Displaying publications 21 - 40 of 780 in total

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  1. Messages from the Malaysian Diabetes Registries on Diabetes Care in Malaysian public healthcare facilities
    Chew BH, Lee PY, Cheong AT, Ismail M, Shariff-Ghazali S, Goh PP
    Prim Care Diabetes, 2016 10;10(5):383-6.
    PMID: 27459893 DOI: 10.1016/j.pcd.2016.07.003
    A persistent and increasing prevalence of diagnosed and undiagnosed diabetes mellitus has recently been reported in the National Health and Morbidity Survey 2015. This commentary recapitulates the relevant and valuable lessons in the Malaysian national diabetes registries to inform the healthcare stakeholders and policy makers on potential areas of clinical practice improvement and future researches. Under performance of the process measures and sub-optimal control of HbA1c, blood pressure and lipids profile were prevalent (<40% achieved treatment targets). Although these had improved slightly from 2009 to 2012, diabetes co-morbidities (hypertension and dyslipidaemia) and complications had also increased. Prevalence of insulin use had doubled, and lipid lowering agent use had increased about 50% in 2012 compared to 2009. We identified six clinical areas for urgent attention and improvement, and three potential areas for future research.
    Matched MeSH terms: Ambulatory Care Facilities
  2. Fulltext Diabetic retinopathy among type 2 diabetes mellitus patients in Sabah primary health clinics - Addressing the underlying factors
    Naserrudin NA, Jeffree MS, Kaur N, Syed Abdul Rahim SS, Ibrahim MY
    PLoS One, 2022 01 28;17(1):e0261249.
    PMID: 35089931 DOI: 10.1371/journal.pone.0264247
    Every person diagnosed with diabetes mellitus (T2DM) is at risk of developing Diabetic retinopathy (DR). Thus, DR is one of the major chronic microvascular complications of T2DM. However, in Malaysia, research about DR is still scarce. This study aimed to determine the prevalence of DR among diabetic patients across 46 primary healthcare clinics in Sabah, Malaysia. Secondly, it purported to identify the factors influencing the development of DR. This cross-sectional study involved a total of 22,345 Type 2 diabetes mellitus (T2DM) patients in the Sabah Diabetic Registry from 2008 to 2015. Of the 22,345 T2DM patients, 13.5% (n = 3,029) of them were diagnosed with DR. Multiple logistic regression revealed seven major risk factors of DR, i.e. patients with diabetic foot ulcer [aOR: 95% CI 3.08 (1.96-4.85)], patients with diabetic nephropathy [aOR: 95% CI 2.47 (2.13-2.86)], hypertension [aOR: 95% CI 1.63 (1.43-1.87)], dyslipidaemia [aOR: 95% CI 1.30 (1.17-1.44)], glycated haemoglobin [(HbA1c) > 6.5 (aOR: 95% CI 1.25 (1.14-1.38)], duration of diabetes mellitus (T2DM) [aOR: 95% CI 1.06 (1.05-1.07)] and age of patient [aOR: 95% CI 1.01 (1.00-1.02)] respectively. DR is a preventable complication. The effective glycaemic control is crucial in preventing DR. In minimizing the prevalence of DR, the healthcare authorities should institute programmes to induce awareness on the management of DR's risk factors among patient and practitioner.
    Matched MeSH terms: Ambulatory Care Facilities
  3. Fulltext Attitudes and factors affecting acceptability of self-administered cervicovaginal sampling for human papillomavirus (HPV) genotyping as an alternative to Pap testing among multiethnic Malaysian women
    Ma'som M, Bhoo-Pathy N, Nasir NH, Bellinson J, Subramaniam S, Ma Y, et al.
    BMJ Open, 2016 08 04;6(8):e011022.
    PMID: 27491667 DOI: 10.1136/bmjopen-2015-011022
    OBJECTIVE: The objective of this study was to determine the attitudes and acceptability of self-administered cervicovaginal sampling compared with conventional physician-acquired Papanicolaou (Pap) smear among multiethnic Malaysian women.

    METHOD: A cross-sectional study was carried out via interviewer-administered surveys from August 2013 through August 2015 at five government-run, urban health clinics in the state of Selangor. Subjects were participants from an ongoing community-based human papillomavirus (HPV) prevalence study who answered a standard questionnaire before and after self-sampling. The cervicovaginal self-sampling for HPV genotyping was performed using a simple brush ('Just for Me'; Preventive Oncology International, Hong Kong). Detailed data on sociodemographics, previous Pap smear experience, and attitudes towards self-administered cervicovaginal sampling were collected and analysed. Acceptability was inferred using a five-item Likert scale that included six different subjective descriptives: experience, difficulty, convenience, embarrassment, discomfort or pain, and confidence in collecting one's own sample.

