{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T05:27:54Z","timestamp":1783229274155,"version":"3.54.6"},"reference-count":52,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T00:00:00Z","timestamp":1707350400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacy"],"abstract":"<jats:p>Background: A collaborative prescribing (CP) practice model, established by the endocrinologists, pharmacists, and advanced practice nurses, aims to provide for the postoperative monitoring and medical and nutritional management of stable patients after bariatric surgery. Method: Under the CP agreement, endocrinologists refer patients who have undergone bariatric surgery with stable medical conditions to CP practitioners, comprising senior pharmacists and advanced practice nurses. CP practitioners review the patient\u2019s weight loss progress, blood test results and vitals, the sufficiency of micronutrient repletion, adherence to supplements and medications, and chronic disease control. CP practitioners can prescribe and adjust the medications and supplements, in accordance with a clinical evaluation and standard guidance. Patients who require immediate attention due to complications or red flags are referred to the primary endocrinologist for further management. Results: From 5 May 2020 to 30 September 2023, CP practitioners provided 672 consultations. At least 68% and 80% of patients achieved appropriate weight loss post-surgery during the acute and maintenance phases, respectively. Less than 10% of the patients presented with anaemia and iron deficiency, and vitamin B12, folate and vitamin D deficiency. More than 80% of patients achieved a HbA1c of less than 7%. Conclusions: The CP practice framework provides a sustainable and viable model to facilitate optimal outcomes after bariatric surgery.<\/jats:p>","DOI":"10.3390\/pharmacy12010031","type":"journal-article","created":{"date-parts":[[2024,2,9]],"date-time":"2024-02-09T03:53:46Z","timestamp":1707450826000},"page":"31","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Collaborative Prescribing Practice in Managing Patients Post-Bariatric Surgery in a Tertiary Centre in Singapore"],"prefix":"10.3390","volume":"12","author":[{"given":"Giat Yeng","family":"Khee","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paik Shia","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoke Ling","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Speciality Nursing, Singapore General Hospital, Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9446-2032","authenticated-orcid":false,"given":"Phong Ching","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Singapore General Hospital, Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1038\/oby.2008.231","article-title":"Obesity as a disease: A white paper on evidence and arguments commissioned by the Council of the Obesity Society","volume":"16","author":"Allison","year":"2008","journal-title":"Obesity"},{"key":"ref_2","unstructured":"World Health Organisation (2000). Obesity: Preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ. Tech. Rep. Ser., 894, 1\u2013253."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1111\/obr.12551","article-title":"Obesity: A chronic relapsing progressive disease process. A position statement of the World Obesity Federation","volume":"18","author":"Bray","year":"2017","journal-title":"Obes. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"National Task Force on the Prevention and Treatment of Obesity, Billington, C.J., Epstein, L.H., Goodwin, N.J., Hill, J.O., Pi-Sunyer, F.X., Rolls, B.J., Stern, J., Wadden, T.A., and Weinsier, R.L. (2000). Overweight, obesity, and health risk. Arch. Intern. Med., 160, 898.","DOI":"10.1001\/archinte.160.7.898"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Collaboration NCDRF (2016). Trends in adult body-mass index in 200 countries from 1975 to 2014: A pooled analysis of 1698 population-based measurement studies with 19.2 million partici-pants. Lancet, 387, 1377\u20131396.","DOI":"10.1016\/S0140-6736(16)30054-X"},{"key":"ref_6","unstructured":"Ministry of Health (2023, November 16). National Population Health Survey 2020, Available online: https:\/\/www.moh.gov.sg\/docs\/librariesprovider5\/default-document-library\/nphs-2020-survey-report.pdf."},{"key":"ref_7","unstructured":"Soon, G., Koh, Y.H., Wong, M.L., and Lam, P.W. (2023, November 16). Obesity Prevention and Control Efforts in Singapore. Available online: https:\/\/www.nbr.org\/wp-content\/uploads\/pdfs\/publications\/obesity-prevention-and-control-efforts-in-singapore-2008-case-study.pdf."},{"key":"ref_8","first-page":"8","article-title":"Obesity in Singapore, Prevention and Control","volume":"38","author":"Goh","year":"2012","journal-title":"Singap. Fam. Physician"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1844","DOI":"10.1161\/CIRCRESAHA.116.307591","article-title":"Treatment of Obesity: Weight Loss and Bariatric Surgery","volume":"118","author":"Wolfe","year":"2016","journal-title":"Circ. Res."},{"key":"ref_10","unstructured":"National Institute for Health and Care Excellence (2023, November 16). Obesity: Identification, Assessment and Management. Clinical Guideline [CG189]. Available online: https:\/\/www.nice.org.uk\/guidance\/cg189."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta22680","article-title":"Bariatric surgery, lifestyle interventions and orlistat for severe obesity: The REBALANCE mixed-methods systematic review and economic evaluation","volume":"22","author":"Avenell","year":"2018","journal-title":"Health Technol. Assess."