ORIGINAL ARTICLE:SOCIAL RESEARCH,
PLANNING AND PRACTICE
Evaluation of an integrated primary care-led dementia
shared care program in Singapore: An effectiveness
and cost-effectiveness study
Pradeep Paul George,
Kelvin WS Teo,
Woan Shin Tan,
Bee Hoon Heng,
Cindy Ying Ying Yeo,
Kang Yih Low,
Noorhazlina Binte Ali
and Mei Sian Chong
Department of Health Services and Outcomes Research, National Healthcare Group,
Formerly from Health Services and Outcomes
Research, National Healthcare Group,
Department of Community and Continuing Care,
Department of Nursing (Nurse Clinician),
Operations (Division for Integrative & Community Care),
Department of Geriatric Medicine, Tan Tock Seng Hospital,
Ang Mo Kio
Polyclinic, National Healthcare Group Polyclinics and
Geriatric Education and Research Institute, Ministry of Health, Singapore,
Aim: With an aging Singapore population, there is an increasing demand for dementia care. The present study
aimed to evaluate the effectiveness and cost-effectiveness of the Primary Care Dementia Clinic (PCDC) in compari-
son with the Memory Clinic (MC; hospital-based) and other polyclinics.
Methods: A quasi-experimental design was implemented. Effectiveness of PCDC was assessed through caregiver sat-
isfaction, quality of life (caregiver-rated) and adverse events rates. Quality-of-Life measures using the EuroQol 5 Dimen-
sion Questionnaire (EQ-5D) at baseline, 6 months and 12 months was assessed. Costs were calculated from a societal
perspective. The incremental cost-effectiveness of the PCDC was compared with MC and other polyclinics.
Results: The present study showed that quality of life and the rate of adverse events at 12 months were similar
between the three groups. Caregiver satisfaction at 12 months was higher in the PCDC group when compared with
other polyclinics. There were no observed differences in societal cost between the three groups. At 6-month follow
up, direct medical costs for PCDC were signiﬁcantly lower that of other polyclinics. At 12-month follow up, PCDC
patients had higher Quality Adjusted Life Years (QALYs) compared with the MC group.
Conclusion: PCDC provided effective care, similar to care at MC and better than care at other polyclinics. Care-
giver satisfaction was higher for the PCDC group, and PCDC patients had lower direct medical costs at 6-month fol-
low up. Given these ﬁndings, adopting a PCDC model in other polyclinics in Singapore can be beneﬁcial for optimal
right siting of patients. Geriatr Gerontol Int 2018; 18: 479–486.
Keywords: dementia, integrated care, primary care, program evaluation, Singapore.
Singapore has one of the fastest aging populations in
Asia. The number of people aged ≥65 years is expected
to increase to nearly 20% by 2030.
With this increase,
dementia prevalence is also expected to escalate from
an estimated 28 000 individuals in 2012 to approxi-
mately 80 000 individuals by 2050.
This highlights the
need for the local healthcare system to provide quick
access to dementia care so that diagnosis and treatment
can be sought promptly.
The current system of
dementia care is fragmented, skewed towards tertiary
care and might not be sustainable in the long term.
Primary care physicians can play an important role
in the diagnosis and management of dementia, as they
are often the ﬁrst point of contact for many individ-
An early diagnosis of dementia can allow patients
and their caregivers to have access to medical and psy-
chosocial support services, which might prevent psy-
chological stress, improve morale and quality of life
(QoL), and delay nursing home admission.
Currently, persons suspected to have dementia are
referred by family physicians (FP) in the polyclinics
Accepted for publication 27 August 2017.
Correspondence: Nakul Saxena, 3 Fusionopolis Link, #03-08
Nexus@One-North, Singapore 138543, Singapore.
doi: 10.1111/ggi.13196 |© 2017 Japan Geriatrics Society
Geriatr Gerontol Int 2018; 18: 479–486