Medical Conditions To Be Consulted At The Medical SOPCs Of HA (This Guideline lists out the common medical conditions that

may be referred to the medical SOPC of HA for consultation. It is not a complete list. Each cluster / hospital may have variations in the preferred conditions seen in its clinics. After consultation and stabilisation, patients may be asked to continue their disease management in the primary care facilities.)
Medical Conditions (A) Cardiology (B) Endocrinology & Metabolism 1. Type 1 diabetes mellitus 2. Type 2 diabetes mellitus Age < 40 years old Pregnant, or planning to conceive within 1 year HbA1c >/= 8% for >/= 6 months and on maximum tolerated doses of oral hypoglycaemic agents Labile diabetic control Have multiple diabetes-related complications Metabolic syndrome Active thyrotoxicosis Thyroid function test results that are difficult to interpret Pregnant Newly diagnosed hypothyroidism Thyroid nodules and hyperthyroidism History of fragility fracture Remarks No explicit condition

3.

Thyroid diseases

4.

Osteoporosis

Documented osteoporosis on DEXA examination 5. Other endocrine disorders Hypothalamic and pituitary disorders Neuroendocrine tumours and endocrine malignancies Adrenal disorders Calcium and metabolic bone disorders other than osteoporosis Growth disorders Disorders of sexual differentiation Reproductive disorders and hypogonadism other than menopause Familial primary hyperlipidaemia Obesity with BMI >/= 30 kg/m2 With complications With H. pylori resistant Achalasia GERD, with erosive oesophagitis GERD, requiring long term regular PPI With complications

(C) Gastroenterology & Hepatology 1. Peptic ulcers 2. Oesophageal motility disorders

3. 4. 5. 6. 7.

NSAID-related gastropathy Malabsorption Inflammatory bowel disease Colon polyps Pancreatic disease

Surveillance colonoscopy for known adenomatous polyp Chronic pancreatitis

8. 9. 10.

Chronic HBV hepatitis Chronic HCV hepatitis Other chronic liver diseases

With active HBV replication and raised ALT With hepatic decompensation or cirrhosis

Autoimmune hepatitis Primary biliary cirrhosis Sclerosing cholangitis Wilsons disease Cirrhosis Age >/= 65 years High fall risk Needs multi-factorial intervention to prevent further falls Dysphagia or choking / coughing after eating or drinking Feeding problem in a demented elderly Consider tube feeding Rehabilitation Uncertain in the diagnosis of dementia or its subtypes / causes Require long term care plan, especially those associated with behaviour or functional disabilities Require community care-giver support The very old with a single system disease Frail elderly with complex, multi-disciplinary health problems

(D) Geriatrics 1. Falls and Instability 2. Feeding problem / Undernutrition

3.

Impaired cognitive function

4.

Multiple interacting problems

5.

Prevention of inappropriate institutionalisation

Functional loss due to disabling diseases Unstable or chronic medical conditions Family / client / carer need for specialist support

6. 7. 8.

Frail elderly with psychosocial problems Recent decline in mobility and self-care ability Urinary incontinence Unclear diagnosis / failure to respond to adequate therapeutic trial Need community support / education No explicit condition

(E) Haematology (F) Infectious Disease 1. Pyrexia of unknown origin (G) Medical Oncology & Palliative Care 1. Proven or suspected malignancy (H) Nephrology 1. Haematuria 2. 3. 4. 5. Proteinuria Acute renal failure Chronic renal failure Post renal transplant

New cases

Serum Cr leverl >200 umol/L

(I) Neurology 1. Neurological disorders 2. 3. 4. 5. Dementia / Cognitive impairment Headache Epilepsy Stroke / TIA

Symptoms / signs of genuine neurological disorders Age </= 60 years With abnormal neurological signs Secondary causes

Including retinal vascular occlusion Other than old cases of Chest Clinic

(J) Respiratory Medicine 1. Asthma 2. 3. 4. 5. 6. Chronic obstructive pulmonary disease Bronchiectasis Interstitial lung disease Obstructive sleep apnoea Lung cancer

New cases, confirmed or suspected

(K) Rheumatology 1. Discrete collagen vascular disease e.g. lupus / SLE, vasculitis, scleroderma, Sjogrens, Behcets, inflammatory

myoisitis 2. Inflammatory arthritis e.g. rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, spondyloarthropathy, reactive arthritis, inflammatory bowel disease related arthritis

3. 4.

Positive autoantibodies Osteoarthritis Require daily NSAID With renal impairment With NSAID-related gastropathy With other comorbidities limiting the use of NSAIDs or other analgesic Require long term regular NSAID With renal impairment With NSAID-related gastropathy With other comorbidities limiting the use of NSAIDs or other analgesic

5.

Gout

6. 7.

Soft tissue rheumatism Chronic musculoskeletal pain Failed to response to non-phramcological treatment and simple analgesic

1 September 2005