Displaying publications 1 - 20 of 700 in total

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  1. Ab Rahman N, Sivasampu S, Mohamad Noh K, Khoo EM
    BMC Health Serv Res, 2016 06 14;16:197.
    PMID: 27301972 DOI: 10.1186/s12913-016-1444-0
    BACKGROUND: The world population has become more globalised with increasing number of people residing in another country for work or other reasons. Little is known about the health profiles of foreign population in Malaysia. The aim of this study was to provide a detailed description of the health problems presented by foreigners attending primary care clinics in Malaysia.

    METHODS: Data were derived from the 2012 National Medical Care Survey (NMCS), a cross sectional survey of primary care encounters from public and private primary care clinics sampled from five regions in Malaysia. Patients with foreign nationality were identified and analysed for demographic profiles, reasons for encounter (RFEs), diagnosis, and provision of care.

    RESULTS: Foreigners accounted for 7.7 % (10,830) of all patient encounters from NMCS. Most encounters were from private clinics (90.2 %). Median age was 28 years (IQR: 24.0, 34.8) and 69.9 % were male. Most visits to the primary care clinics were for symptom-based complaints (69.5 %), followed by procedures (23.0 %) and follow-up visit (7.4 %). The commonest diagnosis in public clinics was antenatal care (21.8 %), followed by high risk pregnancies (7.5 %) and upper respiratory tract infection (URTI) (6.8 %). Private clinics had more cases for general medical examination (13.5 %), URTI (13.1 %) and fever (3.9 %). Medications were prescribed to 76.5 % of these encounters.

    CONCLUSIONS: More foreigners were seeking primary medical care from private clinics and the encounters were for general medical examinations and acute minor ailments. Those who sought care from public clinics were for obstetric problems and chronic diseases. Medications were prescribed to two-thirds of the encounters while other interventions: laboratory investigations, medical procedures and follow-up appointment had lower rates in private clinics. Foreigners are generally of young working group and are expected to have mandatory medical checks. The preponderance of obstetrics seen in public clinics suggests a need for improved access to maternal care and pregnancy related care. This has implication on policy and health care provision and access for foreigners and future studies are needed to look into strategies to solve these problems.
    Matched MeSH terms: Ambulatory Care Facilities
  2. Ab Rahman N, Teng CL, Sivasampu S
    BMC Infect. Dis., 2016 05 17;16:208.
    PMID: 27188538 DOI: 10.1186/s12879-016-1530-2
    BACKGROUND: Antibiotic overuse is driving the emergence of antibiotic resistance worldwide. Good data on prescribing behaviours of healthcare providers are needed to support antimicrobial stewardship initiatives. This study examined the differences in antibiotic prescribing rates of public and private primary care clinics in Malaysia.

    METHODS: We used data from the National Medical Care Survey (NMCS), a nationwide cluster sample of Malaysian public and private primary care clinics in 2014. NMCS contained demographic, diagnoses and prescribing from 129 public clinics and 416 private clinics. We identified all encounters who were prescribed antibiotic and analyse the prescribing rate, types of antibiotics, and diagnoses that resulted in antibiotic.

    RESULTS: Five thousand eight hundred ten encounters were prescribed antibiotics; antibiotic prescribing rate was 21.1 % (public clinics 6.8 %, private clinics 30.8 %). Antibiotic prescribing was higher in private clinics where they contributed almost 87 % of antibiotics prescribed in primary care. Upper respiratory tract infection (URTI) was the most frequent diagnosis in patients receiving antibiotic therapy and accounted for 49.2 % of prescriptions. Of the patients diagnosed with URTI, 46.2 % received antibiotic treatment (public 16.8 %, private 57.7 %). Penicillins, cephalosporins and macrolides were the most commonly prescribed antibiotics and accounted for 30.7, 23.6 and 16.0 % of all antibiotics, respectively. More recently available broad-spectrum antibiotics such as azithromycin and quinolones were more frequently prescribed in private clinics.

