The management of acne vulgaris in young people in primary care: A retrospective cohort study

BackgroundAcne vulgaris (acne) is common among young persons (YPs). Clinical practice guidelines are available for acne management to minimize their physical and psychological impact. However, evidence of adherence to these guidelines is sparse in primary care practices. The study aimed to determine the demographic profile of YPs who sought primary care consultations for acne, their related prescriptions and referrals to specialists for further management.MethodA retrospective study was conducted using data from a cluster of eight public primary care clinics in Singapore. Demographic, clinical, prescription, and referral data were extracted from the electronic health records of YPs aged 10–29 years with a documented diagnosis of acne (ICD-10 classification) from 1st July 2018 to 30th June 2020. The data were reviewed, audited for eligibility criteria, and de-identified before analysis.ResultsComplete data from 2,700 YPs with acne were analyzed. Male (56.1%) YPs and those of Chinese ethnicity (73.8%) had the most frequent attendances for acne. The mean and median age at presentation was 19.2 (standard deviation = 4.3) and 19 (interquartile range = 16–22) years, respectively. Only 69.7% of YPs received an acne-related medication; 33.5% received antibiotic monotherapy; 53.0% were prescribed oral doxycycline, 35.0% acne cream (combination of sulfur, salicylic acid, and resorcinol), and 28.4% benzoyl peroxide 5% gel; 54.3% of those treated with antibiotics were prescribed with a shorter duration than recommended; 51.3% were referred to a dermatologist on their first visit, and 15.8% had more than one visit.ConclusionAcne management for YPs can be enhanced with refresher training among primary care physicians for better adherence to its clinical practice guidelines

Intrauterine contraceptive device insertion simulation training in primary care

Background and objectives: Insertion of a intrauterine contraceptive device (IUCD) is one of the services provided at our public primary care polyclinics. We evaluate the effectiveness of a simulation workshop using low-fidelity mannequins to train primary care doctors. Methods: Questionnaire feedback was collected before and after the workshop. Participants rated their confidence level in performing the insertion of IUCDs using a 10-point scale. Results: A total of 37 out of 44 (84%) participants completed the survey. The median score for confidence level in performing the procedure increased from 2 out of 10 (interquartile range (IQR) 1 to 5) before the workshop to 8 out of 10 (IQR 7 to 9) after the workshop ( p < 0.01). The increase in confidence level was most pronounced among the participants with no previous experience with the procedure and those who had inserted only one or two IUCDs before the workshop. Participants rated a median score of 9 out of 10 (IQR 8 to 10) in their interest level to perform the procedure after the workshop. The overall experience of the workshop recorded a median score of 5 out of 5 using a five-point Likert scale. Conclusions: Bedside procedural training has been challenging. The teaching of the procedure via a structured workshop format including a simulation of the procedure using a low-fidelity mannequin increases the confidence level of participants to perform the procedure. A similar format can be employed for training of other primary care procedural skills

Deprescribing: What are the views and factors influencing this concept among patients with chronic diseases in a developed Asian community?

Objective: Public primary healthcare clinics in Singapore manage a large proportion of elderly patients with chronic diseases. Inappropriate prescribing of medications and polypharmacy in the elderly are associated with adverse outcomes. It is hence important to stop potentially inappropriate medications in this vulnerable group. An approach coined ‘deprescribing’ has been used to describe a patient-centred process of optimising medication regimens. The study aimed to elucidate patients’ attitudes towards the number of medications they were taking and identify factors that might influence acceptance of deprescription. Method: A cross-sectional study using the validated Patients’ Attitudes Towards Deprescribing (PATD) questionnaire was performed at two public primary healthcare institutions in Singapore. Participants were on regular follow-up at the clinics for chronic disease management and had at least five regular prescription medications. Results: The study found that participants (with a mean age of 68) had an average of four medical conditions and six prescription medications, with the majority (60.3%) expressing that they were taking a large number of medications. Of note, 93.4% of participants were willing to stop one of their medications if advised by the doctor. This was associated with a younger age (<65 years old), not having a discount card for medications and having a higher physician trust score (Wake Forest Physician Trust Score). Conclusions: This study showed that majority of the participants were willing to cease a medication that their physician thought was no longer required. Factors were also identified which potentially may be targeted to facilitate deprescription

Study protocol for the validation of a new pictorial functional scale in patients with knee osteoarthritis: the functional activity scoring tool (FAST)

