Primary care characteristics and their association with health screening in a low-socioeconomic status public rental-flat population in Singapore- a mixed methods study

Abstract

BackgroundIn Singapore, subsidized primary care is provided by centralized polyclinics; since 2000, policies have allowed lower-income Singaporeans to utilize subsidies at private general-practitioner (GP) clinics. We sought to determine whether proximity to primary care, subsidised primary care, or having regular primary care associated with health screening participation in a low socioeconomic-status public rental-flat community in Singapore.MethodsFrom 2009–2014, residents in five public rental-flat enclaves (N = 936) and neighboring owner-occupied precincts (N = 1060) were assessed for participation in cardiovascular and cancer screening. We then evaluated whether proximity to primary care, subsidised primary care, or having regular primary care associated with improved adherence to health screening. We also investigated attitudes to health screening using qualitative methodology.ResultsIn the rental flat population, for cardiovascular screening, regular primary care was independently associated with regular diabetes screening (adjusted odds ratio, aOR = 1.59, CI = 1.12–2.26, p = 0.009) and hyperlipidemia screening (aOR = 1.82, CI = 1.10–3.04, p = 0.023). In the owner-occupied flats, regular primary care was independently associated with regular hypertension screening (aOR = 9.34 (1.82–47.85, p = 0.007), while subsidized primary care was associated with regular diabetes screening (aOR = 2.94, CI = 1.04–8.31, p = 0.042). For cancer screening, in the rental flat population, proximity to primary care was associated with less participation in regular colorectal cancer screening (aOR = 0.42, CI = 0.17–0.99, p = 0.049) and breast cancer screening (aOR = 0.29, CI = 0.10–0.84, p = 0.023). In the owner-occupied flat population, for gynecological cancer screening, usage of subsidized primary care and proximity to primary care was associated with higher rates of breast cancer and cervical cancer screening; however, being on regular primary care followup was associated with lower rates of mammography (aOR = 0.10, CI = 0.01–0.75, p = 0.025). On qualitative analysis, patients were discouraged from screening by distrust in the doctor-patient relationship; for cancer screening in particular, patients were discouraged by potential embarrassment.ConclusionsRegular primary care was independently associated with regular participation in cardiovascular screening in both low-SES and higher-SES communities. However, for cancer screening, in the low-SES community, proximity to primary care was associated with less participation in regular screening, while in the higher-SES community, regular primary care was associated with lower screening participation; possibly due to embarrassment regarding screening modalities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0411-5) contains supplementary material, which is available to authorized users.

A systematic review of health status, health seeking behaviour and healthcare utilisation of low socioeconomic status populations in urban Singapore

“…A total of 14 articles which includes 4 prospective studies [ 13 – 16 ], 8 cross-sectional studies [ 17 – 24 ] and 2 retrospective cohort studies [ 25 , 26 ] were obtained for the review. Among these studies, 4 of the articles included qualitative interviews [ 14 , 20 , 23 , 24 ]. Effect of a community interventional program on outcomes was also studied in 4 of the articles [ 13 , 15 , 16 , 22 ].…”

“… Reasons for not participating in screening in both community, and for a majority of modalities: Misperceptions Lack of time Uptake of all screening modalities significantly increased in the rental housing community post-intervention (all p < 0.05). Poor Wee LE (2016) [ 23 ] Cross-sectional and Qualitative From 2009 to 2014 Primary care characteristic and their association with health screening. Residents 40–59 y/o.…”

“…In the study that explored on the primary care characteristic association with health screening [ 23 ], seeing a regular primary care doctor was independently associated with regular diabetes and hyperlipidaemia screening. There was less participation in regular colorectal cancer screening and breast cancer screening with proximity to primary care.…”

Identifying optimal indicators and purposes of population segmentation through engagement of key stakeholders: a qualitative study

“…Taking into consideration the implications of financial instability when segmenting the population would allow policy efforts to focus more on alleviating the economic burden of illness on households [48]. In Singapore, a healthcare assistance scheme, the Community Health Assist Scheme, is available for all Singapore citizens with chronic conditions [49]. The scheme is tiered according to monthly household income or the Annual Value of a home as assessed by the Inland Revenue Authority to enable people, particularly from lower-and middleincome households, to receive subsidies for medical and dental care [49].…”

“…In Singapore, a healthcare assistance scheme, the Community Health Assist Scheme, is available for all Singapore citizens with chronic conditions [49]. The scheme is tiered according to monthly household income or the Annual Value of a home as assessed by the Inland Revenue Authority to enable people, particularly from lower-and middleincome households, to receive subsidies for medical and dental care [49]. Hence, segmenting population according to financial status not only supports the lower-to middleincome class families to cope with their medical expenses, but the segmentation also allows the Ministry of Health to ensure the affordability of healthcare while improving health outcomes [50].…”