    CONCLUSIONS: Antibiotic prescribing rates are high in both public and private primary care settings in Malaysia, especially in the latter. This study provides evidence of excessive and inappropriate antibiotic prescribing for self-limiting conditions. These data highlights the needs for more concerted interventions targeting both prescribers and public. Improvement strategies should focus on reducing inappropriate prescribing.
    Matched MeSH terms: Ambulatory Care Facilities
  3. Ab-Rahman S, Sulaiman AR, Muzaffar T
    Trauma Case Rep, 2016 Apr;3:32-35.
    PMID: 29942842 DOI: 10.1016/j.tcr.2016.05.004
    Irreducible dislocation of the interphalangeal joint (IPJ) big toe is a rare injury Hitori et al. (2006) . We report a case of the right big toe IPJ dislocation following a trauma. The problem was diagnosed and managed at other medical centers with standard treatment of closed manual reduction and splint. The right big toe was splinted accordingly and the patient was referred to our orthopedic outpatient clinic. At the clinic, a repeat plain radiograph was ordered due to high suspicion of the irreducible IPJ.
    Study site: orthopedic clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  4. Abai G, Henry J, Lian CB, Wee ASF, Bili H, Ratu I
    Int J Public Health Res, 2011;1(2):92-99.
    MyJurnal
    Introduction Neonatal jaundice occurs in about 60% of newborns. If not managed properly, it can progress to severe neonatal jaundice (SNNJ) leading to death or permanent disability. The incidence of SNNJ in Kuching District increased from 119.3 per 100,000 live births in 2005 to 123.3 per 100,000 live births in 2008, which was above the Standard National QAP Indicator of 100 per 10,000 live births. SNNJ can be prevented by early detection and proper management of neonatal jaundice. The objective is to increase the knowledge and practise of early detection of neonatal jaundice by nurses in Kuching District. Methods This was an interventional study covering a period of six months. The sample comprised 113 nurses of all categories working in urban and rural maternal and child health clinics in Kuching District. Tools used in the study were self-administered questionnaires in English and Bahasa Malaysia. The preintervention survey started in July 2009 while the post-intervention survey was done in January 2010. The interventions were done through Continuing Nursing Education sessions and included new nursing formats and new reporting procedures. New vehicles were also provided for home nursing. Data was collected and analyzed using MS Excel program. Results The pre-intervention survey on nurses showed that only 56.6% were able to identify the risk of factors causing jaundice; 94.6% able to define jaundice; 41.5% able to detect jaundice while 70.8% knew sign of Kernicterus. In term of recommended post natal nursing schedule only 40.7% able to practice the schedule while only 69.0% able to give advice on management of jaundice. Post intervention; 63.2% of nurses were able to identify the risk factors causing jaundice; 97.2% able to define jaundice while 97.2% were able to detect jaundice and 88.6% know sign of Kernicterus. On recommended post natal nursing schedule, 49.9 % practice the recommended schedule while 92.0% were able to give advice to mother on management of jaundice. The incident of jaundice of Severe Neonatal Jaundice dropped to 78 per 100,000 live births in 2010.
    Conclusions The study shows that the interventions taken helped to improve the knowledge and practice of recommended measures to detect neonatal jaundice early. Stronger emphasis must be placed on using the new reporting procedures and new nursing sheets. Continuous monitoring through regular nursing audits by clinic supervisors is also essential to reduce the incidence of SNNJ. Provision of vehicles for all busy maternal and child health clinics for home nursing care is highly recommended.
    Matched MeSH terms: Ambulatory Care Facilities
  5. Abd Aziz A, Izyan Farhana Nordin N, Mohd Noor N, Bachok N, Nor Ismalina Isa S
    Fam Pract, 2014 Apr;31(2):236-44.
    PMID: 24317538 DOI: 10.1093/fampra/cmt062
    Background. Patient satisfaction influences the outcomes of the patient-physician encounter.
    Objective. The objective of this study was to validate the Malay version patient satisfaction
    (MISS-21) questionnaire using a confirmatory validity approach.
    Methods. A cross-sectional study was conducted involving 252 patients attending primary health
    clinic, Hospital Universiti Sains Malaysia. Construct validity (convergent and discriminant) using
    confirmatory factor analysis and internal consistency were performed after the translation, content
    validity and face validity processes. Criterion validity was assessed using Pearson correlations
    with the scale of shared decision making 9-item questionnaire (SDMQ-9). The data was
    analysed using Analysis of Moment Structure version 19.
    Results. A total of 252 (100%) outpatients responded to this study. The final model that consists
    of three domains with 11 items had a good fit; (χ2
    (df) = 65.805 (32), P care setting because it is acceptably valid, reliable and simple. The validated Malay version
    questionnaire was called as ‘Skala Kepuasan Interaksi Perubatan-11’.
    Key words: Confirmatory factor analysis, patient-physician interaction, patient satisfaction, psychometrics, reliability, validity
    Questionnaire: ‘Skala Kepuasan Interaksi Perubatan-11; Medical Interview Satisfaction Scale; MISS-21

