• Vol. 50 No. 2, 149–158
  • 01 February 2021

Chronic disease self-management competency and care satisfaction between users of public and private primary care in Singapore



Introduction: Primary healthcare providers play a crucial role in educating their patients on chronic disease self-management (CDSM). This study aims to evaluate CDSM competency and satisfaction in patients receiving their healthcare from public or private healthcare providers. Methods: A cross-sectional household study was conducted in a public housing estate using a standardised questionnaire to interview Singaporeans and permanent residents aged 40 years and above, who were diagnosed with at least 1 of these chronic diseases: hyperlipidaemia, hypertension or diabetes mellitus. CDSM competency was evaluated with the Partners In Health (PIH) scale and a knowledgebased questionnaire. Satisfaction was evaluated using a satisfaction scale. Results: In general, the 420 respondents demonstrated good CDSM competency, with 314 followed up at polyclinics and 106 by general practitioners (GPs). There was no significant difference between patients of polyclinics and GPs in CDSM competency scores (mean PIH score 72.9 vs 75.1, P=0.563), hypertension knowledge scores (90.9 vs 85.4, P=0.16) and diabetes knowledge scores (84.3 vs 79.5, P=0.417), except for hyperlipidaemia knowledge scores (78.6 vs 84.7, P=0.043). However, respondents followed up by GPs had higher satisfaction rates than did those followed up at polyclinics (odds ratio 3.6, confidence interval 2.28–5.78). Favourable personality of the doctors and ideal consultation duration led to higher satisfaction in the GP setting. A longer waiting time led to lower satisfaction in the polyclinic group. Conclusion: Polyclinics and GPs provide quality primary care as evidenced by high and comparable levels of CDSM competency. Redistribution of patients from public to private clinics may result in improvements in healthcare service quality.

Primary care in Singapore is set to face challenges in managing a rapidly ageing population. The expected population of older adults aged 65 years and above will be close to 1.5 million by 2030, corresponding to 2.7 working adults per older adult in 2030.2 Between 2019 and 2050, Singapore is foreseen to have the second largest percentage point increase in the share of older persons in the world (20.9%). With greater numbers of older adults, the prevalence of chronic disease and their complications is set to rise. The Transitions in Health, Employment, Social Engagement and Intergenerational Transfers in Singapore Study in 2009 found that the number of respondents with 3 or more chronic diseases have almost doubled from 19.8% to 37%. A 2017 report released by the Ministry of Health revealed that the prevalence of hyperlipidaemia, hypertension and diabetes mellitus among adults in Singapore aged 18 to 69 years were 33.6%, 21.5% and 8.6%, respectively.

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