Polyclinic nurses call diabetics to help keep the doc away

SINGAPORE - Manager Hidayat Buang Abdullah (pictured) was a soft-drink lover who would down 1.5 litres of Coca-Cola every day without fail.

Even after he was diagnosed with diabetes 14 years ago, he continued the habit.

"I didn't care, didn't bother," the 47-year-old said. "Three days before I saw the doctor, I would fast to get good results for blood tests."

But with regular phone calls from polyclinic nurses over the past year, he is now on the verge of attaining healthy blood sugar levels. And he no longer touches soft drinks.

Patients with poorly controlled diabetes like Mr Hidayat are now able to manage their condition better from home, thanks to a new "telecare" programme. Specially trained polyclinic nurses call patients every two weeks to coach them on adjusting their doses of insulin gradually, on their own.

This service started at Pasir Ris Polyclinic a year ago for selected patients. It is now in place at the Geylang and Queenstown polyclinics as well.

Previously, patients had to travel to the polyclinic to see a doctor before they could get their doses adjusted, said family physician Ian Phoon.

"Most patients are rather reluctant to come back so frequently - they may return one or two months later," he said. "Adjusting the dose at this slow rate is not optimal."

Dr Phoon, who works at Pasir Ris Polyclinic, said that the delay in bringing down blood sugar levels means patients face a higher risk of developing long-term complications. This includes eye and blood circulation problems.

So far, some 40 diabetics have been helped under this "insulin titration" service. They are mostly aged 65 and under, with dangerously high blood sugar levels. Eight in 10 have shown an improvement.

This latest service follows two other telecare schemes that began in 2010. Both schemes have been made available at all nine SingHealth polyclinics since June this year.

The first involves monitoring diabetic patients whose conditions are under control. Patients take blood sugar readings at home using a kit, and report the readings to nurses when they call.

If all is well, the patient can then skip having to consult a polyclinic doctor, and head straight to the pharmacy to collect his regular medicine.

In the other scheme, nurses guide patients over the phone on how to get started on insulin jabs for the first time. This "insulin initiation" programme has helped more than 500 patients start using insulin safely so far, with 93 per cent completing the programme.

The rest either decided not to go on insulin, or have suffered from complications, said Dr Phoon.

Over the years, SingHealth polyclinics have seen more patients with diabetes. As of last month, SingHealth has more than 61,000 diabetics coming to its nine polyclinics for treatment - an increase of nearly 4 per cent from last year.

But with the range of telecare services in place today, some patients do not have to visit polyclinics as frequently, noted Dr Phoon.

"Patients do not have to come back to the clinic so often - this saves them money and time," he said, adding that it also allows health-care staff to care for patients "beyond the boundaries of the clinic".

About 35 polyclinic nurses have been trained so far to handle telecare services.

Senior staff nurse Ng Swee Peng said the training involves workshops, as well as a competency test that nurses have to pass before they can be put on the telecare roster.

The job is not always easy, however. "Some patients do not pick up their phone, so we have to keep trying for the next few hours," she said.

"Others do not take their blood sugar readings when they should, or forget to buy needles for insulin injections."

But their persistence has helped patients like Mr Hidayat. Said the father of three: "I feel bad when the nurse takes time to call but I don't take care of myself. It makes me feel a little guilty."


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