    RESULTS: Of the 839 participants, 47.9% were Malays, followed by 30.8% Indians, 18.8% Chinese and 2.5% from other ethnicities. The median age of the participants was 38 years (IQR 30-48). Some 68.2% of participants indicated a preference for self-sampling over the Pap test, with 95% indicating willingness to follow-up a positive result at the hospital. Age, ethnicity and previous Pap test experience were significant independent factors associated with preference for self-sampling. The older the individual, the less likely they were to prefer self-sampling (adjusted OR 0.94, 95% CI 0.90 to 0.98). The Chinese were less likely to prefer self-sampling (72.6%) than the Malays (85.1%) (adjusted OR 0.57, 95% CI 0.33 to 0.98, p=0.004). Participants who had never undergone a Pap smear were also more likely to prefer self-sampling (88.5%) than women who had undergone a previous Pap (80.9%) (adjusted OR 0.06, 95% CI 0.35 to 0.87).

    CONCLUSIONS: Overall, urban Malaysian women from multiethnic backgrounds found self-sampling to be an acceptable alternative to Pap smear.
    Matched MeSH terms: Ambulatory Care Facilities
  4. Fulltext Antihypertensive drugs for elderly patients: a cross- sectional study
    Lim KK, Sivasampu S, Khoo EM
    Singapore Med J, 2015 May;56(5):291-7.
    PMID: 25597751 DOI: 10.11622/smedj.2015019
    As the population ages, the prevalence of hypertension also increases. Although primary care is usually the patient's first point of contact for healthcare, little is known about the management of hypertension among elderly patients at the primary care level. This study aimed to determine the antihypertensive prescription trend for elderly patients, the predictors of antihypertensive use and any inappropriate prescribing practices in both public and private primary care settings.
    Matched MeSH terms: Ambulatory Care Facilities
  5. Fulltext Type 2 diabetes mellitus with hypertension at primary healthcare level in Malaysia: are they managed according to guidelines?
    Chan GC
    Singapore Med J, 2005 Mar;46(3):127-31.
    PMID: 15735877
    A study was conducted at primary healthcare level in the Melaka Tengah district of Malaysia to determine whether hypertension in patients with type 2 diabetes mellitus were managed according to guidelines.
    Matched MeSH terms: Ambulatory Care Facilities
  6. Fulltext Mycoplasma genitalium in Singapore is associated with Chlamydia trachomatis infection and displays high macrolide and Fluoroquinolone resistance rates
    Hart T, Tang WY, Mansoor SAB, Chio MTW, Barkham T
    BMC Infect Dis, 2020 Apr 28;20(1):314.
    PMID: 32345231 DOI: 10.1186/s12879-020-05019-1
    BACKGROUND: Mycoplasma genitalium is an emerging sexually transmitted infection, with increasing rates of resistance to fluroquinolones and macrolides, the recommended treatments. Despite this, M. genitalium is not part of routine screening for Sexually Transmitted Infections (STIs) in many countries and the prevalence of infection and patterns of disease remain to be determined in many populations. Such data is of particular importance in light of the reported rise in antibiotic resistance in M. genitalium isolates.

    METHODS: Urine and urethral swab samples were collected from the primary public sexual health clinic in Singapore and tested for C. trachomatis (CT) or N. gonorrhoeae (NG) infection and for the presence of M. genitalium. Antibiotic resistance in M. genitalium strains detected was determined by screening for genomic mutations associated with macrolide and fluroquinolone resistance.

    RESULTS: We report the results of a study into M. genitalium prevalence at the national sexual health clinic in Singapore. M. genitalium was heavily associated with CT infection (8.1% of cases), but present in only of 2.4% in CT negative cases and not independently linked to NG infection. Furthermore, we found high rates of resistance mutations to both macrolides (25%) and fluoroquinolones (37.5%) with a majority of resistant strains being dual-resistant. Resistance mutations were only found in strains from patients with CT co-infection.

    CONCLUSIONS: Our results support targeted screening of CT positive patients for M. genitalium as a cost-effective strategy to reduce the incidence of M. genitalium in the absence of comprehensive routine screening. The high rate of dual resistance also highlights the need to ensure the availability of alternative antibiotics for the treatment of multi-drug resistant M. genitalium isolates.

