Aim: To explore the help-seeking behavior of primary care doctors during illness. Methods: This qualitative study used focus group discussions to explore participants' help-seeking behavior during illness. It involved 22 primary care doctors (5 lecturers, 12 postgraduate trainees, 5 medical officers) working in a hospital-based primary care clinic. Result: Most primary care doctors in this study managed their illnesses without seeking help. Although most preferred to seek professional help for chronic illnesses and antenatal care, they tend to delay the consultations and were less likely to comply with treatment and follow-up. Explanations for their behavior include their ability to assess and treat themselves, difficulty to find suitable doctors, work commitment, easy access to drugs, and reluctance to assume a sick role. Conclusions: This study found that the help-seeking behavior of primary care doctors was similar to those in other studies. Due to their professional ability, heavy workload and expectations from peer and patients, primary care doctors were more likely to delay in seeking treatment especially for chronic and serious diseases. This highlights the need to enhance support services for doctors during illness. Key words: doctors, help-seeking behavior, illness
Aim. Validation of the Malay version of the Edinburgh Postnatal Depression Scale (EPDS)
Methods. A validation study was done involving 52 mothers who were at 4-12 weeks post-delivery. The women completed the Malay versions of EPDS and the 30-item General Health Questionnaire (GHQ). They were then assessed with the Hamilton Depression Rating Scale (HDRS) and Clinical Interview Schedule (CIS). Psychiatric diagnoses were made based on ICD-10 criteria. The validity of EPDS was tested against this clinical diagnosis and the concurrent validity against the Malay version of 30-item GHQ and HDRS scores was also evaluated.
Results. The best cut-off score of the Malay version of EPDS was 11.5 with the sensitivity of 72.7% and specificity of 92.6 %.
Conclusion. The Malay version of EPDS is a valid and reliable screening tool for PND.
Aims: To evaluate the utilization of complementary and alternative medicine (CAM) in Kuching, Sarawak, Malaysia Methods: This was a cross-sectional study of patients who attended three randomly selected primary care clinics over 4 months from January to April 2004. Results: A total of 198 patients were recruited. One hundred and eighty-one (91.4%) patients agreed to participate by answering the anonymous questionnaire. Results: Ninety (51.4%) patients used CAM of which 43 (47.8%) patients used more than one type of CAM. Utilization rates of CAM were found to be associated with employment status but not with other socio-demographic factors. The common types of alternative medicine used were massage (n = 63; 36.2%) and herbal medicine (n = 44; 25.1%). Forty-two (46%) of the CAM users, used CAM for the problems that led to their current clinic visit. Thirty-four (37.8%) were using alternative and modern medicine at the same time. The reasons for CAM usage given by about half of the patients were that CAM was more effective and better for emotional or mental health problems. Conclusions: Usage of CAM was common in patients who visited primary care clinics. It is important to recognize this fact as combined use of CAM can create potentially dangerous interactions with pharmacotherapies Key words: complementary and alternative medicine (CAM), primary care
Patients who are entering the last phase of their illness and for whom life expectancy is short, have health needs that require particular expertise and multidisciplinary care. A combination of a rapidly changing clinical situation and considerable psychosocial and spiritual demands pose challenges that can only be met with competence, commitment and human compassion. This article is concerned with the definition of suffering, recognition of the terminal phase and application of the biopsychosocial-spiritual model of care where family physicians play an important role in the community. Key words: biopsychosocial-spiritual care, dying, family medicine, good death, palliative care, suffering.
Quality programs are difficult to implement where social support for healthcare costs are inadequate and there is no institutional support for quality programs to guide and assist the doctor in pratice. ‘Quality’ is not the good intention to do better, but the process of measurement of behavioral change against set targets. For the majority of the doctors of this region who practice under great constraints, this article outlines some quality activities that are entirely within their personal initiative and responsibility, but should make a real difference to the quality of care provided.nd responsibility, but should make a real difference to the quality of care you provide.
Republished in: Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019: 68-74
Background: Menopause is a condition that every woman faces in later life and can have many associated effects which might disrupt the quality of life.
