Primary Health Care in Chronic Disease Prevention & Management

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In our daily pursuits at work or at play, it is easy to lose track of our health when everything else seems to demand more of our attention. Most of the time, we adopt a “passive” approach, only taking action when something obvious has gone wrong. Frequently, when a disease has reached a stage where it is also obvious to the patient, treatment is almost always more complicated.

A Proactive Approach to Well-Being

Prevention may be defined as the means to promoting and maintaining health or averting illness. It is concerned with removal or reduction of risks, early diagnosis, early treatment, limitation of complications and maximum adaptation to disability.

The promotion of health concerns helping well people to learn healthy behaviours and to accept responsibility for their own well-being. A better-educated patient will have better health outcomes.

In this article, we look at the well population and what Primary Prevention is about.

Fig 1. Comprehensive Model of Disease Prevention and Control

A Doctor’s Role in Preventing Chronic Diseases

In General Practice (GP), a doctor’s role is two-fold:

  1. I recognise the preventable factors that are involved in an illness and determine the right interventions.
  2. I can act to implement the preventive measures. In cases where the responsibility rests with the individual or community, I can support through education or working with community agencies.

Insights from Singapore’s Mortality Statistics

What can we prevent at the GP level? It is not possible to prevent all types of diseases. To see what matters most, we can look at the death statistics of Singapore:

Fig 2. Principal Causes of Death: Singapore (adapted)

The main causes of death as can be seen are still cancer – 30% and cardiovascular (including Ischaemic Heart Disease, Cerebrovascular and Other Heart Diseases) – 30.4%. Usually, the 1/3 rule applies here: 1/3 is caused by cancer, 1/3 is by cardiovascular. The remainder are composed of Accidents, Poisoning and Violence – 5% and diseases where old age has a higher mortality rate (Pneumonia, Urinary Tract Infection, Chronic Obstructive Lung Disease and Diabetes Mellitus).

The bulk of impactful primary health care for the working population thus lies in:

  1. Prevention and Screening of cancers that are treatable when detected early.
  2. Prevention and Detection of cardiovascular diseases and their precursors (diabetes, hypertension and high cholesterol).
  3. Health Education – to increase literacy so people understand chronic diseases better.

Cancer Prevention

Diets with high alcohol consumption, high in animal fats and low in insoluble fibre, fruits and vegetables are commonly implicated in causing cancer. In the US, at least 35% of all cancer deaths are related to diet. Obese individuals have an increased risk of colon, breast and uterine cancers. High-fat diets are a risk factor for prostate, breast and colon cancers. Salt-cured, preserved, smoked and nitrate-cured foods increase the risk of cancers of the esophagus and stomach.

Overall, diet, smoking, alcohol and occupational exposures (5%) account for over 73% of all cancer deaths. Some studies consider environmental factors to be responsible for up to 90% of cancers and diet is a major factor in the cause of cancer for 40% of men and 60% of women.

Cardiovascular Disease Prevention

Cardiovascular end-stage diseases are typically heart attacks and strokes. The risk of suffering from one is greatly increased if you have poorly controlled Hypertension, Diabetes or High Cholesterol.

Small frequent meals with a low carbohydrate and salt content, regular exercise of at least 150 minutes a week or comprising some form of high-intensity -interval training (HIIT), and substituting pork, beef or mutton with fish or chicken will go a long way to prevent cardiovascular ill-health.

DR+ Medical & Paincare East Coast

Led by Dr. Kwong Seh Meng, DR+ Medical & Paincare East Coast is a family clinic providing chronic disease and diabetes management, general paediatrics, men’s health, musculoskeletal pain and sports medicine, weight management, health screenings, statutory medical/ maid examinations, minor surgical procedures (lumps, bumps, warts), anonymous HIV testing and STD treatment, point-of-care ultrasound (POCUS) and home care/ palliative care services.

Address: 146 East Coast Road, Singapore 428835

Contact number: +65 6320 0116