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  1. Article ; Online: Defining and measuring multimorbidity in primary care in Singapore

    Shilpa Tyagi / Victoria Koh / Gerald Choon-Huat Koh / Lian Leng Low / Eng Sing Lee

    PLoS ONE, Vol 17, Iss

    Results of an online Delphi study

    2022  Volume 12

    Abstract: Multimorbidity, common in the primary care setting, has diverse implications for both the patient and the healthcare system. However, there is no consensus on the definition of multimorbidity globally. Thus, we aimed to conduct a Delphi study to gain ... ...

    Abstract Multimorbidity, common in the primary care setting, has diverse implications for both the patient and the healthcare system. However, there is no consensus on the definition of multimorbidity globally. Thus, we aimed to conduct a Delphi study to gain consensus on the definition of multimorbidity, the list and number of chronic conditions used for defining multimorbidity in the Singapore primary care setting. Our Delphi study comprised three rounds of online voting from purposively sampled family physicians in public and private settings. Delphi round 1 included open-ended questions for idea generation. The subsequent two rounds used questions with pre-selected options. Consensus was achieved based on a pre-defined criteria following an iterative process. The response rates for the three rounds were 61.7% (37/60), 86.5% (32/37) and 93.8% (30/32), respectively. Among 40 panellists who responded, 46.0% were 31–40 years old, 64.9% were male and 73.0% were from the public primary healthcare setting. Based on the findings of rounds 1, 2 and 3, consensus on the definition of a chronic condition, multimorbidity and finalised list of chronic conditions were achieved. For a condition to be chronic, it should last for six months or more, be recurrent or persistent, impact patients across multiple domains and require long-term management. The consensus-derived definition of multimorbidity is the presence of three or more chronic conditions from a finalised list of 23 chronic conditions. We anticipate that our findings will inform multimorbidity conceptualisation at the national level, standardise multimorbidity measurement in primary care and facilitate resource allocation for patients with multimorbidity.
    Keywords Medicine ; R ; Science ; Q
    Language English
    Publishing date 2022-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Preferences and willingness-to-pay for a blood pressure telemonitoring program using a discrete choice experiment

    Ian Yi Han Ang / Yi Wang / Shilpa Tyagi / Gerald Choon Huat Koh / Alex R. Cook

    npj Digital Medicine, Vol 6, Iss 1, Pp 1-

    2023  Volume 9

    Abstract: Abstract This study aimed to elicit the preferences and willingness-to-pay for blood pressure (BP) telemonitoring programs. This study also investigated the different factors or participant characteristics that could influence preferences and choice ... ...

    Abstract Abstract This study aimed to elicit the preferences and willingness-to-pay for blood pressure (BP) telemonitoring programs. This study also investigated the different factors or participant characteristics that could influence preferences and choice behaviors. Participants with hypertension were identified from an online survey panel demographically representative of Singapore’s general population. Participants completed a discrete choice experiment (DCE) with 12 choice sets, selecting their preferred BP monitoring program differing on five attributes: mode of consultation, BP machine type (with Bluetooth or not), BP machine price, monthly fee, and program duration. The base reference population (male, married, higher income, more formal education years, full-time worker, aged 55 to <65 years, and digital skills score of 36) preferred teleconsultation over in-person consultation, Bluetooth feature, lower machine price, lower monthly fee, and shorter program duration. A subgroup of participants can be considered teleconsultation-resistant, and three demographic factors were associated with lower preference for teleconsultation: female, fewer formal education years, and lower income. Considering the reference population and Bluetooth attribute, participants were willing to pay 66 SGD (~49 USD) additional for the machine to obtain the Bluetooth feature. Considering the reference population and teleconsultation attribute, participants were willing to pay 6.80 SGD (~5.10 USD) extra monthly fee for a program using teleconsultation. Here we report that amongst participants with hypertension, there is strong preference for the use of teleconsultation and a BP machine with Bluetooth feature in a BP monitoring program. However, a subgroup of participants are teleconsultation-resistant and would prefer in-person consultation.
    Keywords Computer applications to medicine. Medical informatics ; R858-859.7
    Subject code 336
    Language English
    Publishing date 2023-09-01T00:00:00Z
    Publisher Nature Portfolio
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Qualitative study exploring heterogeneity in caregiving experiences post-stroke in Singapore