    Study site: Primary health clinic, Hospital Universiti Sains Malaysia (HUSM)
    Matched MeSH terms: Ambulatory Care Facilities
  6. Abd Rahman M, Ahmad Zaki R, Sarimin R, Ariff MI, Suli Z, Mahmud M, et al.
    PLoS ONE, 2017;12(11):e0184559.
    PMID: 29095822 DOI: 10.1371/journal.pone.0184559
    The Malaysian Dengue Clinical Practice Guidelines (CPG) have been developed to provide evidence-based guidance in the management of dengue infections. The use of these guidelines is essential to ensure its recommendations are being practiced. However, the adherence to the guidelines for management of dengue (revised 2nd edition) by healthcare providers still remains unknown. Therefore, the aim of this study was to evaluate the proportion among healthcare providers that adhere to this Dengue CPG. A retrospective cohort study of dengue cases registered from 1 January 2014 to 1 June 2015 was conducted in public hospitals and health clinics in Selangor, Putrajaya and Kuala Lumpur. Adherence to the CPG recommendations were recorded by reviewing patients' case notes. Overall proportion of adherence in clinical components of the recommendation were (7.1 to 100.0% versus 7.7 to 73.8%) in history taking, (6.7 to 100.0% versus 12.3 to 60.0%) in physical examinations, (18.4 to 100.0% versus 23.1 to 83.2%) in assessment of warning signs, (0.6 to 100.0% versus 12.3 to 87.7%) in assessment of haemodynamic status, (60.0 to 100.0% versus 27.7 to 40.0%) in diagnosis, (46.6 to 80.0% versus 52.3%) in case notifications, (73.2 to 100.0% versus 89.2 to 96.9%) in performing specific laboratory investigations and (7.9 to 100.0% versus 21.5%) in monitoring, for outpatient versus inpatient, respectively. Adherence trends were demonstrated to be higher in hospital settings compared to outpatient settings. Adherence to this Dengue CPG varies widely with overall good clinical outcomes observed.

