Primary care in Singapore: an occupational therapy perspective

The recent editorial by Matchar and colleagues ¹ outlined the potential role of primary care for addressing the complex needs of individuals with chronic diseases. In Singapore, the recently established primary care networks and community health centres are ideal facilities for developing health promotion and chronic disease prevention programmes. The World Health Organization (WHO) global goals for managing and reducing the risk of developing non-communicable or chronic diseases is achieved through facilitating positive lifestyle choices and promoting health and wellness for all age groups. ² However, healthcare interventions and programmes that facilitate health behaviour change and address psychosocial issues associated with chronic diseases require a multidisciplinary approach. The WHO therefore recommends a multifaceted approach to tackling chronic diseases in primary care, which involves a range of healthcare professionals including, but not limited to, dieticians, nurses, occupational therapists, physiotherapists, social workers and psychologists. ²

Internationally, occupational therapy has been involved in primary care initiatives for many years including Australia, Canada, New Zealand, South Africa and the United States. Disease prevention, health and wellness promotion, health advocacy and education have been highlighted as methods that occupational therapists can contribute to for the management of chronic disease in primary care. ³ Research supports the impact of occupational therapy-led interventions in primary care. Such interventions include self-management programmes for individuals with multimorbidity, lifestyle interventions to promote active ageing, mental health wellness and recovery programmes for community-dwelling adults, and vocational rehabilitation programmes to enable individuals with chronic musculoskeletal injuries to remain in the workforce.

These interventions have resulted in improved activity engagement, function, quality of life, mobility and satisfaction. The management of diabetes, and long-term disabilities resulting from diabetes, are priorities for healthcare services globally. An occupational therapy designed programme for adolescents with type 1 diabetes has demonstrated effectiveness at improving medical and psychosocial outcomes. ⁴ Given the current ‘War on Diabetes’ in Singapore, occupational therapists, along with other relevant healthcare professionals, can deliver self-management education to facilitate lifestyle changes to prevent and reverse the long-term impacts of diabetes.

Occupational therapy education and training in human development (cognitive, physical, social, emotional), disease process intervention, activity analysis, behaviour modification, modification of the environment, adaptive equipment provision, health promotion and lifestyle interventions ensures that the core competencies and skills of occupational therapists are well suited to primary care. ³ Occupational therapists are trained in analysing how roles, habits, routines and lifestyle choices affect occupational performance and overall function, mental health and quality of life, ³ which fits well with chronic disease management within primary care settings. Better management of chronic conditions results in less frequent utilisation of hospital services, reducing costs and demands and allowing for the achievement of improved global health. ²

Occupational therapy’s contribution to the delivery of high-quality and efficient primary care has been summarised by Halle et al. ⁵ who reported that occupational therapy programmes can reduce hospital readmissions, improve treatment adherence, identify early intervention need, promote chronic disease management and functional independence, support transition through the care continuum and delay long-term institutionalisation.

Positioning occupational therapists in Singapore’s primary care polyclinics and/or community health centres will facilitate health promotion and self-management interventions to reduce morbidity, maximise functional capacity and improve quality of life for individuals with chronic disease. This multidisciplinary approach could contribute towards stemming the flow of admissions to acute care services and facilitate early hospital discharges for individuals with chronic disease.