Aim: To determine both the prevalence of menopause and menopausal symptoms in a group of employed Malaysian women and to determine their sources of information regarding menopause.
Methods: A cross sectional study was conducted among female teachers aged 35 and above in Seremban, Negeri Sembilan, Malaysia between 1 June and 31 December 2000. A total of 550 self administered questionnaires were distributed to teachers selected through simple random sampling of selected schools.
Results: The response rate was 78.9%. The prevalence of menopause was 21.9%. There was a high prevalence of skin dryness (44.2%), hot flushes (43.2%), fatigue (41.0%) and excessive sweating (34.7%) among the menopausal respondents and there was a significant difference between menopausal and non menopausal symptoms of respondents (p<0.05).
Conclusion: The prevalence of menopause and each menopausal symptom are high in the present group of women. Improved health care programs about the menopause might help give women a better quality of life.
Background: Emotional disorder, one of the common human emotional states is defined as feelings of sadness and tiredness in response to life events, such as disappointments. It is one of the major problems among students and although it consists of more than half of all mental disorders, it is often left untreated each year worldwide. Aim: To determine the prevalence of emotional disorders among medical students at a university in Malaysia.
Methods: A cross sectional study design was used. All medical students at a local university in Malaysia were included in the study. A questionnaire similar to the General Health Questionnaire (GHQ-12) was used as a screening instrument.
Results: A total of 41.9% of the medical students were found to have emotional disorders. Factors found to have a significant association with emotional disorders were relationship of the respondents with their parents (chi-square=6.02, d.f.=1, p<0.05), siblings (chi-square=6.94, d.f.=1, p<0.05) and lecturers (chi-square=4.80, d.f.=1, p<0.05), as well as pressure prior to exams (chi-square=10.30, d.f.=1, p<0.05).
Conclusion: The prevalence of emotional disorders among medical students was high. There was significant association between emotional disorders and respondents' relationship with their parents, siblings and lecturers, as well as level of pressure prior to exam. Early detection of this condition is important to prevent psychological morbidity and its unwanted effects on medical students and young doctors.
Introduction: Depression is the most common psychiatric disorder among the elderly. The hallmark of depression in the elderly is its comorbidity with medical illness. Aim: To determine the prevalence of depression and its association with chronic illness among the elderly in a rural community setting. Methods: A cross sectional study design was used. A 30-item Geriatric Depression Scale questionnaire was used as a screening instrument. Results: The prevalence of depression was higher among elderly with chronic illness (9.0%) compared to elderly without chronic illness (5.6%). Depression among the elderly was signi.cantly associated with ischemic heart disease. Conclusion: The prevalence of depression among the elderly with chronic illness in the community is high. Primary care providers need to be vigilant when treating elderly patients in their care as depression is commonly found in this group.
BACKGROUND: Hypertension is one of the world's most common health conditions and is a leading risk factor for mortality. Although blood pressure can be modified, there is a large proportion of patients whose blood pressure remains uncontrolled. The aim of this study, termed Edvantage 360°, was to gain a deeper understanding of hypertension management in Asia from the perspective of patients and doctors, and to propose strategies to improve blood pressure control.
METHODS: Conducted in Hong Kong, Indonesia, Malaysia, the Philippines, South Korea, Taiwan, and Thailand, Edvantage 360° was a mixed-methods observational study that used both qualitative and quantitative elements: qualitative interviews and focus groups with patients (N = 110), quantitative interviews with patients (N = 709), and qualitative interviews with doctors (N = 85).
RESULTS: This study found that, although there is good understanding of the causes and consequences of hypertension among Asian patients, there is a lack of urgency to control blood pressure. Doctors and patients have different expectations of each other and a divergent view on what constitutes successful hypertension management. We also identified a fundamental gap between the beliefs of doctors and patients as to who should be most responsible for the patients' hypertension management. In addition, because patients find it difficult to comply with lifestyle modifications (often because of a decreased understanding of the changes required), adherence to medication regimens may be less of a limiting factor than doctors believe.
