SCHS followed 63,000 middle-aged and elderly Chinese Singaporeans for 15 years to determine how lifestyle and diets affect their health outcomes, in particular in chronic diseases common among Singaporeans.
Dr Jasmine Lew, Resident Physician at SingHealth Polyclinics (SHP) - Bedok, could be a rare specimen of clinician: primary care clinician-researcher.
An enthusiastic advocate of research and a Khoo scholar, she was roped in by Professor Koh Woon Puay of Duke-NUS, the site-principal investigator of the Singapore Chinese Health Study (SCHS), and Professor Tazeen Jafar, Dr Lew's Khoo scholar mentor, to study end-stage renal disease (ESRD) using its population data.
SCHS followed 63,000 middle-aged and elderly Chinese Singaporeans for 15 years to determine how lifestyle and diets affect their health outcomes, in particular in chronic diseases common among Singaporeans. More than 60 peer-reviewed findings have resulted from it.
What Dr Lew (above) and her collaborators found was intriguing: eating red meat may increase the risk of kidney failure, and replacing red meat with other proteins can reduce the risk of ESRD. Their findings were published in July 2016.
"From a primary care provider's point of view, this information is very important," Dr Lew, who was first author of the paper said, "The results from this study are directly applicable, suggesting that we should advise patients who are at high risk of developing ESRD to reduce their red meat consumption."
It was her introduction to a major epidemiologic study as a clinician, but Dr Lew's journey really started in her undergraduate days in the US. She said, "My undergraduate school was research-intensive, and it was a journey that taught me that there are many ways to do research. Such an environment allows research to thrive."
Dr Lew then continued to be involved in research during her further training in outpatient paediatrics, nutrition and epidemiology, before returning to Singapore and joining SHP. "As a primary care physician, I'm interested in preventive care medicine. Research with large data sets supports primary care so that we can treat patients' existing diseases more effectively and delay the progression of illnesses."
"Knowledge gleaned from studies is important ... But even more important is how we interpret it for our patients, to preserve its key message."
- Dr Jasmine Lew, Resident Physician, SHP-Bedok
Prof Tazeen Jafar, Professor at Duke-NUS Medical School's Health Services & Systems Research Programme and visiting consultant at Singapore General Hospital, said, "In health services research (HSR), we try to find systems or population level patterns associated with health outcomes. These include lifestyle, behaviours, and social factors, and their determinants and policies that influence such factors. We try to find solutions by improving delivery and access to care and reducing disparities in healthcare."
"I'm guiding Jasmine in further studies to determine the prevalence and determinants of chronic kidney disease (CKD) in Singhealth polyclinics, and to develop programs for optimal recognition and management of CKD. We need a primary care physician because they are the ones working closely with patients at the community level to control and prevent such a chronic condition."
Working with SCHS' huge data set had its challenges, but none that Dr Lew couldn't overcome. She shared, "Prof Koh Woon Puay recruited me to lead the study and guided me throughout. I also had support from Dr Tan Ngiap Chuan, SHP's Director of Research, who first introduced me to Prof Koh and ensured that I have protected time for research."
Dr Lew also worked hand in hand with an epidemiologist at the National Registry of Diseases Office to understand how the data can be interpreted for both the public and the individual patient.
"Knowledge gleaned from studies is important because it affects the wider population and reinforces what we tell our patients. But even more important is how we interpret it for our patients, to preserve its key message," Dr Lew said, "The key is to humanise the information for our patients so it makes sense for them."
Health Services Research
Health Services Research (HSR) is a multi-disciplinary field of scientific investigation, consisting of both basic and applied sciences, that aims to identify the most effective ways to organise, manage, finance, and deliver high quality care in order to optimise population health, service costs, and satisfaction of patients and providers.
This field draws from many disciplines to address the breadth of research, including biostatistics, epidemiology, decision sciences, health economics, medicine, nursing, operations research, psychology and medical sociology.
In 2015, SingHealth established the SingHealth Health Services Research Centre to coordinate and synergize existing HSR capabilities across various SingHealth institutions. The Health Services Research Institute (HSRI) was also set up as a functional bridge between HSR researchers at SingHealth and Duke-NUS Medical School.