些差距？在人口老龄化背景下提供社会医疗服务，对于这个城市国家应对前所未有的需求至关重要，因为在过去十年中，有多种复杂医疗需求的老年人比例几乎翻了一番。
本研究使用SCIROCCO Exchange工具（一种由提供综合医疗所需的12个维度组成的在线自我评估工具）来衡量新加坡综合医疗的成熟水平，确定关键差距并讨论其影响。
采用三步混合方法德尔菲研究以达成专家共识。纳入了社会医疗保健部门的参与者以及来自所有三个公共医疗服务网络且具有至少五年经验的代表。参与者根据六点序数尺度对SCIROCCO Exchange工具的十二个维度进行评分，并为每个评分提供理由。采用了兰德加州大学适宜性方法的标准和主题分析进行分析。
所有参与者均完成了研究。研究发现有五个维度处于“初始”成熟水平，五个维度处于“进展中”成熟水平。有两个维度由于回答分歧而处于“不确定”状态，这可能是由于他们对综合医疗的不同观点和概念化。总体中位数绘制在蜘蛛图上。缺乏综合医疗的系统方法是所有维度中最常见的子主题。这是综合医疗的基础，因为这将使卫生和社会护理领域的利益相关者能够认同一个共同目标。
研究结果强调了通过关注基础维度（如结构、治理和公民赋权）来重塑社会医疗服务的紧迫性，以推动其他维度的进展。在本研究结束后，新加坡于2023年7月启动了“更健康的新加坡”初级医疗改革。未来的研究不妨探讨“更健康的新加坡”对新加坡综合医疗成熟度的影响。
