EmPaTHy Programme Projects

Overview & Aims | Team | Projects | Workshops & Events | Collaborations 

Ongoing Projects:

i. Chest X-ray AI Study
In primary care settings, chest X-rays (CXRs) are among the most frequently ordered first-line investigations for patients. However, the high number of normal CXR results has led to inefficient resource utilization and reporting delays. Recently, Artificial Intelligence (AI) has been increasingly used to assist medical professionals in decision-making and clinical management. In this study, we use an Implementation Science approach to develop and pilot test strategies for implementing an AI system to generate CXR reports in Singapore Polyclinic setting.

ii. Hypertension Phenotype Study
In this study, we employed ambulatory blood pressure monitoring (ABPM) to identify the patient's hypertensive phenotype, along with their co-existing chronic conditions and chronotype. By doing so, this study aims to provide evidence to support healthcare providers and patients in managing hypertension more precisely, tailoring pharmacologic and lifestyle interventions to the specfic phenotype and the patient's clinical and sleep profiles.

iii. The Mental Health Right-Site-Primary Care Study 
The Prevalence of mental health conditions is increasing and placing a significant burden on patients and healthcare systems. Currently, hospitals are managing a significant proportion of people with mental health conditions, including those with mild and stable depression, anxiety, resulting in increasing healthcare cost and waiting time. Primary care has the capacity and capability to manage this population. This study adopts an implementation science approach to develop and pilot a transitional care model for elderly patients with stable mental health conditions aiming to enhance coordination and continuity of care between hospital and primary care services.  

iv. IMCWH Evaluation Study
The Integrated Maternal and Child Wellness Hub (IMCWH) programme was introduced at Punggol Polyclinic in 2020 to enhance and strengthen maternal and child wellness. As the integrated care for mother-child dyads model was found to be favourable, the programme was expanded to additional SingHealth polyclinics in 2023. This study aims to evaluate the implementation of the IMCWH programme to provide key insights on improving the programme delivery. We also aim to explore the barriers and facilitators to implementing the programme (process evaluation).

v. PACE-It Programme Evaluation Study
PACE-It (PrimAry CarE Based Integrated Community Care Team) is designed to provide coordinated care between health and social care for patients with complex needs attending SingHealth Polyclinics in Singapore. The programme was developed based on the Innovative Care for Chronic Condition theory. This study evaluates the effectiveness of the PACE-It programme based on the RE-AIM framework and investigates the barriers and facilitators to implementing the programme based on the Tailored Implementation for Chronic Disease (TICD) framework.

vi. Hurdles in managing blood pressure among patients with uncontrolled hypertension (Hi-BP) Study
The 2022 National Population Health Survey in Singapore found that among those with diagnosed hypertension, two-thirds had uncontrolled blood pressure. Understanding patients’ experience in managing their hypertension, including their healthcare experiences and self-management, is critical in tackling this problem. This study aims to explore patients’ experiences and challenges they face when managing their hypertension. This study is an extension of the Hypertension Qualitative Study which examined healthcare professionals’ perspectives when managing patients with hypertension.

vii. Systematic review on prevalence of nocturnal hypertension
Nocturnal hypertension is a strong predictor heart attacks, stroke and heart failure. With increasing access to conventional and wearable 24-hour ambulatory blood pressure monitoring devices, measurement of sleep time blood pressure is becoming more feasible. However, the prevalences of nocturnal hypertension across different countries and populations remain variable. This systematic review aims to provide a comprehensive overview of the prevalence of nocturnal hypertension across the world and in general and at-risk populations.

viii. Perceived barriers and facilitators to HPV self-testing: a qualitative study
Cervical cancer screening is a key component of the WHO’s cervical cancer elimination strategy. In Singapore, screening rates remain low (45.4%) despite a national programme utilising physician-collected samples. HPV self-testing was recently included in the 2025 Cervical Cancer Screening Clinical Management Guidelines to improve screening uptake. This study explores the perceived barriers and facilitators to HPV self-testing among women attending a public primary care clinic in Singapore prior to its implementation.

ix. Implementation of a Primary Care-based Memory Clinic: A Retrospective Evaluation Study
With Singapore’s aging population, family physicians are playing an increasingly important role in the early detection, diagnosis and management of dementia, delaying cognitive decline and providing timely support for caregivers. It also reduces reliance on specialist care from the healthcare system perspective. Primary care-based memory clinics was introduced in SingHealth Polyclinics in 2017 to provide accessible and holistic care for patients with dementia and cognitive impairment. This retrospective study evaluates the implementation outcomes of the Memory Clinic using the RE-AIM framework.

