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Title: Comparing patient and healthcare worker experiences during a dengue outbreak in Singapore: Understanding the patient journey and the introduction of a point-of-care test (POCT) toward better care delivery
Authors: Tan Q.
Hildon Z.J.-L. 
Singh S. 
Jing J. 
Thein T.L.
Coker R. 
Vrijhoef H.J.M. 
Leo Y.S. 
Keywords: adult
clinical article
comparative study
dengue rapid test
diagnostic accuracy
diagnostic value
emergency ward
health care delivery
health care quality
health personnel attitude
help seeking behavior
patient attitude
point of care testing
semi structured interview
diagnostic kit
health care personnel
health personnel attitude
information processing
middle aged
point of care system
public opinion
time factor
diagnostic kit
Attitude of Health Personnel
Delivery of Health Care
Disease Outbreaks
Focus Groups
Health Personnel
Middle Aged
Point-of-Care Systems
Public Opinion
Reagent Kits, Diagnostic
Time Factors
Issue Date: 2017
Publisher: BioMed Central Ltd.
Citation: Tan Q., Hildon Z.J.-L., Singh S., Jing J., Thein T.L., Coker R., Vrijhoef H.J.M., Leo Y.S. (2017). Comparing patient and healthcare worker experiences during a dengue outbreak in Singapore: Understanding the patient journey and the introduction of a point-of-care test (POCT) toward better care delivery. BMC Infectious Diseases 17 (1) : 503. ScholarBank@NUS Repository.
Abstract: Background: In the aftermath of an upsurge in the number of dengue cases in 2013 and 2014, the SD BIOLINE Dengue Duo rapid diagnostic Point-of-Care Test (POCT) kit was introduced in Tan Tock Seng Hospital, Singapore in June 2013. It is known that the success of POCT usage is contingent on its implementation within the health system. We evaluated health services delivery and the Dengue Duo rapid diagnostic test kit application in Singapore from healthcare workers' perspectives and patient experiences of dengue at surge times. Methods: Focus group discussions were conducted with dengue patients, from before and after the POCT implementation period. In-depth interviews with semi-structured components with healthcare workers were carried out. A patient centred process mapping technique was used for evaluation, which mapped the patient's journey and was mirrored from the healthcare worker's perspective. Results: Patients and healthcare workers confirmed a wide range of symptoms in adults, making it challenging to determine diagnosis. There were multiple routes to help seeking, and no 'typical patient journey', with patients either presenting directly to the hospital emergency department, or being referred there by a primary care provider. Patients groups diagnosed before and after POCT implementation expressed some differences between speed of diagnoses and attitudes of doctors, yet shared negative feelings about waiting times and a lack of communication and poor information delivery. However, the POCT did not in its current implementation do much to help waiting times. Healthcare workers expressed that public perceptions of dengue in recent years was a major factor in changing patient management, and that the POCT kit was helpful in improving the speed and accuracy of diagnoses. Conclusions: Health service delivery for dengue patients in Singapore was overall perceived to be of an acceptable clinical standard, which was enhanced by the introduction of the POCT. However, improvements can be focused on Adapting to outbreaks by reducing and rendering Waiting experiences more comfortable; Advancing education about symptom recognition, while also Recognising better communication strategies; and Expanding follow-up care options. This is presented as the Dengue AWARE model of care delivery. © 2017 The Author(s).
Source Title: BMC Infectious Diseases
ISSN: 14712334
DOI: 10.1186/s12879-017-2580-9
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