L.HA NGOC HUONG LIEN1, J.P.H.TENG1, H.T.R.TAN2, W.S.LIM3, Y.Y.DING1, W.S.TAN4
Geriatric Education and Research Institute1, National University of Singapore2, Tan Tock Seng Hospital3, Health Services & Outcomes Research4
Frail older persons are more susceptible to health problems. With an ageing population, to better recognise and manage frailty, the Ministry of Health piloted a novel community-based programme in 2018. The five pilot sites aim to deliver comprehensive geriatric assessments and to coordinate and manage care using multi-disciplinary teams. This qualitative study aims to describe the factors that influenced the conceptualisation and implementation of the Geriatric Services Hub (GSH) programmes.
Using purposive sampling, we identified and interviewed fourteen key informants across five implementation sites. The Framework Analysis approach was used to generate themes encapsulating the salient elements that have influenced GSH’s conceptualisation and implementation.
Four major themes emerged. GSH operated within health system settings where care is disease-centred and the national healthcare financing framework is geared towards ensuring the affordability of defined episodes of care. Systematic constraints faced by primary care physicians limited their ability to manage frailty despite capability-building efforts. The conceptualization and planning of each programme was influenced by organisational leadership, culture and strategies of the different hospitals. Establishing external partnerships with like-minded partners, providing capability building and setting a clear value proposition appeared essential. Lastly, GSH’s care operationalisation could improve with a clearer agreed referral criterion and better-resourced care coordination.
We learned that there were overarching systematic factors that have influenced programme implementation. Considerations for improvements include addressing fragmented financing across services, building long-term relationships with partners, harmonising frailty screening tools for defining service eligibility and assessing and addressing missing resources.