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Providing Care That Is Up-to-date With Current Medical Evidence Or Consensus

F1. Are Our Diabetic Patients Receiving Care In Accordance With The Clinical Practice Guidelines?

Diabetes mellitus (DM), or simply diabetes, is a metabolic disease in which a person has abnormally high blood sugar [1]. It is a major cause for heart disease and stroke, and can also lead to vision loss, kidney failure, or amputations of legs or feet. With timely and appropriate control of the level of blood glucose, these complications could be prevented or significantly delayed. Meanwhile, blood pressure control also plays an important role in preventing the occurrence of cardiovascular diseases in DM patients. Clinical Practice Guidelines recommended by Singapore Ministry of Health (MOH) states at least once a year clinical assessments on blood glucose, eye and blood pressure among the patients with DM [2]. In SGH, our DM patients have received appropriate care according to MOH’s guidelines and the compliant rates were comparable to those reported by our Ministry, the United Kingdom and the United States.
* HBA1c is an important indicator of the effectiveness of blood glucose control

References:
1. David Gardner, D.S., Greenspan's Basic and Clinical Endocrinology. Ninth Edition ed. LANGE Clinical Medicine. 2011: McGraw-Hill Medical.
2. MOH Clinical Practice Guideline : Diabetes Mellitus.
3. UK: National Diabetes Audit - Report for the audit period 2006-2007, Accessed on 01 Sep 2009
4. US HEDIS (Healthcare Effectiveness Data and Information Set), Accessed on 01 Sep 2009
5. MOH. Medisave for Chronic Disease Management Programme (CDMP) – The Second Year, Accessed on 01 Sep 2009 

F2. Are Our Patients With Hypertension Receiving Care In Accordance With The Clinical Practice Guidelines?

Hypertension (raised blood pressure) is a chronic medical condition in which the blood pressure in the arteries is elevated. It is a common disease affecting 1 in 4 Singaporeans [1] and a major risk factor for coronary heart disease and ischaemic as well as hemorrhagic stroke [2]. Complications of uncontrolled hypertension include heart failure, peripheral vascular disease, kidney impairment, retinal hemorrhage and visual impairment [3]. With timely and appropriate medical intervention, the risk of long-term complications of hypertension may be minimized. According to the Clinical Practice Guidelines developed by Ministry of Health (MOH), at least 2 blood pressure measurements and 1 bodyweight measurement should be performed in a year to monitor effective hypertension management [1]. Our rates of compliance to the guidelines are close to those reported by our Ministry of Health.
References:
1. MOH Clinical Practice Guidelines: Hypertension. 2005.
2. Policy and action for cancer prevention. Food, nutrition, and physical activity: a global perspective. 2009, Washington, DC, World cancer research fund/american institute for cancer research.
3. Williams, B., et al., British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary. BMJ, 2004. 328(7440): p. 634-40.
4. MOH. Medisave for Chronic Disease Management Programme (CDMP) – The Second Year Accessed on 09 June 2009

F3. Are Our Patients With Hypercholesterolemia Receiving Care In Accordance With The Clinical Practice Guidelines?

High levels of harmful cholesterol, Low Density Cholesterol (LDL), contribute significantly to the risks of heart diseases and stroke. With timely and appropriate medical intervention, the risk of long-term complications can be minimized. For people with moderate and high risk of coronary heart disease and cardiovascular disease, the Clinical Practice Guideline for hypercholesterolemia management recommends at least one blood cholesterol level check every year [1]. In the year 2008, approximately 85.2% of the patients with hypercholesterolemia in SGH had one or more LDL-cholesterol test. This rate was comparable to the data reported by Ministry of Health-Singapore (77.8%).

References:
1. Mannu, G.S., et al., Update on guidelines for management of hypercholesterolemia. Expert Rev Cardiovasc Ther, 2012. 10(10): p. 1239-49.

Last Modified Date :05 Dec 2013