    Chuen Seng Tan / Gerald Choon-Huat Koh / Shilpa Tyagi / Nan Luo / Kelvin Bryan Tan / Edward Menon / Boon Yeow Tan / N Venketasubramanian / Wei Chin Loh / Shu Hui Fan / Kenneth Lam Thuan Yang / Audrey Swee Ling Chan / Aysha Farwin / Zunairah Binti Lukman

    BMJ Open, Vol 13, Iss

    2023  Volume 3

    Abstract: Objective Stroke, a common illness in older adults, accounts for up to 4% of direct medical costs in developed nations. Informal caregiving contributing a significant proportion of economic burden post-stroke warrants a deeper understanding of the ... ...

    Abstract Objective Stroke, a common illness in older adults, accounts for up to 4% of direct medical costs in developed nations. Informal caregiving contributing a significant proportion of economic burden post-stroke warrants a deeper understanding of the caregiving context to sustain caregiving arrangement. While literature exists describing differences in motivation and preferences of caregivers, limited literature explores differences in caregiving experiences of different types of caregivers (ie, spouse, adult-child, sibling or others). Addressing this gap, our study aimed to explore the caregiving experience of stroke survivors and their family caregivers across different caregiver identities in an Asian setting.Design Qualitative descriptive study.Setting Community setting.Participants We conducted semi-structured interviews with 26 stroke survivors and 35 caregivers purposively sampled from an outpatient rehabilitation setting, an outpatient clinic and a support organisation. Data were analysed using thematic analysis.Outcome measures Themes including caregiving experience of stroke survivors and their family caregivers across different caregiver identities.Results Following five themes were reported: caregiver reserve, coping strategies, caregiver burden, competing commitments and role of foreign domestic worker (FDW) in family caregiving. Spouse caregivers were less willing to ask for help, commonly adopted faith-based, and spacing or recharging types of coping, reported emotional strain and shared limited accounts of FDWs. Adult-child caregivers were more willing to ask for help, engaged in alternative care arrangements involving FDWs, commonly adopted action-focussed coping and reported multidimensional caregiver burden.Conclusion Our findings illustrated the heterogeneity in factors affecting caregiving experience across spouse and adult-child caregivers. Practical implications include conducting a needs assessment for caregiver-stroke survivor dyads and providing tailored support, training and information ...
    Keywords Medicine ; R
    Subject code 360
    Language English
    Publishing date 2023-03-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Burden of informal care in stroke survivors and its determinants

    Yi Wang / Shilpa Tyagi / Helen Hoenig / Kim En Lee / Narayanaswamy Venketasubramanian / Edward Menon / Deidre Anne De Silva / Philip Yap / Boon Yeow Tan / Sherry H. Young / Yee Sien Ng / Tian Ming Tu / Yan Hoon Ang / Keng He Kong / Rajinder Singh / Reshma A. Merchant / Hui Meng Chang / Chou Ning / Angela Cheong /
    Gerald Choon-Huat Koh

    BMC Public Health, Vol 21, Iss 1, Pp 1-

    a prospective observational study in an Asian setting

    2021  Volume 14

    Abstract: Abstract Background Informal caregiving is an integral part of post-stroke recovery with strenuous caregiving demands often resulting in caregiving burden, threatening sustainability of caregiving and potentially impacting stroke survivor’s outcomes. Our ...