    Study site: public hospitals and health clinics in Selangor, Putrajaya and Kuala Lumpur
    Matched MeSH terms: Ambulatory Care Facilities
  7. Abdollahi F, Zarghami M, Sazlina SG, Lye MS
    Early Interv Psychiatry, 2017 Feb;11(1):57-62.
    PMID: 25582677 DOI: 10.1111/eip.12215
    AIM: Prolonged depression during the post-partum period is associated with maternal and infant mortality and morbidity. Less attention has been given to factors that predict the persistence of depression beyond the first 3 months post-partum.
    METHODS: From a longitudinal cohort of 2279 women who attended Mazandaran's primary health centres in 2009, 478 women with an Edinburgh Postnatal Depression Scale (EPDS) score of 12 or greater in the third trimester of pregnancy were recruited. Persistently depressed women (depressed at all three occasions: during pregnancy, and at 2 and 12 weeks post-partum) were compared with those without depression to determine demographic, cultural, obstetric and biopsychosocial predictors for persistence of depression. Data were analysed using chi-square test, t-test and logistic regression models.
    RESULTS: The stability of depression was found in 193 (46.2 %) of 418 depressed cases who were followed up over the study period. Of those mothers who scored more than the threshold of 12 during the third trimester of pregnancy, 277 (66.3%) and 221 (52.9%) had high EPDS at 2 and 12 weeks post-partum. Psychological distress (based upon the General Health Questionnaire), low maternal parental self-efficacy (based upon the Parental Expectation Survey) and perceived social isolation (based upon the Network Orientation Scale) were independent predictors of persistent depression.
    CONCLUSION: Fewer depressed mothers in this study were found to recover during the first 3 months after giving birth. Psychosocial factors predicted sustained depression from pregnancy to 3 months post-partum. The findings highlight the significance of support in enhancing maternal mental health.
    Matched MeSH terms: Ambulatory Care Facilities
  8. Abdollahi F, Etemadinezhad S, Lye MS
    Taiwan J Obstet Gynecol, 2016 Feb;55(1):76-80.
    PMID: 26927254 DOI: 10.1016/j.tjog.2015.12.008
    OBJECTIVES: Cultural practices have been found to positively impact the mothering experience. This study sought to identify the relationship between sociocultural practices and postpartum depression (PPD) in a cohort of Iranian women for the first time.
    MATERIALS AND METHODS: In a longitudinal cohort design, 2279 pregnant women attending primary health centers of Mazandaran province in Iran were recruited using stratified random sampling method. Data were collected using the Edinburgh Postnatal Depression Scale and researchers developed validated cultural practices questionnaire at 3 months after delivery. Data were analyzed using Chi-square test and multiple logistic regression models.
    RESULTS: The prevalence of PPD was 19% among 1910 women who were followed postdelivery in this study. Cultural practices were not associated with lower odds of PPD in multiple logistic regression model after adjustment for all sociodemographic factors. The results of this study do not also provide any evidence to support that sex of baby is associated with the greater risk of PPD.
    CONCLUSIONS: Cultural practices could not be perceived as protective mechanisms that protect women from PPD in this traditional society. However, health professionals should be familiar with postpartum beliefs and practices that could support mothers in the postpartum period.
    KEYWORDS: culture; depression; postpartum; practices
    Matched MeSH terms: Ambulatory Care Facilities
  9. Abdollahi F, Zarghami M, Sazlina SG, Zain AM, Mohammad AJ, Lye MS
    Arch Med Sci, 2016 Oct 1;12(5):1043-1051.
    PMID: 27695496
    INTRODUCTION: Post-partum depression (PPD) is the most prevalent mental problem associated with childbirth. The purpose of the present study was to determine the incidence of early PPD and possible relevant risk factors among women attending primary health centers in Mazandaran province, Iran for the first time.
    MATERIAL AND METHODS: A longitudinal cohort study was conducted among 2279 eligible women during weeks 32-42 of pregnancy to determine bio-psycho-socio-cultural risk factors of depression at 2 weeks post-partum using the Iranian version of the Edinburgh Postnatal Depression Scale (EPDS). Univariate and hierarchical multiple logistic regression models were used for data analysis.
    RESULTS: Among 1,739 mothers whose EPDS scores were ≤ 12 during weeks 32-42 of gestation and at the follow-up study, the cumulative incidence rate of depression was 6.9% (120/1,739) at 2 weeks post-partum. In the multivariate model the factor that predicted depression symptomatology at 2 weeks post-partum was having psychiatric distress in pregnancy based on the General Health Questionnaire (GHQ) (OR = 1.06, (95% CI: 1.04-1.09), p = 0.001). The risk of PPD also lower in those with sufficient parenting skills (OR = 0.78 (95% CI: 0.69-0.88), p = 0.001), increased marital satisfaction (OR = 0.94 (95% CI: 0.9-0.99), p = 0.03), increased frequency of practicing rituals (OR = 0.94 (95% CI: 0.89-0.99), p = 0.004) and in those whose husbands had better education (OR = 0.03 (95% CI: 0.88-0.99), p = 0.04).
    CONCLUSIONS: The findings indicated that a combination of demographic, sociological, psychological and cultural risk factors can make mothers vulnerable to PPD.
    KEYWORDS: depression; incidence; post-partum
    Matched MeSH terms: Ambulatory Care Facilities
  10. Abdul Aziz AF, Mohd Nordin NA, Abd Aziz N, Abdullah S, Sulong S, Aljunid SM
    BMC Fam Pract, 2014;15:40.
    PMID: 24580779 DOI: 10.1186/1471-2296-15-40
    BACKGROUND: Provision of post stroke care in developing countries is hampered by discoordination of services and limited access to specialised care. Albeit shortcomings, primary care continues to provide post-stroke services in less than favourable circumstances. This paper aimed to review provision of post-stroke care and related problems among Family Medicine Specialists managing public primary health care services.
    METHODS: A semi-structured questionnaire was distributed to 121 Family Physicians servicing public funded health centres in a pilot survey focused on improving post stroke care provision at community level. The questionnaire assessed respondents background and practice details i.e. estimated stroke care burden, current service provision and opinion on service improvement. Means and frequencies described quantitative data. For qualitative data, constant comparison method was used until saturation of themes was reached.
    RESULTS: Response rate of 48.8% was obtained. For every 100 patients seen at public healthcentres each month, 2 patients have stroke. Median number of stroke patients seen per month is 5 (IQR 2-10). 57.6% of respondents estimated total stroke patients treated per year at each centre was less than 40 patients. 72.4% lacked a standard care plan although 96.6% agreed one was needed. Patients seen were: discharged from tertiary care (88.1%), shared care plan with specialists (67.8%) and patients who developed stroke during follow up at primary care (64.4%). Follow-ups were done at 8-12 weekly intervals (60.3%) with 3.4% on 'as needed' basis. Referrals ranked in order of frequency were to physiotherapy services, dietitian and speech and language pathologists in public facilities. The FMS' perceived 4 important 'needs' in managing stroke patients at primary care level; access to rehabilitation services, coordinated care between tertiary centres and primary care using multidisciplinary care approach, a standardized guideline and family and caregiver support.
    CONCLUSIONS: Post discharge stroke care guidelines and access to rehabilitation services at primary care is needed for post stroke patients residing at home in the community.
    Matched MeSH terms: Ambulatory Care Facilities
  11. Abdul Aziz AF, Hamzah Z, Tong SF, Nadeson S, Wan Puteh SE
    Asia Pac Fam Med, 2009;8(1):4.
    PMID: 19435494 DOI: 10.1186/1447-056X-8-4
    BACKGROUND: Optimum management of dyspepsia in primary care is a debatable subject. Testing for Helicobacter pylori (HP) has been recommended in primary care as this strategy will cure most underlying peptic ulcer disease and prevent future gastro duodenal disease.
    METHODS: A total of 98 patients completed Modified Glasgow Dyspepsia Severity Score Questionnaire (MGDSSQ) at initial presentation before undergoing the 13Carbon Urea Breath Test (UBT) for HP. Those with positive UBT received Eradication Therapy with oral Omeprazole 20 mg twice daily, Clarithromycin 500 mg daily and Amoxycillin 500 mg twice daily for one week followed by Omeprazole to be completed for another 4 to 6 weeks. Those with negative UBT received empirical treatment with oral Omeprazole 20 mg twice daily for 4 to 6 weeks. Patients were assessed again using the MGDSSQ at the completion of treatment and one month after stopping treatment.
    RESULTS: The prevalence of dyspepsia at Universiti Kebangsaan Malaysia-Primary Care Centre was 1.12% (124/11037), out of which 23.5% (23/98) was due to HP. Post treatment assessment in both HP (95.7%, 22/23) and non HP-related dyspepsia (86.7%, 65/75) groups showed complete or almost complete resolution of dyspepsia. Only about 4.3% (1/23) in the HP related dyspepsia and 13.3% (10/75) in the non HP group required endoscopy.
    CONCLUSION: The prevalence of dyspepsia due to HP in this primary care centre was 23.5%. Detection of HP related dyspepsia yielded good treatment outcomes (95.7%).
    Matched MeSH terms: Ambulatory Care Facilities
  12. Abdul Aziz AF, Mohd Nordin NA, Ali MF, Abd Aziz NA, Sulong S, Aljunid SM
    BMC Health Serv Res, 2017 01 13;17(1):35.
    PMID: 28086871 DOI: 10.1186/s12913-016-1963-8
    BACKGROUND: Lack of intersectoral collaboration within public health sectors compound efforts to promote effective multidisciplinary post stroke care after discharge following acute phase. A coordinated, primary care-led care pathway to manage post stroke patients residing at home in the community was designed by an expert panel of specialist stroke care providers to help overcome fragmented post stroke care in areas where access is limited or lacking.