CONCLUSIONS: Doctors may provide better care by aligning with their patients on a common understanding of successful hypertension management. Doctors may also find it helpful to provide a more personalized explanation of any needed lifestyle modifications. The willingness of the doctor to adjust their patient interaction style to form a 'doctor-patient team' is important. In addition, we recommend that doctors should not attribute ineffectiveness of the treatment plan to patient non-adherence to medications, but rather adjust the medication regimen as needed.
KEYWORDS: Attitude to health; Hong Kong; Hypertension; Indonesia; Malaysia; Philippines; Qualitative research; South Korea; Taiwan; Thailand
BACKGROUND: Malaysia is an upper middle income country that provides subsidized healthcare to ensure universal coverage to its citizens. The challenge of escalating health care cost occurs in most countries, including Malaysia due to increase in disease prevalence, which induced an escalation in drug expenditure. In 2009, the Ministry of Health has allocated up to Malaysian Ringgit (MYR) 1.402 billion (approximately USD 390 million) on subsidised drugs. This study was conducted to measure patients' willingness to pay (WTP) for treatment of chronic condition or acute illnesses, in an urbanized population.
METHODS: A cross-sectional study, through face-to-face interview was conducted in an urban state in 2012-2013. Systematic random sampling of 324 patients was selected from a list of patients attending ten public primary cares with Family Medicine Specialist service. Patients were asked using a bidding technique of maximum amount (in MYR) if they are WTP for chronic or acute illnesses.
RESULTS: Patients are mostly young, female, of lower education and lower income. A total of 234 respondents (72.2%) were not willing to pay for drug charges. WTP for drugs either for chronic or acute illness were at low at median of MYR10 per visit (USD 3.8). Bivariate analysis showed that lower numbers of dependent children (≤3), higher personal and household income are associated with WTP. Multivariate analysis showed only number of dependent children (≤3) as significant (p = 0.009; 95% CI 1.27-5.44) predictor to drugs' WTP.
CONCLUSION: The result indicates that primary care patients have low WTP for drugs, either for chronic condition or acute illness. Citizens are comfortable in the comfort zone whereby health services are highly subsidized through universal coverage. Hence, there is a resistance to pay for drugs.
Aims: To determine whether the Edinburgh Claudication Questionnaire (ECQ) can be used as a screening tool for detecting peripheral arterial disease in patients with diabetes mellitus.
Methods: A cross-sectional study of 200 patients with diabetes over 18 years of age who attended a primary care clinic at a teaching hospital in Kuala Lumpur, Malaysia. Face-to-face interviews were conducted using the ECQ for the presence of intermittent claudication. Blood pressure and peripheral neuropathy were assessed. Ankle brachial pressure index (ABPI) was measured and used as a gold standard for the diagnosis of eripheral arterial disease (PAD), which was defined as an ABPI of < 0.9 on either leg.
Results: The overall prevalence of PAD was found to be 16% among patients with diabetes based on ABPI. Among these 32 patients with PAD, eight (25%) had symptoms of intermittent claudication based on the ECQ. The ECQ was found to have a low sensitivity (25%) but a high specificity (99.4%), with a positive predictive value of 88.9% and a negative predictive value of 88% for diagnosing PAD in patients with diabetes.
Conclusions: The ECQ is not a good screening tool for detection of PAD among patients with diabetes due to its low sensitivity. Key words: ankle brachial pressure, diabetes mellitus, Edinburgh Claudication Questionnaires, intermittent claudication, peripheral arterial disease.
In Indonesia, Family Medicine as a discipline is being developed through short courses since 12 years ago. A conversion program to become Family Physicians has been introduced recently. Among the 70,000 primary care physicians there are variety of practitioners, from new interns who start general practice to senior general practitioners. This study aims to describe the current Indonesian Primary Care Physicians (PCPs) profile which includes services provided and facilities as well as comparing the profile according to participation in the conversion program and practice hours.
Chronic obstructive pulmonary disease (COPD) is a clinical syndrome encompassing a group of chronic, progressive, and debilitating respiratory conditions, that are characterized by incompletely reversible airflow limitation. Within the Asia-Pacific region, prevalence estimates have been derived using various protocols and study methods, and there is little data on the impact of COPD exacerbations. This study aimed to provide a comprehensive picture of the current prevalence and burden of COPD in this region.