Background Patient-reported outcome measures (PROMs) are required for patient-centred care. There are limited PROMs with good psychometric properties, and limitations to any language-based scale are often constrained by the written words or numerals used. Therefore, we developed the Functional Activity Scoring Tool (FAST), a self-reporting pictorial scale. FAST measures the impact of knee osteoarthritis on essential activities of daily living (ADL) and the significant changes in the self-perceived functional status over time.Objectives This study aims to (1) develop FAST with adaptation from the Wong-Baker FACES pain rating scale, (2) validate FAST against the Patient-Specific Functional Scale (PSFS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) and (3) establish the reliability, validity and responsiveness of FAST in individuals with knee osteoarthritis.Methods and analysis The prospective study protocol investigates the validity, responsiveness and reliability of FAST. The PSFS and KOOS will be gold standard comparisons. Participant recruitment will occur at four public polyclinics that offer physiotherapy outpatient services in Singapore. Onsite physiotherapists familiar with the study eligibilities will refer potential participants to the investigators after the routine physiotherapy assessment. After providing written consent, eligible participants will complete outcome measurements with FAST, the PSFS and KOOS during baseline and follow-up assessments. The Global Rating of Change (GROC) scale will determine how the participant’s knee status was changed compared with the beginning of the physiotherapy intervention.Ethics and dissemination SingHealth Centralised Institutional Review Board approved the study (CIRB reference number: 2022/2602). The final results will be published via scientific publication. FAST will benefit the evaluation and management of those who suffer knee osteoarthritis regardless of English proficiency or language barriers.Trial registration number NCT0559066

A cross-sectional study of gender differences in lifestyle behavior and usage of medications among community-dwelling Asians towards achieving their LDL-Cholesterol treatment goals

Background: Men differ from women in their cardiovascular mortality and morbidity globally, possibly due to their varying dietary and lifestyle behavior and usage of medications in dyslipidemia control. Objectives: The study aimed to compare the gender differences among community-dwelling Asians in their dietary habits, physical activity, their perception and use of lipid-lowering medications towards achieving their LDL-Cholesterol goals. Methods: A cross-sectional study was conducted, which included patients with physician-diagnosed dyslipidemia, aged 31–80 years in two public primary care clinics in Singapore. They were administered a questionnaire survey on their diet, exercise and lipid-lowering medication. Their latest laboratory fasting lipid tests, retrieved from their electronic health records, defined their treatment goals based on adapted Framingham risk scores. Results: Amongst 1093 patients, 61.9% were female. Fewer men (65.9%) achieved LDL-C treatment goals compared with women (75.2%). Comparing with their counterpart, more women were willing to change their diet (75.8% vs. 46.2%) and exercise (78.4% vs. 70.9%) to achieve their LDL treatment goals. However, men who were treated with lipid medication were more likely to reach LDL-C treatment goals. Conclusion: Fewer Asian men in Singapore attained their LDL-C treatment goals than women, which appeared to be associated with greater reluctance to embark on dietary and lifestyle changes. Gender-specific interventions should be considered to address these differences

Prevalence of and factors associated with sarcopenia among multi-ethnic ambulatory older Asians with type 2 diabetes mellitus in a primary care setting

Abstract Background Sarcopenia is the age-related loss of muscle mass and function, which increases fall risks in older persons. Hyperglycemia relating to Type-2 Diabetes Mellitus (T2DM) is postulated to aggravate sarcopenia. This study aimed to determine the prevalence of sarcopenia among ambulatory community-dwelling older patients, aged 60–89 years, with T2DM in a primary care setting and to identify factors which mitigate sarcopenia. Methods A total of 387 patients were recruited from a public primary care clinic in Singapore. Data on their socio-demography, clinical and functional status, levels of physical activity (International Physical Activity Questionnaire) and frailty status was collected. The Asian Working Group for Sarcopenia (AWGS) criteria were used to define sarcopenia based on muscle mass, grip strength and gait speed. Results The study population comprised men (53%), Chinese (69%), mean age = 68.3 ± SD5.66 years, lived in public housing (90%), had hypertension (88%) and dyslipidemia (96%). Their mean muscle mass was 6.3 ± SD1.2 kg/m2; mean gait speed was 1.0 ± SD0.2 m/s and mean grip strength was 25.5 ± SD8.1 kg. Overall, 30% had pre-sarcopenia, 24% with sarcopenia and 4% with severe sarcopenia. Age (OR = 1.14; 95%CI = 1.09–1.20;p < 0.001), multi-morbidity (OR = 1.25;95%CI = 1.05–1.49;p = 0.011) diabetic nephropathy (OR = 2.50;95%CI = 1.35–5.13;p = 0.004), hip circumference (OR = 0.86;95%CI = 0.82–0.90;p < 0.001) and number of clinic visits in past 1 year (OR = 0.74; 95%CI = 0.59–0.92;p = 0.008) were associated with sarcopenia. Conclusions Using AWGS criteria, 58% of older patients with T2DM had pre-sarcopenia and sarcopenia. Age, diabetic nephropathy, hip circumference, multi-morbidity and fewer clinic visits, but not a recent single HBA1c reading, were significantly associated with sarcopenia among patients with T2DM. A longitudinal relationship between clinic visits and sarcopenia should be further evaluated. (250 words