    METHODS: Expert panel discussions comprising Family Medicine Specialists, Neurologists, Rehabilitation Physicians and Therapists, and Nurse Managers from Ministry of Health and acadaemia were conducted. In Phase One, experts chartered current care processes in public healthcare facilities, from acute stroke till discharge and also patients who presented late with stroke symptoms to public primary care health centres. In Phase Two, modified Delphi technique was employed to obtain consensus on recommendations, based on current evidence and best care practices. Care algorithms were designed around existing work schedules at public health centres.

    RESULTS: Indication for patients eligible for monitoring by primary care at public health centres were identified. Gaps in transfer of care occurred either at post discharge from acute care or primary care patients diagnosed at or beyond subacute phase at health centres. Essential information required during transfer of care from tertiary care to primary care providers was identified. Care algorithms including appropriate tools were summarised to guide primary care teams to identify patients requiring further multidisciplinary interventions. Shared care approaches with Specialist Stroke care team were outlined. Components of the iCaPPS were developed simultaneously: (i) iCaPPS-Rehab© for rehabilitation of stroke patients at community level (ii) iCaPPS-Swallow© guided the primary care team to screen and manage stroke related swallowing problems.

    CONCLUSION: Coordinated post stroke care monitoring service for patients at community level is achievable using the iCaPPS and its components as a guide. The iCaPPS may be used for post stroke care monitoring of patients in similar fragmented healthcare delivery systems or areas with limited access to specialist stroke care services.

