Speech by Dr Lam Pin Min, Senior Minister of State for Health, at the Singapore Prevention and Cardiac Rehabilitation Symposium 2017, 21 October 2017

Prof Tan Huay Cheem, Chairman of the Organising Committee

Dr Raymond Wong and Dr Peter Ting, Co-Chairman of the Organising Committee

Dr Yeo Tee Joo, Scientific Chairman of the Scientific Committee

Adjunct Associate Professor Tan Swee Yaw, Scientific Co-Chairman of the Scientific Committee

Singapore Heart Foundation Board Members

Distinguished guests,

Ladies and gentlemen

Good morning.

1    I am delighted to be here today at the 2^nd Singapore Prevention and Cardiac Rehabilitation Symposium (SPCRS). The event brings together healthcare professionals for the exchange of ideas and to find new solutions to help improve healthcare services, particularly in the area of cardiovascular disease. 

DISEASE BURDEN OF CARDIOVASCULAR DISEASE IN SINGAPORE

2    Cardiovascular disease is the world’s number one killer, and is responsible for about one-third of all global deaths. Similar to the developed countries, it is a serious concern in Singapore. According to the Singapore Burden of Disease Study in 2010, it accounts for almost 20% of total disease burden^[1]. Cardiovascular disease also accounted for almost 30% of all deaths in Singapore in 2016^[2].  This is nearly 1 out of 3 deaths, which also means that about 16 people die from heart disease and stroke every day.

3    Singapore is facing an ageing population. The prevalence of chronic diseases such as ischaemic heart disease is, and will be, a growing challenge that all healthcare professionals will face.  While we continue to provide good quality treatment for these diseases, we must also not forget to ensure that patients continue to have a good quality of life. This will mean ensuring that they remain independent and are physically fit to do day-to-day activities.

4    As such, rehabilitation and preventive medicine will play an increasingly bigger role in the management of chronic diseases. This also means that the need for such services will be on the rise. As part of Singapore’s drive to push towards a Smart Nation, it is heartening to know that the theme for the symposium today has a special focus on e-health.

CHANGING MODELS FOR DELIVERY OF CARE IN LIGHT OF TECHNOLOGICAL ADVANCEMENTS ESPECIALLY IN CARDIAC REHABILITATION

5    The advancement of technology in the 21^st century has impacted every aspect of our lives. The healthcare sector is no exception. With limited healthcare resources amidst rising demands, many healthcare institutions have turned to the use of technology to deliver better yet efficient healthcare services. One such example is the use of technology to shift patient care beyond hospitals and into the community.

6    In May this year, the healthcare technology agency in Singapore, Integrated Health Information Systems (IHiS), launched the “Smart Health TeleRehab”, a device that assists patients with rehabilitation therapy in their own homes^[3]. This device consists of an iPad and two sets of wearable sensors, which will instruct patients to undergo a series of exercises. It can also evaluate if the exercise is done correctly and provide immediate feedback to the patient. Physiotherapists are able to monitor the patient’s exercise regime remotely and can adjust the difficulty level with the click of a button. Should a consultation be required, the device also has video conferencing capabilities, allowing the patient to communicate with his physiotherapist remotely. To-date, the device has shown to be beneficial both to patients and physiotherapists.

7    Not only does TeleRehab make rehabilitation more convenient, it has also lowered the cost of physiotherapy for patients^[3]. For physiotherapists, it has increased their productivity, allowing them to spend more time with patients who require more direct attention for their rehabilitation. In fact, an initial study showed that the system has increased productivity by more than 30 per cent. This device will soon be trialled for cardiac rehabilitation.

8    In other parts of the world, many healthcare institutions have also adopted technology to enhance patient care, albeit differently. For instance, Mayo clinic in the United States, conducted a study looking at using technology to complement their cardiac rehabilitation programme^[4]. In that study, the team used both mobile apps and web portals to provide educational and motivational messages to patients. These tools also provide patients with videos, articles and quizzes to keep them updated and engaged about their condition. The technology allows patients to log and track their exercise and dietary habits. As a result, patients were found to be more compliant to exercise and dietary recommendations. These patients also lost 4 times more weight compared to the traditional cardiac rehabilitation group.

