چکیده (انگلیسی):

Background:In Singapore, subsidized primary care is provided by centralized polyclinics; since 2000, policies have
allowed lower-income Singaporeans to utilize subsidies at private general-practitioner (GP) clinics. We sought to
determine whether proximity to primary care, subsidised primary care, or having regular primary care associated
with health screening participation in a low socioeconomic-status public rental-flat community in Singapore.
Methods:From 2009–2014, residents in five public rental-flat enclaves (N= 936) and neighboring owner-occupied
precincts (N= 1060) were assessed for participation in cardiovascular and cancer screening. We then evaluated
whether proximity to primary care, subsidised primary care, or having regular primary care associated with improved
adherence to health screening. We also investigated attitudes to health screening using qualitative methodology.
Results:In the rental flat population, for cardiovascular screening, regular primary care was independently associated
with regular diabetes screening (adjusted odds ratio, aOR = 1.59, CI = 1.12–2.26,p= 0.009) and hyperlipidemia screening
(aOR = 1.82, CI = 1.10–3.04,p= 0.023). In the owner-occupied flats, regular primary care was independently associated
with regular hypertension screening (aOR = 9.34 (1.82–47.85,p= 0.007), while subsidized primary care was associated
with regular diabetes screening (aOR = 2.94, CI = 1.04–8.31,p= 0.042). For cancer screening, in the rental flat population,
proximity to primary care was associated with less participation in regular colorectal cancer screening (aOR = 0.42,
CI = 0.17–0.99,p= 0.049) and breast cancer screening (aOR = 0.29, CI = 0.10–0.84,p= 0.023). In the owner-occupied flat
population, for gynecological cancer screening, usage of subsidized primary care and proximity to primary care was
associated with higher rates of breast cancer and cervical cancer screening; however, being on regular primary care
followup was associated with lower rates of mammography (aOR = 0.10, CI = 0.01–0.75,p= 0.025). On qualitative analysis,
patients were discouraged from screening by distrust in the doctor-patient relationship; for cancer screening in
particular, patients were discouraged by potential embarrassment.
Conclusions:Regular primary care was independently associated with regular participation in cardiovascular
screening in both low-SES and higher-SES communities. However, for cancer screening, in the low-SES
community, proximity to primary care was associated withless participation in regular screening, while in the
higher-SES community, regular primary care was associated with lower screening participation; possibly due to
embarrassment regarding screening modalities.