x. Evaluating the process and outcome of a patient and public involvement (PPI) program: a mixed-methods pilot study
Traditionally, research has been dictated by clinicians, researchers and the industry with little or no input from the very population it is meant to benefit. Patient and public involvement (PPI) in research is defined as research that is carried out with or by members of the public rather than to, about, or for them. By involving the public at various stages of the research journey, the relevance, quality and impact of the study can be maximized. To improve PPI in primary care research in Singapore, a PPI group named Patient Research Advocate and Guidance to Maximise Safety in Trials and Innovation Committee (PRAGMATIC) was set up in September 2020. This mixed-method study aims to evaluate the impact of the PRAGMATIC program on PPI in research.

xi. ENHANCe (ENgaging Home-monitored Assessment to Navigate Clinical decision-making) study
The study is aimed to develop and pilot evaluate a clinical decision support system (CDSS) for hypertension management based on home BP monitoring in primary care. The study includes two phases:

Phase 1. Development of the CDSS to capture and process home BP records and provide a recommendation to primary care physicians (PCPs) on management of hypertension based on these records;

Phase 2. A mixed method study to assess the feasibility, acceptability, and preliminary effectiveness of the CDSS to guide PCPs in managing patients with hypertension.

The intervention is expected to standardise the practices among the PCPs in interpreting and managing patients on HBP monitoring; it will help PCPs make prompt decisions and optimise hypertension management, leading to improved health outcomes among patients with hypertension.

xii. Cost-effectiveness analysis of different ABPM service models
Recent international clinical guidelines recommend using ambulatory blood pressure monitoring (ABPM) to diagnose, monitor and manage hypertension. Conventionally, ABPM services are provided in the hospital setting, which has resulted in underutilization of the potentially useful investigation in some patients, causing incorrect diagnosis and, hence, over or under-treatment. There is therefore a need to explore alternative clinical pathways in offering ABPM. Using Singapore health system as an example, this study aims to conduct a cost-effectiveness analysis of different ABPM service models.

Completed Projects:

i. Hypertension Qualitative Study
Despite established clinical practice guidelines and effective treatment options, the prevalence of hypertension is increasing globally and in Singapore, and the proportion of patients with uncontrolled BP remains high. This exploratory study attempts to identify the possible causes from the healthcare professionals' perspectives. This study uses a qualitative methodology to explore the challenges faced by primary care doctors, nurses and pharmacists when managing patients with hypertension.

ii. Ambulatory Blood Pressure Monitoring (ABPM) Feasibility Study
ABPM has been recommended as a more accurate way to diagnose resistant, white-coat, masked, and other phenotypes of hypertension. However, ABPM is currently only available in hospitals. This study explores whether it is feasible to implement ABPM in the primary care setting. We are also testing three wearable ABPM devices (cuff, wrist and chest) in this study. This study is conducted in collaboration with researchers from National Heart Centre Singapore and Chinese University of Hong Kong.

iii. Team-based Care Evaluation Study
In July 2022, SingHealth Polyclinics piloted 'My Care Team' (MCT), a team-based care model that focused on providing comprehensive and coordinated care for patients with chronic conditions. This mixed-methods study at two SingHealth Polyclinics aims to understand the barriers and facilitators to implementing team-based care in the primary care setting, and to provide recommendations to further improve this care model.

iv. PACE-It App Evaluation Study
The PACE-It App is a mobile application that facilitates communication among the healthcare providers from SingHealth Polyclinics and its social care partners who are managing patients with complex needs. The study investigates the perspectives and experiences of decision makers, the app developers, and the users so that lessons learnt could contribute towards future health apps. This study involves collaborators from the University of New South Wales (UNSW), Sydney, Australia.

v. Weight Management Programme Implementation Study
SingHealth Polyclinics is planning to introduce an evidence-based weight management programme (SHP WMP) to help with weight management of overweight or obese patients. The research team aims to conduct a preliminary study to identify potential barriers and facilitators to implementing the complex weight management programme from the perspectives of the healthcare professionals. The findings from this study will help inform the development of tailored implementation strategies before the programme gets implemented in the polyclinics.

vi. Diffuse Speckle Pulsatile Flowmetry (DSPF) Study
This study aims to assess the accuracy of using the DSPF technology combined with machine learning models to measure BP in patients attending in the primary care setting. It has the potential to be developed into a more accurate, accessible and cheaper BP measurement device. This study involves collaborators from the Institute of Materials Research and Engineering (IMRE), A*STAR.

vii. Palliative Care in Primary Care Study
The number of people living with life-limiting illnesses requiring palliative care need is increasing due to the rapidly ageing population and those with chronic illnesses. Primary care is recognized as a potential healthcare setting to implement palliative care. This study explores primary care physicians' readiness to adopt palliative care in their routine practice.

viii. Postnatal Mothers Study 
Existing literature shows that postnatal mothers experience anxiety and lack confidence in childcare. Additionally, Asian mothers may face specific cultural practices that can impact their overall well-being during and post pregnancy. This necessitates understanding of their experiences and needs in the Asian context. This study explores the biopsychosocial needs and health seeking behaviour of postnatal mothers through in-depth qualitative interviews.

For more information, please contact the EmPaTHy secretariat at empathy@singhealth.com.sg.