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1056\/NEJMra1514009","article-title":"Mechanisms, pathophysiology, and management of obesity","volume":"376","author":"Heymsfield","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1056\/NEJMoa066254","article-title":"Effects of bariatric surgery on mortality in Swedish obese subjects","volume":"357","author":"Sjostrom","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1001\/jamasurg.2015.1534","article-title":"Three-year outcomes of bariatric surgery vs lifestyle intervention for type 2 diabetes mellitus treatment: A randomized clinical trial","volume":"150","author":"Courcoulas","year":"2015","journal-title":"JAMA Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1830","DOI":"10.1016\/S0140-6736(21)00591-2","article-title":"Association of metabolic\u2013bariatric surgery with long-term survival in adults with and without diabetes: A one-stage meta-analysis of matched cohort and prospective controlled studies with 174,772 participants","volume":"397","author":"Syn","year":"2021","journal-title":"Lancet"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1001\/jama.2011.1914","article-title":"Bariatric surgery and long-term cardiovascular events","volume":"307","author":"Peltonen","year":"2012","journal-title":"J. Am. Med. Assoc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.ijcard.2014.02.026","article-title":"Bariatric surgery and its impact on cardiovascular disease and mortality: A systematic review and meta-analysis","volume":"173","author":"Kwok","year":"2014","journal-title":"Int. J. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S128","DOI":"10.2337\/dc23-S008","article-title":"Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standard of Care in Diabetes\u20142023","volume":"46","author":"ElSayed","year":"2023","journal-title":"Diabetes Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"337","DOI":"10.4158\/EP12437.GL","article-title":"Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient: 2013 update. Cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery","volume":"19","author":"Mechanick","year":"2013","journal-title":"Endocr. Pract."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S73","DOI":"10.1016\/j.soard.2008.03.002","article-title":"ASMBS Allied health nutritional guidelines for the surgical weight loss patient","volume":"4","author":"Aills","year":"2008","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1016\/j.soard.2016.12.018","article-title":"American Society for Metabolic and Bariatric Surgery integrated health nutritional guidelines for the surgical weight loss patient 2016 update: Micronutrients","volume":"13","author":"Parrott","year":"2017","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1038\/oby.2008.614","article-title":"Acquired copper deficiency: A potentially serious and preventable complication following gastric bypass surgery","volume":"17","author":"Griffith","year":"2009","journal-title":"Obesity"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s10633-009-9200-y","article-title":"Fundus white spots and acquired night blindness due to vitamin A deficiency","volume":"119","author":"Genead","year":"2009","journal-title":"Doc. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/j.orcp.2017.05.004","article-title":"Bilateral leg oedema after bariatric surgery: A selenium-deficient cardiomyopathy","volume":"11","author":"Massoure","year":"2017","journal-title":"Obes. Res. Clin. Pract."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1177\/0004563214535562","article-title":"Complications from micronutrient deficiency following bariatric surgery","volume":"51","author":"Wilson","year":"2014","journal-title":"Ann. Clin. Biochem."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"165","DOI":"10.3109\/01658107.2012.700993","article-title":"Nutritional optic neuropathy status post bariatric surgery","volume":"36","author":"Chacko","year":"2012","journal-title":"Neuroophthalmology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1007\/s11695-018-3494-3","article-title":"Nutritional Deficiencies in Severe Obesity: A Multiethnic Asian Cohort","volume":"29","author":"Lee","year":"2019","journal-title":"Obes. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"464","DOI":"10.4239\/wjd.v8.i11.464","article-title":"Bariatric surgery and long-term nutritional issues","volume":"8","author":"Lupoli","year":"2017","journal-title":"World J. Diabetes"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e205123","DOI":"10.1001\/jamanetworkopen.2020.5123","article-title":"Associations of Bariatric Interventions With Micronutrient and Endocrine Disturbances","volume":"3","author":"Syn","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1001\/jama.2020.12567","article-title":"Benefits and Risks of Bariatric Surgery in Adults: A Review","volume":"324","author":"David","year":"2020","journal-title":"JAMA"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1007\/s11695-014-1178-1","article-title":"Does patient compliance with follow-up influence weight loss after gastric bypass surgery? A systematic review and meta-analysis","volume":"24","author":"Kim","year":"2014","journal-title":"Obes. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1007\/s11695-014-1500-y","article-title":"Prevalence of anemia and related deficiencies 10 years after gastric bypass: A retrospective study","volume":"25","author":"Karefylakis","year":"2015","journal-title":"Obes. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/j.soard.2018.03.029","article-title":"Do specialized bariatric multivitamins lower deficiencies after RYGB?","volume":"14","author":"Schijns","year":"2018","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_34","first-page":"175","article-title":"Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical support of the Patients Undergoing Bariatric Procedures\u20142019 Update: Cosponsored by American Association of Clinical Endocrinologists\/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists","volume":"16","author":"Mechanick","year":"2020","journal-title":"Obesity"},{"key":"ref_35","unstructured":"National Institute for Health and Care Excellence (2023, November 16). Obesity: Clinical Assessment and Management. Quality Standard [QS127]. Available online: https:\/\/www.nice.org.uk\/guidance\/qs127."},{"key":"ref_36","unstructured":"O\u2019Kane, M., Pinkney, J., Aasheim, E., Barth, J.H., Batterham, R.L., and Welbourn, R. (2023, November 16). BOMSS Guidelines on Peri-Operative and Postoperative Biochemical Monitoring and Micronutrient Replacement for Patients Undergoing Bariatric Surgery. Available online: https:\/\/bomss.org\/wp-content\/uploads\/2021\/06\/BOMSS-guidelines-Final-version1Oct14.pdf."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1159\/000481825","article-title":"Practical recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the post-bariatric surgery medical management","volume":"10","author":"Busetto","year":"2017","journal-title":"Obes. Facts"},{"key":"ref_38","unstructured":"National University of Singapore (2023, November 16). Media Factsheet on National Collaborative Prescribing Programme. Available online: https:\/\/medicine.nus.edu.sg\/nursing\/2018\/07\/media-factsheet-on-national-collaborative-prescribing-programme\/."},{"key":"ref_39","unstructured":"Ministry of Health (2023, November 16). Guidelines for the Implementation of Collaborative Prescribing Services, Available online: https:\/\/www.moh.gov.sg\/docs\/librariesprovider4\/guidelines\/guidelines-for-implementation-of-collaborative-prescribing-services.pdf."},{"key":"ref_40","unstructured":"Committee of Supply: Beyond Quality to Value (2023, November 16). Ensuring an Affordable and Sustainable Healthcare System, Available online: https:\/\/www.moh.gov.sg\/docs\/librariesprovider5\/pressroom\/current-issues\/cos-2018-media-factsheet-beyond-quality-to-value.pdf."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2618","DOI":"10.1007\/s11695-022-06022-y","article-title":"Efficacy of a Bariatric Surgery Clinic-Based Pharmacist","volume":"32","author":"Han","year":"2022","journal-title":"Obes. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1177\/08971900211030238","article-title":"Evaluation of an Inpatient Pharmacy Consult on Discharge Medications in Bariatric Surgery Patients","volume":"36","author":"Prooyen","year":"2021","journal-title":"J. Pharm. Pract."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1097\/JXX.0000000000000463","article-title":"Management of inadequate weight loss or weight regain in post-bariatric surgical patients","volume":"32","author":"Sahebzamani","year":"2020","journal-title":"J. Am. Assoc. Nurse Pract."},{"key":"ref_44","first-page":"129","article-title":"Nursing care of the person having bariatric surgery","volume":"15","author":"Grindel","year":"2006","journal-title":"Medsurg Nurs. Off. J. Acad. Med.-Surg. Nurses"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"40","DOI":"10.7748\/ns.2018.e11078","article-title":"An overview of developments in nurse prescribing in the UK","volume":"33","author":"Courtenay","year":"2018","journal-title":"Nurs. Stand."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1111\/bcp.13624","article-title":"Stakeholders\u2019 views and experiences of pharmacist prescribing: A systematic review","volume":"84","author":"Jebara","year":"2018","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.12968\/bjon.2009.18.21.45366","article-title":"An evaluation of nurse prescribing. Part 1: A literature review","volume":"18","author":"Creedon","year":"2009","journal-title":"Br. J. Nurs."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1724","DOI":"10.1001\/jama.292.14.1724","article-title":"Bariatric surgery: A systematic review and meta-analysis","volume":"292","author":"Buchwald","year":"2004","journal-title":"JAMA"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1007\/s11695-017-3050-6","article-title":"Ethnicity Does Not Influence Glycemic Outcomes or Diabetes Remission After Sleeve Gastrectomy or Gastric Bypass in a Multiethnic Asian Cohort","volume":"28","author":"Lee","year":"2018","journal-title":"Obes. Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1177\/0884533609332174","article-title":"Anemia after bariatric surgery: More than just iron deficiency","volume":"24","author":"Von","year":"2009","journal-title":"Nutr. Clin. Pract."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1001\/jamasurg.2017.3158","article-title":"Prevalence of Anemia 10 Years After Roux-en-Y Gastric Bypass in a Single Veterans Affairs Medical Center","volume":"153","author":"Chen","year":"2018","journal-title":"JAMA Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"4781","DOI":"10.1007\/s11695-021-05618-0","article-title":"Centile Charts for Monitoring of Weight Loss Trajectories After Bariatric Surgery in Asian Patients","volume":"31","author":"Tan","year":"2021","journal-title":"Obes. Surg."}],"container-title":["Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2226-4787\/12\/1\/31\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:57:32Z","timestamp":1760104652000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2226-4787\/12\/1\/31"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,8]]},"references-count":52,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["pharmacy12010031"],"URL":"https:\/\/doi.org\/10.3390\/pharmacy12010031","relation":{},"ISSN":["2226-4787"],"issn-type":[{"value":"2226-4787","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,8]]}}}