By Kwan Yu Heng
MD-PhD candidate, Duke-NUS Medical School
Co-chairperson, cross-cluster Population Health Special Interest Group

In 2015, I had the honour of serving the Singapore Heart Foundation as a volunteer researcher. I was tasked to evaluate the effectiveness of the cardiac rehabilitation services that SHF was providing and how the services impact the population. That was how I got started on a most rewarding journey in population health.

In layman's terms, population health refers to an approach to improve the health of an entire population that a healthcare system manages, by keeping those who are well healthy while treating those who are sick. Population health looks beyond just medical care, into other factors affecting health outcomes such as social issues, policies and community support.

Delivering care to people, before they need a doctor

The Singapore healthcare system has mostly been episodic, where healthcare providers only interact with the sick.   When our patients go back to the community after treatment, many are on their own with no healthcare support.   Consequently, we see many instances of people seeking treatment too late.

A population health approach means changing our mindsets to take care of the population even before they need to see us.   There are many benefits to this—better health outcomes, lower complication rates for patients and also lower cost for the healthcare system.

Three years ago, I was involved in a project where pharmacy students helped 300 Bedok rental flat residents get their health screened.   The students befriended them, packed their medication into unit dosing, and also learnt a lot about interacting with patients.

I found out from the socioeconomically disadvantage residents that they could not stop working every day, sometimes even on weekends, because they had to earn enough to put food on the table.   Even then, the food they ate were unhealthy—not by choice, but because it was what made them fuller for longer.   Due to such challenges, the less privileged often find healthy habits like eating fruits and vegetables or exercising—which most of us take for granted—difficult to incorporate into their lives.   With the help of community health providers, so much more can be achieved to keep them well and improve their health outcomes.

Translating my research into the real world

My particular area of interest in population health is on implementation science—how to translate new ideas from scientific literature or pilot projects to real life setting.   There are many issues faced when doing this : Will clinicians accept this new procedure or treatment?   Will patients use it?   How can we ensure patients continue to use it?   Will it involve more resources than ever? From what we know, only 17 per cent of efficacious findings were finally implemented in the clinical setting.   This is quite a huge waste of resources if no one tries their best to incorporate useful research into real life.

I spend a big portion of my time in the Rheumatology and Immunology department at Singapore General Hospital.   We noticed that the treatment approach in managing patients with axial spondyloarthritis, a form of arthritis affecting the spine and pelvis, is sorely lacking.   Nonsteroidal anti-inflammatory drugs (NSAIDs), a common group of pain relief medicines, are cheap but may not be effective in 30 per cent of the patients.

Biologics, a new and more effective treatment, costs almost S$25,000—very costly, especially for our patients who are mostly young graduates who just started working.   We needed to find a way to help manage their pain so that they can continue living normal lives.

With the support of my mentors Prof Julian Thumboo, Prof Truls Ostbye and Dr Warren Fong, and the Department of Rheumatology and Immunology, we secured a grant to study how Traditional Chinese Medicine (TCM) can help our patients with Spondyloarthritis.   The study is conducted by partnering the Singapore Thong Chai Medical Institution, a leading TCM expert in the TCM Free Clinic Space in the community.   We hope that our research can reveal a more affordable effective alternative for our patients.

In Duke-NUS, besides my work on TCM and quality of life in Rheumatology for my PhD, I am also currently working on population segmentation projects with Dr Low Lian Leng, a Consultant with SGH's Department of Family Medicine and Continuing Care.   We are in the process of validating our novel approach to managing patients with chronic disease through an upcoming trial.

Getting the healthcare community on board

I currently co-chair the cross-cluster Population Health Special Interest Group (SIG), made up of residents and students across the country.   Our mandate is to inculcate interest in this area in junior doctors, nurses, allied health professionals, researchers and students across Singapore's healthcare clusters.

I am trying to bring population health interest groups across Singapore such as those from Duke-NUS and NUS Life Science as our SIG's affiliates, so that we can tap on one another's expertise and best practices.

In the next few years, we hope that we can grow and benefit more members in the long run.   We will be conducting workshops and also competitions to attract people from other specialties, especially in the social and communication components of healthcare.   We are also engaging principal investigators to list their projects on our database, to encourage students and residents to get directly involved.   Our Facebook page routinely publishes research articles by Singapore researchers on population health.  

To achieve more meaningful outcomes, strong collaborations among healthcare professions are needed.   Researchers need clinicians' input, while clinicians need strong methodologists to do the good work – we cannot work alone.   Through platforms like the SIG, we hope to get all on board the efforts to improve population health.

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