An exhaled carbon monoxide self-monitoring device linked to social media to support smoking cessation: A proof of concept pilot study

Background: A recent systematic review alludes to the effectiveness of social media in facilitating smoking cessation. However, most interventions center on mobile applications in engaging smokers. A novel portable exhaled-carbon-monoxide self-monitoring device, the Smoke-analyzer to Track and Expedite Actions and Decisions to Eliminate Smoking (STEADES) linked to a specially-designed mobile phone application has been developed, which relays exhaled carbon monoxide-related data from the smokers to their selected quit supporters via social media. Aim: The study aimed to determine the precision and feasibility of using the STEADES device among smokers in primary care. Method: This pilot study recruited 15 Asian adult smokers from a primary care polyclinic in Singapore. Their exhaled carbon monoxide measurements were measured serially using STEADES, compared to a commercial smokerlyzer as reference. The subjects could use the device to transmit their exhaled carbon monoxide measurements via mobile application and social media to their acquaintances in the next two weeks. Data on the subjects’ demographic and clinical characteristics, their views on STEADES (from a questionnaire), and its utility (from the application) were collated on enrolment and at the end of study. Results: Measurements using STEADES were significantly correlated with those from a commercial smokerlyzer (Pearson correlation=0.882, p <0.01). The majority of the subjects perceived that the exhaled carbon monoxide data would allow them to track progress of their quit attempts, perceived recipients of these data would support their smoking cessation (92.3%), and reported willingness to use it with improved accuracy. Conclusion: The STEADES prototype had shown feasibility in this proof of concept study. Most subjects were in favor of using it to support their smoking cessation but its accuracy required enhancement

Comparing and determining factors associated with hypertension self-care profiles of patients in two multi-ethnic Asian countries: cross-sectional studies between two study populations

Objectives To compare the sociodemography, disease characteristics and hypertension self-care profiles and to determine the factors influencing Hypertension Self-Care Profiles (HTN-SCP) in two populations in primary care settings from Singapore and Malaysia.Design Cross-sectional, cross national.Setting Multi-centre, primary care clinics Malaysia and Singapore.Participants 1123 adults with hypertension enrolled and analysed.Primary and secondary outcome measures Comparison between sociodemography, disease characteristics and the mean scores of HTN-SCP domains (behaviour, motivation and self-efficacy) and the factors influencing hypertension self-care.Results 1123 adults with hypertension attending primary care clinics in Malaysia and Singapore were involved. The participants’ mean age was 63.6 years (SD 9.7) in Singapore and 60.4 (SD 9.1) in Malaysia. Most of the participants in Singapore had tertiary education (22.3%) compared with Malaysia (13.0%), p&lt;0.001. A higher proportion of participants from Singapore had controlled blood pressure (74.6%) compared with Malaysia (33.8%), p&lt;0.001. The mean total score of HTN-SCP was significantly higher among Singapore participants compared with Malaysia participants 190 (SD 28) versus 184 (SD 23) (p&lt;0.001). Similarly, the mean score for motivation domain 67 (SD 10) versus 65 (SD 9), followed by self-efficacy score 65 (SD 11) versus 62 (SD 9) and behaviour score (58 SD 9 vs 56 SD 9) were higher among Singapore participants. In both countries, the factors which influenced higher HTN-SCP mean scores across all domains were being Indian and had tertiary education.Conclusions The study population in Singapore had a higher HTN-SCP mean score compared with Malaysia. The common factors influencing higher HTN-SCP mean scores at both study sites were ethnicity and level of education. Future intervention to improve self-care among people with hypertension may need to be tailored to their behaviour, motivation and self-efficacy levels