Aim: This study explored the health beliefs, concerns and expectations of primary care patients presenting with abdominal pain, headache and chest pain. Methods: Over a 6-week period, 107 adult patients with symptoms of pain were interviewed using a semistructured questionnaire. Results: The presenting symptoms of these patients were: abdominal pain, 41; headache, 35; and chest pain, 31. Females made up 53.3%; the ethnic groups were Malay (35.5%), Chinese (18.7%) and Indian (45.8%); and 71.8% of the patients had primary or secondary education. The patients' attributions of their symptoms were predominantly non-medical in all three ethnic groups. The non-medical causes mentioned include food, trauma, stress, weather changes and winds ('angin'). Only two fifths of the patients mentioned disease-specific concerns. Three quarters of these patients expected either medications or wanted the doctor to look for serious causes. Very few patients specifically wanted referral or special tests. Conclusions: The patients in the study had health beliefs and concerns, in view of their non-medical focus, that was at variance with those of the health care providers. However, having decided to consult the health clinic, they were mainly looking for symptomatic relief or evaluation for serious pathology.
Background: A community-based general practice course has been developed in the Penang Medical College (PMC) (a joint Ireland-Malaysia venture) that simultaneously satisfies the medical regulatory authorities in Ireland and re-orients the current medical education to the health needs of the Malaysian community. Objectives: This paper describes the community-based general practice course in PMC, explores student evaluation of the various course objectives, student perception of general practice in Malaysia, and whether course experience has any influence on their choice of general practice specialty as a future career. Methods: Two consecutive classes of students (n = 78) were invited to complete anonymous, confidential pre-general practice rotation and post-general practice rotation course questionnaires. Results: Overall responses from both classes were 75/78 (96.1%) for pre-course and 73/78 (93.6%) for post-course questionnaire. Although students had minimal knowledge of Irish and Malaysian primary health care before the course, 60% were keen to learn about Irish primary healthcare and 54.7% expected to learn about the Malaysian healthcare system in the course. Overall, there was a slight reduction of 'No' response and increment of 'Maybe' response after the course with regard to working as a general practitioner in both countries but statistical tests show that there is no significance in the difference. Conclusions: An innovative community-based general practice course has been implemented in PMC but course experience of students does not seem to have any influence on their choice of general practice specialty as a future career. Key words: community, general practice course, Ireland, Malaysia, primary healthcare
The concept of palliative care is still quite new in Malaysia. Through the experience of delivering palliative care in both the hospital and community settings, the author has realized that there are many false beliefs among the medical and nursing professionals, as well as patients and their caregivers. By exploring and providing factual explanations to these beliefs, the present article highlights the differences in approach between acute and palliative management and the importance of good communication skills, as well as correcting the myths of patients and their caregivers, with the aim of improving the understanding of palliative care., (C) 2003 Blackwell Science Ltd
Aim: To identify the factors associated with depression among elderly patients attending a primary health care clinic in Malaysia. Methods: A cross sectional study was conducted on patients aged 60 years and above in Klinik Kesihatan Butterworth, Seberang Perai Utara, Pulau Pinang, Malaysia from April to September 1999. The Geriatric Depression Scale questionnaire was used as a screening instrument. Results: The response rate was 99.0%. A total of 18% of the patients were found to have depression. The associated factors were females (odds ratio (OR) = 2.87, 95% confidence interval (CI) = 1.37-6.02), those who were unmarried (OR = 3.46, 95% CI = 1.66-7.21), without formal education (OR = 8.0, 95% CI = 2.97-21.48), low total family income (OR = 7.97, 95% CI = 2.71-23.46) and urban residence (OR = 2.23, 95% CI = 1.09-4.58). Conclusion: Depression is very common among the elderly. As this is an important problem in primary care practice, primary care doctors should be aware of this problem so that early detection and management can be implemented., (C) 2003 Blackwell Science Ltd