    Abstract Abstract Background Informal caregiving is an integral part of post-stroke recovery with strenuous caregiving demands often resulting in caregiving burden, threatening sustainability of caregiving and potentially impacting stroke survivor’s outcomes. Our study aimed to examine and quantify objective and subjective informal care burden after stroke; and to explore the factors associated with informal care burden in Singapore. Methods Stroke patients and their informal caregivers were recruited from all five tertiary hospitals in Singapore from December 2010 to September 2013. Informal care comprised of assistance provided by informal caregivers with any of the activities of daily living. Informal care burden was measured by patients’ likelihood of requiring informal care, hours of informal care required, and informal caregivers’ Zarit’s Burden Score. We examined informal care burden at 3-months and 12-months post-stroke. Generalized linear regressions were applied with control variables including patients’ and informal caregivers’ demographic characteristics, arrangement of informal care, and patients’ health status including stroke severity (measured using National Institute of Health Stroke Scale), functional status (measured using Modified Rankin Scale), self-reported depression, and common comorbidities. Results Three hundred and five patients and 263 patients were examined at 3-months and 12-months. Around 35% were female and 60% were Chinese. Sixty three percent and 49% of the patients required informal care at 3-months and 12-months point, respectively. Among those who required informal care, average hours required per week were 64.3 h at 3-months and 76.6 h at 12-months point. Patients with higher functional dependency were more likely to require informal care at both time points, and required more hours of informal care at 3-months point. Female informal caregivers and those caring for patients with higher functional dependency reported higher Zarit’s Burden. While informal caregivers who worked full-time reported higher burden, those caring for married stroke patients reported lower burden at 3-months point. Informal caregivers who co-cared with foreign domestic workers, i.e.: stay-in migrant female waged domestic workers, reported lower burden. Conclusions Informal care burden remains high up to 12-months post-stroke. Factors such as functional dependency, stroke severity, informal caregiver gender and co-caring with foreign domestic workers were associated with informal care burden.
    Keywords Informal care ; Quality of life ; Rehabilitation ; Stroke ; Stroke management ; Socio-economic factors ; Public aspects of medicine ; RA1-1270
    Subject code 360 ; 150
    Language English
    Publishing date 2021-10-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Healthcare utilization and cost trajectories post-stroke

    Shilpa Tyagi / Gerald Choon-Huat Koh / Luo Nan / Kelvin Bryan Tan / Helen Hoenig / David B. Matchar / Joanne Yoong / Eric A. Finkelstein / Kim En Lee / N. Venketasubramanian / Edward Menon / Kin Ming Chan / Deidre Anne De Silva / Philip Yap / Boon Yeow Tan / Effie Chew / Sherry H. Young / Yee Sien Ng / Tian Ming Tu /
    Yan Hoon Ang / Keng Hee Kong / Rajinder Singh / Reshma A. Merchant / Hui Meng Chang / Tseng Tsai Yeo / Chou Ning / Angela Cheong / Yu Li Ng / Chuen Seng Tan

    BMC Health Services Research, Vol 18, Iss 1, Pp 1-

    role of caregiver and stroke factors

    2018  Volume 13

    Abstract: Abstract Background It is essential to study post-stroke healthcare utilization trajectories from a stroke patient caregiver dyadic perspective to improve healthcare delivery, practices and eventually improve long-term outcomes for stroke patients. ... ...

