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Both living and working environments have a substantial influence on promoting healthy living habits. A holistic and accurate assessment of the community health-promoting practices is important to identify gaps and to make continuous, tangible improvements. The aim of the study is to assess the prevalence of the Singapore community health-promoting practices. The community health-promoting practices in all residential zones of an electoral constituency were assessed based on a composite health promotion scoring system comprising of 44 measurable elements under the 5 domains of community support and resources; healthy behaviours; chronic conditions; mental health; and common medical emergencies. An alphabetical grading system was used based on the score ranges: grade 'A' (75% and above), grade 'B' (60% to below 75%), grade 'C' (50% to below 60%) and grade 'D' (below 50%). The community health-promoting practices were graded 'D' with an overall average score of 41%. The constituency achieved grade 'C' (59%) for mental health domain and grade 'B' (72%) for common medical emergencies. The health-promoting practices for the other domains were graded 'D' (<50%) except for healthy behaviour (physical activity) sub-domain which achieved grade 'B' (65%). Significant gaps were identified in the community health-promoting practices. The residential zones may benefit from the scoring system to identify gaps and prioritize high-impact strategies to improve their health practices.

ObjectiveTo measure the extent of multispecialty care fragmentation among outpatients receiving specialist care and identify associated risk factors for fragmented care.DesignA retrospective cross-sectional study.SettingSpecialist outpatient clinics (SOCs) in a Singapore regional hospital.ParticipantsA total of 40 333 patients aged 21 and above with at least two SOC visits in the year 2016. Data for 146 792 physician consultation visits were used in the analysis and visits for allied health services and medical procedures were excluded.Outcome measuresThe Fragmentation of Care Index (FCI) was used to measure care fragmentation for specialist outpatients. Log-linear regression with stepwise selection was used to investigate the association between FCI and patient age, gender, race and Most Frequently Visited Specialty (MFVS), controlling for number of different specialities seen.ResultsAbout 36% experienced fragmented care (FCI >0) and their mean FCI was 0.70 (SD=0.20). FCI was found to be positively associated with age (p<0.001). Patients who most frequently visited Haematology, Endocrinology and Anaesthesiology specialities were associated with more fragmented care while those who most frequently visited Medical Oncology, Ophthalmology and Orthopaedics Surgery specialities were associated with less fragmented care.ConclusionMultispecialty care fragmentation was found to be moderately high in the outpatient specialist clinics and was found to be associated with patients’ age and certain medical specialties. With an ageing population and a rising prevalence of multimorbidity, healthcare providers should seek to eliminate unnecessary referrals to reduce the extent of care fragmentation.

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INTRODUCTION In view of the important role of the environment in improving population health, implementation of health promotion programmes is recommended in living and working environments. Assessing the prevalence of such community health-promoting practices is important to identify gaps and make continuous and tangible improvements to health-promoting environments. We aimed to evaluate the inter-rater reliability of a composite scorecard used to assess the prevalence of community health-promoting practices in Singapore. METHODS Inter-rater reliability for the use of the composite health promotion scorecards was evaluated in eight residential zones in the western region of Singapore. The assessment involved three raters, and each zone was evaluated by two raters. Health-promoting practices in residential zones were assessed based on 44 measurable elements under five domains – community support and resources, healthy behaviours, chronic conditions, mental health and common medical emergencies – in the composite scorecard using weighted kappa. The strength of agreement was determined based on Landis and Koch’s classification method. RESULTS A high degree of agreement (almost perfect-to-perfect) was observed between both raters for the measurable elements from most domains and subdomains. An exception was observed for the community support and resources domain, where there was a lower degree of agreement between the raters for a few elements. CONCLUSION The composite scorecard demonstrated a high degree of reliability and yielded similar scores for the same residential zone, even when used by different raters.