PURPOSE: This study aimed to investigate the current practice and barriers to the transition of care (TOC) from the perspectives of adult surgeons.
METHODS: A cross-sectional study was conducted with purposive sampling of adult surgeons from different subspecialties. An online self-administered questionnaire was distributed.
RESULTS: There were 60 respondents. 62% of the respondents had experience managing referrals for continuation of care or complications in patients with congenital abnormalities. 38% of the respondents believed that TOC should be implemented when patients reached ages 17-18 years. 93% of the respondents agreed that a proper TOC model would greatly benefit patient care, and 97% asserted the need to develop TOC pathways in Malaysia. The absence of a proper guideline was the greatest barrier to a smooth TOC.
CONCLUSION: This study offered insights into the obstacles to TOC based on the perspectives and experiences of adult surgeons who participated. While not exhaustive, our study provided a better understanding of the challenges in developing the appropriate referral pathways for the continued care of these patients.
METHODOLOGY: A qualitative study was conducted from October 2020 to July 2021 using a semi-structured interview technique with doctors in the internal medicine, surgical, and orthopedic departments of 6 public hospitals in Malaysia. Purposive sampling was applied to select doctors with at least 6 months of working experience, and interviews were conducted until data saturation. The interviews were recorded and transcribed verbatim. Thematic analysis was used to analyze data by generating codes and grouping into main themes and subthemes.
RESULTS: Twenty-two doctors were recruited for interviews, and 5 interrelated themes were generated. The complex decision-making process for prescribing antibiotics involved intra-personal and socio-cultural context of the hospital settings. The prescriber-related factors affecting decision-making included prescribers' competency, attitude, and the influence of other prescribers; and patient-related factors included clinical presentation and medical history. Orthopedic and surgical practices frequently considered surgery-related factors and types and sources of infection. Antibiotic-related factors consisting of pharmacokinetic and pharmacodynamic properties were also determinants. Organization setting-related factors included organizational policies, working environment, and resource availability; and these were mainly described by respondents from limited-resource hospitals.
CONCLUSIONS: This study provides valuable insights into the intrinsic and extrinsic factors and barriers that influence doctors' decisions to prescribe antibiotics to inpatients in Malaysian public hospitals. These findings should be considered when developing future interventions aimed at improving antibiotic prescribing practices.
METHODS: This randomised controlled trial will be conducted at a teaching hospital in Kuala Lumpur, Malaysia. Participants will involve individuals aged ≥60 years with at least one chronic disease requiring pharmacological treatment, attending the falls and syncope clinic with ≥1 potentially inappropriate medication (PIM) undergoing systematic multidomain assessment and attending physicians at the clinic. The joint pharmacist-physician intervention comprises five steps: 1) PIM identification, 2) decision on cessation and prioritisation, 3) medication withdrawal, 4) monitoring and support, 5) and documentation.
CONCLUSION: The P3ID trial tests the hypothesis that a jointly led pharmacist-physician intervention in an outpatient will reduce the total number of medications, improve medication adherence, reduce falls and improve patients' and doctors' satisfaction towards pharmacist services. Findings from this study would inform future deprescribing practices, particularly in LMIC, pertaining to fall prevention as well as aid the development of future deprescribing interventions in other settings.
METHODS: A cross-sectional survey was conducted among primary care physicians (PCPs) in public primary care clinics in Kuala Lumpur, Malaysia. A 30-item self-administered questionnaire was used to assess the knowledge and practice of CRC screening.
RESULTS: The response rate was 86.4% (n = 197/228). Less than half (39.1%) of the respondents answered correctly for all risk stratification scenarios. Mean knowledge score on CRC screening modalities was 48.7% ± 17.7%. The knowledge score was positively associated with having postgraduate educational qualification and usage of screening guidelines. Overall, 69.9% of PCPs reported that they practised screening. However, of these, only 25.9% of PCPs screened over 50% of all eligible patients. PCPs who agreed that screening was cost-effective (odds ratio [OR] 3.34, 95% confidence interval [CI] 1.69‒6.59) and those who agreed that they had adequate resources in their locality (OR 1.92, 95% CI 1.01‒3.68) were more likely to practise screening. Knowledge score was not associated with the practice of screening (p = 0.185).
CONCLUSION: Knowledge and practice of CRC screening was inadequate among PCPs. Knowledge of screening did not translate into its practice. PCPs' perceptions about cost-effectiveness of screening and adequate resources were important determinants of the practice of screening.
METHODS: We conducted a qualitative study with doctors and patients in Malaysia. We used convenience sampling to recruit patients until data saturation. Eighteen patients and eighteen doctors consented and were interviewed using a semi-structured interview guide. The interviews were audio-recorded, transcribed verbatim and checked by the interviewers. Data were analysed using a thematic approach.
RESULTS: The themes were similar for both the patients and doctors. Three main themes emerged: knowledge and awareness of COPD, psychosocial and physical impact of COPD and the utility of self-management. Knowledge about COPD was generally poor. Patients were not familiar with the term chronic obstructive pulmonary disease or COPD. The word 'asthma' was used synonymously with COPD by both patients and doctors. Most patients experienced difficulties in their psychosocial and physical functions such as breathlessness, fear and helplessness. Most patients were not confident in self-managing their illness and prefer a more passive role with doctors directing their care.
CONCLUSIONS: In conclusion, our study showed that knowledge of COPD is generally poor. There was mislabelling of COPD as asthma by both patients and physicians. This could have resulted in the lack of understanding of treatment options, outcomes, and prognosis of COPD. The misconception that cough due to COPD was contagious, and breathlessness that resulted from COPD, had important physical and psychosocial impact, and could lead to social isolation. Most patients and physicians did not favour self-management approaches, suggesting innovations based on self-management may be of limited benefit.
METHOD: A model was formulated by extending an existing generic knowledge management systems success model by including organisational and system factors relevant to healthcare. It was tested by using data obtained from 263 doctors working within two district health boards in New Zealand.
RESULTS: Of the system factors, knowledge content quality was found to be particularly important for knowledge management systems success. Of the organisational factors, leadership was the most important, and more important than incentives.
CONCLUSION: Leadership promoted knowledge management systems success primarily by positively affecting knowledge content quality. Leadership also promoted knowledge management use for retrieval, which should lead to the use of that better quality knowledge by the doctors, ultimately resulting in better outcomes for patients.