Table 3.

Evolving Modalities of Care Amid the COVID-19 Pandemic

Modalities of Chronic Care	Opportunities	Challenges
Self-management support for patients with chronic diseases (Phone consultation; Medication delivery service; Joint video consultation)	“With the joint video consultation, nurses and social workers are able to come together on the same platform during the consult. They can give the doctor feedback on the patient's condition, and then together with the doctor, devising a more comprehensive care plan for the patient. Most importantly, they can do it at the comfort of their homes, without having to come to the hospital, and the patients like it a lot as it is very convenient.” #6 Nurse, F “We started to do more medicine delivery during the Circuit Breaker [lockdown period] for patients with stable conditions. They are happy because they didn't want to come to the hospital anyway just to collect their medication.” #11 Nurse, F	“I think the first challenge [for teleconsultation] seems to be cybersecurity. We have zero-tolerance for data breach. We are not so keen to use the usual Zoom platform as it might not be secure enough; we need to have a special platform that is cleared by hospital or Ministry. So that's a limiting factor. And I suppose following the previous cyber-attack on our institution, vigilance is very high, and the tolerance for lapses is zero.” #50 Doctor, M “We are having difficulty to get patients on board with the idea, because a lot of patients they come to us for treatment. That means they come to us for in-person procedure, not only for consultation. Often, we need to do physical assessments as well, which cannot be done via teleconference.” #15 AHP, M
Novel delivery system to improve chronic care (Nurse-led platform for real-time communication; Remote monitoring; Telehealth Kiosk in the community)	“We started tele-vital signs monitoring during the pandemic. We started off first with hypertension, so it was tele-blood pressure monitoring. We are now moving on into diabetes, which includes both tele-blood sugar monitoring and glycated haemoglobin A1c monitoring. The idea is to empower patients to care for their chronic conditions by themselves at home, with the support from the health care team, without them visiting the clinics unnecessarily.” #25 Hospital Management Officer, M “We launched the telehealth kiosk initiative at the peak of COVID-19 infection. So, we placed electronic devices like tablets at community centers. This allows residents with low SES to have a video consultation with the doctors and nurses in the hospital. Residents like this because services are provided free-of-charge.” #6 Nurse, F	“The Nursing Department has launched AskMissy, an enquiry platform for the public to address any health care–related queries they may have. The nurse on duty will address questions and make clinically sound suggestions to the enquirer. So far, it is well received by the public, but we are still thinking about ways to reach the not so tech-savvy elderly patients.” #31 Nurse, F “For patients who are not IT savvy, or IT connected, who do not have access to video conferencing or devices, or even Internet at their home, they are basically shut off from the virtual health care system such as teleconsulting and tele-vital signs monitoring.” #25 Hospital Management Officer, M