9    While these studies are currently only tried in small groups, they show us the potential benefits of using technological advancements in improving patient care. Regardless, technology can never replace the human touch. As healthcare professionals, we must find the right balance and leverage technology to further improve patient care.

REITERATING ROLE OF HEALTHCARE PROFESSIONALS IN PROMOTING PREVENTIVE HEALTH

10    We know that prevention is better than cure. However, preventive healthcare is not without its challenges. As healthcare professionals, we have all encountered patients who lack compliance to treatments, strongly resist lifestyle changes, taking medication or vaccination when they “are well”. Even though there is overwhelming evidence to show the benefits of disease prevention, this may still be an abstract concept to many individuals. Hence, as healthcare professionals, we have a duty and obligation to continue promoting preventive health.

Screening

11    Emphasis must be placed on the importance of regular and appropriate health screenings. With early detection and timely follow up of cardiovascular risk factors such as diabetes, hyperlipidaemia and hypertension, we can avert unnecessary complications and healthcare costs.

12    To encourage eligible Singaporeans to attend evidence-based screening, the Ministry of Health (MOH) has enhanced the Screen for Life subsidies since 1 September this year. Eligible Singaporeans need to only pay a fee of no more than $5 for their screening test.

13    We have also recently launched the Diabetes Risk Assessment (DRA) tool on Health Promotion Board’s (HPB) HealthHub to help younger adults between 18 to 39 years assess their current risk for undiagnosed diabetes. Should they be assessed to be at a higher risk, they would be encouraged to go for screening, and enjoy the enhanced Screen for Life subsidies.

Vaccination

14    Vaccination provides a person with protection against infectious diseases, and is one of the strategies to reduce the risk of disease outbreaks in the community. Healthcare professionals should actively look into the vaccination needs of individual patients according to their age and risk factors. Patients should be advised to receive the appropriate vaccinations to protect them against these diseases.

15    For example, pneumococcal disease has resulted in about 56 hospitalisations in every 100,000 persons who are aged 65 years and above. The risk in this vulnerable population can be reduced by vaccination, which costs between $70 to 170.

16    To facilitate the take up of important vaccinations amongst adults and help individuals make more informed decisions, MOH has established the National Adult Immunisation Schedule (NAIS) to provide guidance on vaccinations that persons aged 18 years and older should adopt to protect themselves against vaccine-preventable diseases. 

17    While the coverage for vaccinations under the National Childhood Immunisation Programme has been high for most of the vaccines, there is low awareness of the benefits of adult vaccination for personal protection and protection of at-risk family members. With the introduction of the NAIS, we hope to encourage Singaporeans to take up the recommendations made in the NAIS, to protect themselves and their loved ones against the relevant infectious diseases.

18    To encourage the take up of important vaccinations, from 1 November, Singaporeans will be able to use up to $400 of their Medisave per account, under the Medisave400 scheme, to pay for the seven recommended vaccinations for the specific target adult population groups in the NAIS.  

CONCLUSION

19    While initiatives such as the Diabetes Risk Assessment or the National Adult Immunisation Schedule are launched with the benefits to patients in mind, they are only beneficial if they are adopted widely and appropriately. This is where as healthcare professionals, you can make a big difference in your patients’ lives.

20    Being experts in your respective fields, you will be in the best position to advocate the importance of preventive healthcare and the importance of personal health ownership. Similarly, you will also be in the best position to harness technology to further improve the health of your patients.

21    To conclude, I would like to commend the organisers for putting together this symposium to facilitate the exchange of new ideas on cardiac rehabilitation and the prevention of cardiovascular disease. I wish you a fruitful symposium. Thank you.

^[1] Ministry of Health (Singapore). The Singapore Burden of Disease (SBoD) Study 2010.

^[2] Report on Registration of Births and Deaths 2016 by the Registry of Births and Deaths, Immigration and Checkpoints Authority, Singapore

^[3] Tan, A. (2017, May 5). ‘Telerehab’ system allows patients to do physiotherapy at home. The Straits Times.

^[4] American College of Cardiology. (2016, March 23). “Digital health tool helps cardiac rehab patients shed more pounds: Study shows smartphone app, Web portal help patients adhere to diet, exercise plans post-heart. ScienceDaily. Retrieved August 25, 2017, from http://www.sciencedaily.com/releases/2016/03/160323185641.htm