Chronic disease management and preventive care
This domain tests longitudinal care: whether targets are individualised, complications actively screened for, and the national subsidy architecture used correctly rather than as an afterthought.
Structure you must know
- The Chronic Disease Management Programme (CDMP) covers diabetes, hypertension, lipid disorders, asthma, COPD and selected mental health conditions. It permits MediSave use for outpatient treatment of listed conditions, within annual withdrawal limits - the diagnosis must be documented and the drug must be a listed one.
- Screen for Life subsidises FIT from age 50, mammography from 40, cervical screening (Pap 25-29, HPV test from 30) and chronic disease screening from 40, or earlier with risk factors.
- Healthier SG enrols residents with a family doctor, a documented health plan, and fully subsidised recommended screenings and vaccinations.
- Diabetes complication screening is annual: retinal photography, foot examination, urine albumin-creatinine ratio, eGFR and lipids.
Targets
- HbA1c below 7% for most; 7.5-8% for frail older adults or those at hypoglycaemia risk.
- BP below 130/80 where tolerated; LDL below 2.6 mmol/L, or below 1.8 mmol/L with established atherosclerotic disease.
- Individualise and record the reason whenever you relax a target.
Worked example
A 62-year-old with type 2 diabetes, eGFR 38, HbA1c 8.4%, on metformin 1 g twice daily. Reasoning: metformin must be reduced - maximum 1 g daily at eGFR 30-44 and stopped below 30. Add an SGLT2 inhibitor for renal and cardiovascular protection, which may be initiated down to eGFR 20. Add a statin and an ACE inhibitor or ARB with albuminuria monitoring, plus retinal photo and foot examination. Refer if eGFR falls below 30, declines rapidly, or albuminuria progresses despite treatment.
Traps
- Uptitrating metformin without checking renal function.
- Chasing HbA1c while never examining the feet.
- Assuming every drug for a CDMP condition is claimable.
- Mixing up screening intervals: FIT annual, mammogram biennial.