    TRIAL REGISTRATION: No.: ACTRN12616001322426 (Registration Date: 21st September 2016).
    Matched MeSH terms: Ambulatory Care Facilities
  13. Abdul Aziz AF, Ali MF, Yusof MF, Che' Man Z, Sulong S, Aljunid SM
    Sci Rep, 2018 Dec 19;8(1):17965.
    PMID: 30568180 DOI: 10.1038/s41598-018-36154-0
    Data on post stroke outcomes in developing countries are scarce due to uncoordinated healthcare delivery systems. In Malaysia, the national stroke clinical practice guideline does not address transfer of care and longer term post stroke care beyond tertiary care. Hence, post stroke care delivery may be delivered at either tertiary or primary care facilities. This study aimed at describing patients' characteristics and outcomes of post stroke care delivered by the primary care teams at public primary care healthcentres across Peninsular Malaysia. Multi staged sampling was done to select public primary care health centres to recruit post stroke patients. At each health centre, convenience sampling was done to recruit adult patients (≥18 years) who received post stroke care between July-December 2012. Baseline measurements were recorded at recruitment and retrospective medical record review was done simultaneously, for details on medical and / or rehabilitation treatment at health centre. Changes in the measurements for post stroke care were compared using paired t-tests and Wilcoxon Rank test where appropriate. Total of 151 patients were recruited from ten public primary care healthcentres. The mean age at stroke presentation was 55.8 ± 9.8 years. Median duration of follow up was 2.3 (IQR 5.1) years. Majority co-resided with a relative (80.8%), and a family member was primary caregiver (75.%). Eleven percent were current smokers. Almost 71.0% of patients achieved BP ≤ 140/90 mmHg. Only 68.9% of the patients had been referred for neurorehabilitation. Percentage of recorded data was highest for blood pressure (88.1%) while lowest was HbA1c (43.0%). For clinical outcomes, systolic and diastolic blood pressure, triglyceride level and calculated GFR (eGFR) showed statistically significant changes during follow up (p care at public primary care healthcentres showed benefits in stroke risk factors control (i.e. hypertension and dyslipidaemia) but deterioration in renal function. A more structured coordination is needed to optimise post stroke care beyond acute phase management for patients who reside at home in the community.
    Study site: ten Klinik Kesihatan from six states in Peninsular Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  14. Abdul Aziz AM, Manan MM, Bahri S, Md Yusof FA, Kamarruddin Z, Said S, et al.
    ISBN: 978-967-5570-45-2
    Citation: Abdul Aziz AM, et al. Drug Utilization in the Treatment of Diabetes Mellitus in the Ministry of Health Facilities. Petaling Jaya: Pharmaceutical Services Division, Ministry of Health, Malaysia; 2013

