Singapore

Clinical Practice Guideline Development in Singapore

Singapore - tropical city-state

Singapore is a small country in South-East Asia with a total population of 4.6 million. You may be aware that Singapore is a popular tourist destination for its warm tropical climate, good food and great shopping. Singaporeans enjoy good health with high life expectancy, low infant and maternal mortality, and a healthcare system that was ranked 6^th in overall health system performance in the World Health Report 2000. This was achieved with a relatively low healthcare expenditure. In 2005, Singapore spent about S$7.4 billion or 3.7% of GDP on health care. Out of this, Government expenditure on health services was S$1.8 billion or 0.9% of GDP. Factors that have contributed to these outcomes are a relatively young population and a sustained period of good economic growth with rising standards of living, safe food and water supply, good housing, sanitation, education and public health.

Empirical evidence that G-I-N members enjoy Singapore food

Health care in Singapore (which is provided by both a private and a public sector) is financed by a combination of taxes, employee medical benefits, compulsory health savings, insurance and out-of-pocket payment. The financing philosophy of Singapore's health care delivery system is based on individual responsibility and community support. Patients are expected to co-pay part of their medical expenses and to pay more when they demand a higher level of service. At the same time, Government subsidies help to keep basic health care affordable.

Guidelines in Singapore

In the 1990s, various guidelines were occasionally published by professional bodies, such as the Academy of Medicine, Singapore (e.g. Gynaecological endoscopic procedures, AMS, 1996). The Ministry of Health also published occasional clinical guidelines (e.g. Diabetes mellitus, MOH, 1994). In 1997, the MOH’s Department of Clinical Standards took on the task of developing guidelines on a sustained basis and in 1998, the MOH published the first two guidelines (on Management of Paediatric Asthma and Management of Helicobacter Pylori Infection) in its series of national clinical practice guidelines. To date, 59 guidelines have been published. Since 2001, the MOH has also published 10 nursing practice guidelines; in 2006 and 2007, MOH published it’s first two clinical pharmacy practice guidelines.

Today, the Health Technology Assessment (HTA) branch in the MOH oversees the national clinical practice guidelines programme and publishes 4 to 6 guidelines a year. The branch also performs health technology assessments to inform policy development and decision-making; a function that taps on the same methodologies used in evidence-based guideline development.

The process of developing a set of MOH clinical practice guidelines begins with a prioritisation exercise where professional bodies and divisions in the MOH are invited to submit topics for guideline development. These topics are assessed by a process adapted from the Scottish Intercollegiate Guidelines Network (SIGN), where prioritisation depends on whether there is variation in practice, whether there is high quality evidence to guide practice, the importance of the topic, whether there is a perceived need for the topic, and the potential for the guideline to impact on practice. Once prioritised, an expert workgroup is formed to develop the guidelines, comprising relevant clinical specialists, family practitioners, allied health professionals and stakeholder representatives (including patient representatives).

Workgroups receive training on developing evidence-based guidelines, which is provided with the help of the Singapore Clinical Research Institute (where the Singapore branch of the Australasian Cochrane Centre is located). In the past three years, SIGN have also conducted an annual short course in clinical practice guidelines development in Singapore. The HTA branch provides methodological and secretariat support to the workgroup, and publishes and disseminates the completed guidelines. Guidelines are sent to all registered medical practitioners in Singapore and are also freely available for downloading from the MOH website in various formats. Each set of guidelines is launched with a professional symposium – the slides and speeches used in the launch are also available for downloading online.

The MOH is committed to promoting evidence-based practice to achieve our vision of championing a healthy nation with our people - to live well, live long and with peace of mind. The 6^th Health Technology Assessment International Annual Meeting will be organised in Singapore from 21 to 24 June 2009. Later in the year, the 17^th Cochrane Colloquium will also be held here from 11 to 14 October. Come visit us soon!