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A dialogue on seamless care: Australia, Malaysia, Singapore, Thailand

Organized in conjunction with the Global Learning Collaborative on Health Systems Resilience 2nd Annual Conclave at the Orchard Hotel in Singapore, the Alliance hosted a lunch dialogue on seamless care in the Asia-Pacific featuring patients, healthcare professionals and payers from Australia, Malaysia, Singapore, and Thailand.

Dr Christian Verdicchio, CEO, Heart Support Australia highlighted sobering statistics in Australia:

  • CVD accounts for 25% of all deaths;
  • is the leading killer in men;
  • second-leading cause of death in women, and
  • Only 9% of Australian patients took up cardiac rehabilitation after a heart attack or stroke.

Yet most were reluctant to focus on cardiac rehabilitation and secondary prevention. General primary prevention and awareness campaigns did not move the needle in the last few years, with prevalence  increasing.Patients were often left in limbo given primary care physician shortages, with as many as 40% of re-hospitalizations were avoidable. Many chose to get off medication and were not appropriately followed up.

Heart Support Australia‘s mission was thus to help patients come to terms with their diagnosis, help cardiologists by reinforcing key concepts, and ultimately help health systems by keeping them out of the hospital. Peer support was thus a cost-effective way of secondary prevention – organizing them together on a regular basis helped to improve mental health and health literacy.

Dr Doreen Tan, Associate Professor, National University of Singapore, and cardiac specialist pharmacist at the National University Heart Centre, shared that 30% of patients who suffered an acute incident stopped following up with their primary care doctor within 3 years, while 60% of patients stopped adherence to statin medications. There were deeper reasons for why this was the case, but solutions were not easy to implement.

Citing the example of Singapore’s AMI-HOPE program which used digital health and AI tools to deliver information to patients and receive treatment/counselling from cardiac pharmacists, the take-up rate was still low. Patients were daunted by the cost of enrolling in the service – the financing model for such services had to be right from the start to make an impact in continuity of care for patients.

Other solutions were needed – one important step was to meet patients where they were. Training healthcare professionals to focus their conversations around the patients was an important one and something that was sorely needed in both primary and hospital care.

 

Dr Raja Ezman Raja Shariff, Head of Heart Failure Service, Universiti Teknologi MARA Faculty of Medicine, shared his experience in creating a multidisciplinary care team to improve outcomes for patients with heart failure. Recognizing that heart failure has a worse 5-year prognosis than some cancers, Dr Raja Ezman shared that it was essential for healthcare professionals from different disciplines to work together.

Yet there were constraints – other healthcare professionals had inertia and fear of referring patients for cardiac rehabilitation programs, despite its effectiveness. Dieticians could potentially play a bigger role in hospitals by revamping menus for heart failure patients, but had not happened. Enabling pharmacists to take on roles of prescribing medication would help in community settings, but there were barriers in the way.

Nonetheless, running a multidisciplinary care team was highly encouraged to ensure a better quality of life and outcomes for patients. UiTM had brought down re-hospitalizations to 2-5% within one year – better than the Malaysian national average. They also implemented a virtual clinic for high-risk patients at danger of deteriorating.

Rounding off the discussion, Dr Chaiyos Kunanusont, Senior Advisor, National Health Security Office Thailand (NHSO) shared NHSO’s approach in:

  • Standardizing service quality, by registering cardiac centers, monitoring of outcomes, expansion of claims to cover post-intervention care, and self-assessment with supervision monitoring;
  • Improving public education and patient participation
  • Improving policy advocacy for sustainable resources and sustainable quality advocacy, using evidence-based approaches from patient feedback, cardiac centers’ self-assessment, and NHSO’s assessment.

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A dialogue on seamless care: Australia, Malaysia, Singapore, Thailand

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