    Diabetes Mellitus (DM) is a costly disease to manage because of its chronic nature and severity of complications. Treatment of DM incurred high healthcare cost in both developed and developing countries. In Malaysia, treatment of DM is provided by all Ministry of Health (MOH) healthcare facilities and treatment may vary according to types of facilities. These differences may be associated with the utilization pattern and patient’s adherence to therapy and it is important to link actual medication therapy and the direct medical cost in the management of Malaysian DM patients. Thus, this study is to describe the utilization of medications in the treatment of DM in the MOH healthcare facilities and DM patient’s adherence towards their medication. This is a cross-sectional study in 94 MOH health facilities from November 2010 to December 2011. The healthcare facilities were categorized as National Referral Hospital, State Hospitals, Hospitals with Specialist, Hospitals without Specialist and Health Clinics. Patients were selected by the method of systematic random sampling and screened based on the inclusion and exclusion criteria. Face-to-face interview and retrospective data retrieval of patients’ medical record were conducted. The questionnaire and Morisky’s four questions adherence scale were utilized during the interview. A total of 2,509 (88.2%) patients were included in the study. The findings showed that variables for age, gender, race, marital status, household income, and occupation were essential components in examining its impact towards DM care. Most of the patients were between 45 to 55 years old and were burdened with co-morbidities. The observed trend in disease status showed that DM is closely related to co-morbidities such as hypertension, cardiovascular diseases, and hyperlipidaemia; more commonly in patients with more than 5 disease years. A total of 14.6% of DM patients have yet to be initiated with insulin while 84% and 78.9% of patients had poor control of HbA1c and fasting blood glucose. In terms of drug utilization and medication cost, there was no significant difference in the pattern of medication used for the first-line treatment of DM among type of facilities. Biguanides, sulphonamides, urea derivatives, and insulin are the top three DM medications. Insulin usage ranges from 25.6% at Hospitals without Specialist to 57.8% at State Hospitals and this corresponds to 2.5 to 7.0 times increment from National Health and Morbidity Survey (NHMS) III. Use of non-antidiabetic agents (ADA) corresponds with the top 10 co-morbidities. These include platelet aggregating inhibitors, ACE-inhibitors and statins. The pattern of treatment for co-morbidities showed significant differences among facilities and may be due to the degree of severity of DM patients. Also, the policies of categorizing A*/A/KK has led to these medications being less commonly prescribed in Hospitals without Specialist and Health Clinics. Adherence is an issue that DM patients need to improve. This study found that race, household income, and age were significant indicators for poor adherence. The odds ratio (OR) for age showed it contributed to almost one time lower in adherence. The OR for inter-racial differences found that both Chinese and Indian patients were about 0.7 times more likely to be non-adherence than Malays. Household income of less than RM1,000 per month similarly showed a 0.8 times less adherence compared to households earning between RM1,000 to RM3,000 per month.  Pharmacists had been giving counselling to patients and the personalized approach by pharmacist had shown positive impact on Diabetic Medication Therapy Adherence Clinic (DMTAC) patients. The study findings, however, showed no improvement in adherence between those who attended DMTAC and those who have not. These findings might not be generalizable since most facilities had a very small percentage of DM patients and they are usually the problematic or difficult patients; this could have led to the rather uneventful findings. Finally, this study showed that there is no significant difference in the utilization of medication among health facilities in the treatment of DM. Adherence is still an area of concern and collaboration between healthcare professionals is vital for better treatment outcome. 
    Matched MeSH terms: Ambulatory Care Facilities
  15. Abdul Ghani, M., Mohd Zaki, M.H., Cheah, C.W.
    Ann Dent, 2015;22(2):38-44.
    MyJurnal
    The aim of study was to evaluate the level of satisfaction of patients treated in the undergraduate Year 4 and Year 5 of University of Malaya. The subjects were patients treated in the Year 4 periodontology clinic (Polyclinic B) (n=38) and Year 5 periodontology clinic (Polyclinic C) (n=30). Data was gathered using a questionnaire which consisted of 4 components namely appointment facilities, infrastructure and basic facilities, behaviour of students dental clinician, and quality and efficiency of treatment provided. The results showed that for appointment facilities the level of satisfaction was almost 80%; for infrastructure and basic facilities the satisfaction was more than 85%; for behavior of students dental clinician the level of satisfaction was more than 90% and for quality and efficiency of treatment provided the level of satisfaction was more than 60%. When all the components were compared between patients treated in Polyclinic B to patients treated in Polyclinic C, there was no statistically significant difference (p>0.05). In conclusion, the level of satisfaction of patients treated in the undergraduate Year 4 and Year 5 periodontology clinic of University of Malaya is the same
    Matched MeSH terms: Ambulatory Care Facilities
  16. Abdul Kadir Abu Bakar, Firdaus Mukhtar, Mazni Mat Junus, Azizul Awaludin, Salina Abdul Aziz, Marhaini Midin, et al.
    ASEAN Journal of Psychiatry, 2012;13(2):157-164.
    MyJurnal
    Objective: The MINI International Neuropsychiatric Interview (MINI) is a short, structured diagnostic interview compatible with the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). It was designed for clinical practice, research in psychiatric, primary care settings and epidemiological surveys. This preliminary study aims to evaluate the reliability and validity of the Malaysian Version of MINI for Major Depressive Disorder and Generalized Anxiety Disorder symptoms criteria only.

    Methods: Six hours of MINI training was given as part of a National Health Morbidity Survey training program for layman interviewers (n=229) and three videos were prepared by an expert psychiatrist for inter-rater reliability purposes. Meanwhile, for validity purposes, the MINI was administered to patients with Major Depressive Disorder (n=30), Generalized Anxiety Disorder (n=20) and to a normal population (n=60), to conform against the Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) that was administered by psychiatrists.

    Results: Overall the inter-rater reliability was satisfactory (0.67 to 0.85) and the concordance between the MINI’s and expert diagnoses was good, with kappa values of greater than 0.88.

    Conclusions: The Malay version of the MINI is adjusted to the clinical setting and for the assessment of positive cases in a community setting. Modifications were highlighted to correct any identified problems and to improve the reliability of the MINI for future research and clinical use.
    Matched MeSH terms: Ambulatory Care Facilities
  17. Abdulameer AH, Sulaiman SABS, Kader MBSA
    J Clin Diagn Res, 2017 Mar;11(3):OC21-OC24.
    PMID: 28511429 DOI: 10.7860/JCDR/2017/23829.9483
    INTRODUCTION: Warfarin is an oral anticoagulant which is associated with a decrease in Bone Mass Density (BMD).

    AIM: The study aimed to explore the prevalence of osteoporosis conditions in Malaysians with chronic warfarin patients using calcaneal quarter of Quantitative Ultrasound (QUS) machine and to investigate whether long-term sodium warfarin therapy that antagonizes vitamin K is affecting the increasing rate of osteoporosis in Penang and to find the risk factors of getting osteoporosis among warfarin users and its non users.

    MATERIALS AND METHODS: A case-control study was conducted among 130 patients using warfarin, attending the outpatient clinic at Hospital Pulau Pinang. A convenience sampling method was used to recruit the required sample. Another 140 subjects were selected from the community as a control group (non-users of warfarin).

