Family Medicine Clinic: a case study of a hospital–family medicine practice redesign to improve chronic disease care in the community in Singapore

Background: Singapore's health care system is strained by the health care needs of a rapidly aging population. The unprecedented collaboration between a public hospital and a private family practice to set up the Family Medicine Clinic (FMC) to co-manage patients with chronic disease is an example of efforts to shift care to the community. Objective: To explore patients' initial experience of shared chronic disease care in a private family practice setting. Methods: In this exploratory case study, we surveyed 330 patients with stable chronic diseases and interviewed 10 complex care patients and their caregivers. Results: Most patients were willing to transfer their care from the hospital to a FMC and satisfied with the care received. Patients reported enhanced access at FMC and appreciated the improvement in care continuity and care coordination across settings. Patients with complex care needs felt engaged with their case manager even though they did not understand case management. Despite the favourable assessment of FMC, patients sought care from other health care providers and a third of patients would leave if the subsidy for their care at FMC was removed. Families and caregivers felt that their needs could be better addressed and that FMC could play a role. Conclusions: To ensure that patients' initial positive experience translates to a long-term relationship with FMC, providers should move beyond providing improved access to care. It is necessary to help patients understand the comparative advantage of community-based care and its contribution to long-term health outcomes. Providers should also elicit patients' desires and expectations when designing future models of care. At a policy level, higher cost of private primary care should be addressed.