    Abstract Abstract Background It is essential to study post-stroke healthcare utilization trajectories from a stroke patient caregiver dyadic perspective to improve healthcare delivery, practices and eventually improve long-term outcomes for stroke patients. However, literature addressing this area is currently limited. Addressing this gap, our study described the trajectory of healthcare service utilization by stroke patients and associated costs over 1-year post-stroke and examined the association with caregiver identity and clinical stroke factors. Methods Patient and caregiver variables were obtained from a prospective cohort, while healthcare data was obtained from the national claims database. Generalized estimating equation approach was used to get the population average estimates of healthcare utilization and cost trend across 4 quarters post-stroke. Results Five hundred ninety-two stroke patient and caregiver dyads were available for current analysis. The highest utilization occurred in the first quarter post-stroke across all service types and decreased with time. The incidence rate ratio (IRR) of hospitalization decreased by 51, 40, 11 and 1% for patients having spouse, sibling, child and others as caregivers respectively when compared with not having a caregiver (p = 0.017). Disability level modified the specialist outpatient clinic usage trajectory with increasing difference between mildly and severely disabled sub-groups across quarters. Stroke type and severity modified the primary care cost trajectory with expected cost estimates differing across second to fourth quarters for moderately-severe ischemic (IRR: 1.67, 1.74, 1.64; p = 0.003), moderately-severe non-ischemic (IRR: 1.61, 3.15, 2.44; p = 0.001) and severe non-ischemic (IRR: 2.18, 4.92, 4.77; p = 0.032) subgroups respectively, compared to first quarter. Conclusion Highlighting the quarterly variations, we reported distinct utilization trajectories across subgroups based on clinical characteristics. Caregiver availability reducing hospitalization ...
    Keywords Stroke ; Caregivers ; Health services ; Healthcare costs ; Hospitalization ; Public aspects of medicine ; RA1-1270
    Subject code 360
    Language English
    Publishing date 2018-11-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Can caregivers report their care recipients’ post-stroke hospitalizations and outpatient visits accurately? Findings of an Asian prospective stroke cohort

    Shilpa Tyagi / Gerald Choon-Huat Koh / Nan Luo / Kelvin Bryan Tan / Helen Hoenig / David B. Matchar / Joanne Yoong / Eric A. Finkelstein / Kim En Lee / N. Venketasubramanian / Edward Menon / Kin Ming Chan / Deidre Anne De Silva / Philip Yap / Boon Yeow Tan / Effie Chew / Sherry H. Young / Yee Sien Ng / Tian Ming Tu /
    Yan Hoon Ang / Keng He Kong / Rajinder Singh / Reshma A. Merchant / Hui Meng Chang / Tseng Tsai Yeo / Chou Ning / Angela Cheong / Yu Li Ng / Chuen Seng Tan

    BMC Health Services Research, Vol 18, Iss 1, Pp 1-

    2018  Volume 8

    Abstract: Abstract Background Health services research aimed at understanding service use and improving resource allocation often relies on collecting subjectively reported or proxy-reported healthcare service utilization (HSU) data. It is important to know the ... ...

    Abstract Abstract Background Health services research aimed at understanding service use and improving resource allocation often relies on collecting subjectively reported or proxy-reported healthcare service utilization (HSU) data. It is important to know the discrepancies in such self or proxy reports, as they have significant financial and policy implications. In high-dependency populations, such as stroke survivors, with varying levels of cognitive impairment and dysphasia, caregivers are often potential sources of stroke survivors’ HSU information. Most of the work conducted on agreement analysis to date has focused on validating different sources of self-reported data, with few studies exploring the validity of caregiver-reported data. Addressing this gap, our study aimed to quantify the agreement across the caregiver-reported and national claims-based HSU of stroke patients. Methods A prospective study comprising multi-ethnic stroke patient and caregiver dyads (N = 485) in Singapore was the basis of the current analysis, which used linked national claims records. Caregiver-reported health services data were collected via face-to-face and telephone interviews, and similar health services data were extracted from the national claims records. The main outcome variable was the modified intraclass correlation coefficient (ICC), which provided the level of agreement across both data sources. We further identified the amount of over- or under-reporting by caregivers across different service types. Results We observed variations in agreement for different health services, with agreement across caregiver reports and national claims records being the highest for outpatient visits (specialist and primary care), followed by hospitalizations and emergency department visits. Interestingly, caregivers over-reported hospitalizations by approximately 49% and under-reported specialist and primary care visits by approximately 20 to 30%. Conclusions The accuracy of the caregiver-reported HSU of stroke patients varies across different ...
    Keywords Healthcare ; Validation ; Caregiver ; Intraclass correlation coefficient ; Stroke ; Public aspects of medicine ; RA1-1270
    Subject code 360
    Language English
    Publishing date 2018-10-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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