    RESULTS: This study showed that more than three-quarter patients (82%) were at high risk of abnormal BMD. The warfarin users were two times more likely to have a higher osteoporosis risk compared to control group. Moreover, BMD has a negative correlation with age, but has a positive correlation with Body Mass Index (BMI). Patients showed a negative correlation with a higher dose of warfarin intake.

    CONCLUSION: This study concluded that osteopenia and osteoporosis are serious problems between users and non-users warfarin in Penang. Therefore, it should be taken into consideration in the Malaysian Health Ministry's agenda.

    Matched MeSH terms: Ambulatory Care Facilities
  18. Abdullah A, Othman S
    BMC Fam Pract, 2011;12:143.
    PMID: 22208768 DOI: 10.1186/1471-2296-12-143
    BACKGROUND:
    Home blood pressure monitoring (HBPM) is gaining popularity among hypertensive patients. This study aimed to explore the influence of self-initiated HBPM on primary care patients with hypertension.
    METHODS:
    Six in-depth interviews and two focus group discussions were conducted, taking into consideration the experiences of 24 primary care patients with hypertension. These patients had been using HBPM as part of their hypertension management. The overriding influences were grouped under themes which emerged from analyzing the data using the grounded theory approach.
    RESULTS:
    There are both positive and negative influences of self-initiated HBPM. Patients used the readings of their HBPM to decide on many aspects of their hypertension management. The HBPM readings both influenced their adherence to diet and exercise and provided certain reassurance when they experienced symptoms. In addition, the act of discussing their HBPM readings with their health care providers resulted in an enhanced doctor-patient therapeutic relationship. Nevertheless, HBPM created confusion at times in some patients, particularly with regard to the target blood pressure level and the need for medication. This led to some patients making their own medical decisions based on their own standards.
    CONCLUSIONS:
    HBPM is becoming an integral part of hypertension management. Primary care patients who self-initiated HBPM reported being more self-efficacious, but lack of participation and guidance from their doctors created confusion, and hindered the true benefit of HBPM.

    Study site: urban primary care clinic, located within the University Malaya Medical Centre
    Matched MeSH terms: Ambulatory Care Facilities
  19. Abdullah A, Liew SM, Hanafi NS, Ng CJ, Lai PS, Chia YC, et al.
    Patient Prefer Adherence, 2016;10:99-106.
    PMID: 26869773 DOI: 10.2147/PPA.S94687
    Telemonitoring of home blood pressure (BP) is found to have a positive effect on BP control. Delivering a BP telemonitoring service in primary care offers primary care physicians an innovative approach toward management of their patients with hypertension. However, little is known about patients' acceptance of such service in routine clinical care.
    Matched MeSH terms: Ambulatory Care Facilities
  20. Abdullah MF, Nor NM, Mohd Ali SZ, Ismail Bukhary NB, Amat A, Latif LA, et al.
    Ann. Acad. Med. Singap., 2011 Apr;40(4):168-78.
    PMID: 21678002
    INTRODUCTION: Diabetes mellitus (DM) is a chronic disease that is prevalent in many countries. The prevalence of DM is on the rise, and its complications pose a heavy burden on the healthcare systems and on the patients' quality of life worldwide.
    MATERIALS AND METHODS: This is a multicentre, cross-sectional study involving 5 Health Clinics conducted by Family Medicine Specialists in Malaysia. Convenience sampling of 100 respondents with DM were selected. The International Classifi cation of Functioning, Disability and Health (ICF) based measures were collected using the Comprehensive Core Set for DM. SF-36 and self-administered forms and comorbidity questionnaire (SCQ) were also used.
    RESULTS: Ninety-seven percent had Type 2 DM and 3% had Type 1 DM. The mean period of having DM was 6 years. Body functions related to physical health including exercise tolerance (b455), general physical endurance (b4550), aerobic capacity (b4551) and fatiguability (b4552) were the most affected. For body structures, the structure of pancreas (s550) was the most affected. In the ICF component of activities and participation, limitation in sports (d9201) was the highest most affected followed by driving (d475), intimate relationships (d770), handling stress and other psychological demands (d240) and moving around (d455). Only 7% (e355 and e450) in the environmental category were documented as being a relevant factor by more than 90% of the patients.
    CONCLUSION: The content validity of the comprehensive ICF Core set DM for Malaysian population were identified and the results show that physical and mental functioning were impaired in contrast to what the respondents perceived as leading healthy lifestyles.
    Study site: Klinik Kesihatan, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
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