    Matched MeSH terms: Ambulatory Care Facilities
  7. Fulltext Health profiles of foreigners attending primary care clinics in Malaysia
    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
  8. Fulltext Safety culture perceptions of pharmacists in Malaysian hospitals and health clinics: a multicentre assessment using the Safety Attitudes Questionnaire
    Samsuri SE, Lua PL, Fahrni ML
    BMJ Open, 2015 Nov 26;5(11):e008889.
    PMID: 26610761 DOI: 10.1136/bmjopen-2015-008889
    OBJECTIVE: To assess the safety attitudes of pharmacists, provide a profile of their domains of safety attitude and correlate their attitudes with self-reported rates of medication errors.
    DESIGN: A cross-sectional study utilising the Safety Attitudes Questionnaire (SAQ).
    SETTING: 3 public hospitals and 27 health clinics.
    PARTICIPANTS: 117 pharmacists.
    MAIN OUTCOME MEASURES: Safety culture mean scores, variation in scores across working units and between hospitals versus health clinics, predictors of safety culture, and medication errors and their correlation.
    RESULTS: Response rate was 83.6% (117 valid questionnaires returned). Stress recognition (73.0±20.4) and working condition (54.8±17.4) received the highest and lowest mean scores, respectively. Pharmacists exhibited positive attitudes towards: stress recognition (58.1%), job satisfaction (46.2%), teamwork climate (38.5%), safety climate (33.3%), perception of management (29.9%) and working condition (15.4%). With the exception of stress recognition, those who worked in health clinics scored higher than those in hospitals (p<0.05) and higher scores (overall score as well as score for each domain except for stress recognition) correlated negatively with reported number of medication errors. Conversely, those working in hospital (versus health clinic) were 8.9 times more likely (p<0.01) to report a medication error (OR 8.9, CI 3.08 to 25.7). As stress recognition increased, the number of medication errors reported increased (p=0.023). Years of work experience (p=0.017) influenced the number of medication errors reported. For every additional year of work experience, pharmacists were 0.87 times less likely to report a medication error (OR 0.87, CI 0.78 to 0.98).
    CONCLUSIONS: A minority (20.5%) of the pharmacists working in hospitals and health clinics was in agreement with the overall SAQ questions and scales. Pharmacists in outpatient and ambulatory units and those in health clinics had better perceptions of safety culture. As perceptions improved, the number of medication errors reported decreased. Group-specific interventions that target specific domains are necessary to improve the safety culture.
    Study site: Klinik kesihatan, hospitals, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  9. Fulltext Unintentional injury and its prevention in infant: knowledge and self-reported practices of main caregivers
    Ramdzan SN, Liew SM, Khoo EM
    BMC Pediatr, 2014;14:132.
    PMID: 24885332 DOI: 10.1186/1471-2431-14-132
    BACKGROUND:
    Unintentional injuries are the major cause of morbidity and mortality in infants. Prevention of unintentional injuries has been shown to be effective with education. Understanding the level of knowledge and practices of caregivers in infant safety would be useful to identify gaps for improvement.

    METHODS:
    A cross-sectional study was conducted in an urban government health clinic in Malaysia among main caregivers of infants aged 11 to 15 months. Face-to-face interviews were conducted using a semi-structured self-designed questionnaire. Responses to the items were categorised by the percentage of correct answers: poor (<50%), moderate (50% - 70%) and good (>70%).

    RESULTS:
    A total of 403 caregivers participated in the study. Of the 21 items in the questionnaire on knowledge, 19 had good-to-moderate responses and two had poor responses. The two items on knowledge with poor responses were on the use of infant walkers (26.8%) and allowing infants on motorcycles as pillion riders (27.3%). Self-reported practice of infant safety was poor. None of the participants followed all 19 safety practices measured. Eight (42.1%) items on self-reported practices had poor responses. The worst three of these were on the use of baby cots (16.4%), avoiding the use of infant walkers (23.8%) and putting infants to sleep in the supine position (25.6%). Better knowledge was associated with self-reported safety practices in infants (p < 0.05). However, knowledge did not correspond to correct practice, particularly on the use of baby cots, infant walkers and sarong cradles.

    CONCLUSION:
    Main caregivers' knowledge on infant safety was good but self-reported practice was poor. Further research in the future is required to identify interventions that target these potentially harmful practices.
    Matched MeSH terms: Ambulatory Care Facilities
  10. Pregnancy complications, mental health-related problems and type 2 diabetes mellitus in Malaysian women
    Hasan SS, Thiruchelvam K, Ahmed SI, Clavarino AM, Mamun AA, Kairuz T
    Diabetes Metab Syndr, 2013;7(4):191-7.
    PMID: 24290082 DOI: 10.1016/j.dsx.2013.10.023
    AIMS: The aim of this study was to investigate the association between pregnancy complications, mental health-related problems, and type 2 diabetes mellitus (T2DM) in Malaysian women.
    MATERIALS AND METHODS: A case-control study of women with T2DM (n=160) matched by age range to controls without T2DM (n=160). Data were collected in the Negeri Sembilan and PutraJaya regions in Malaysia, from two hospital outpatient clinics, PutraJaya Hospital and Tuanku Jaa'far Hospital Seremban, and one health clinic at Seremban. Validated, interviewer-administered questionnaires were used to obtain the data. The unadjusted and adjusted estimates were calculated using the Mantel-Haenszel method.
    RESULTS: Neither depression (RR 0.74, 95% CI: 0.39-1.41) nor anxiety (RR 1.00, 95% CI: 0.53-1.88) symptoms increased the risk of T2DM significantly. However, gestational diabetes (RR 1.35, 95% CI: 1.02-1.79), and ≥3 pregnancies (RR 1.39, 95% CI: 1.08-1.79) were significant risk factors for the development of T2DM. T2DM was not a significant risk factor for either depression (RR 1.26, 95% CI: 0.91-1.74) or anxiety symptoms (RR 1.13, 95% CI: 0.59-2.19).
    CONCLUSION: In this study, T2DM is not a significant risk factor for depression and anxiety; similarly, neither are depression and anxiety significant risk factors for T2DM. Although prevalence of depression and anxiety is not alarming, the findings reported here should alert clinicians to screen and treat anxiety and depression in people with diabetes and also note the importance of monitoring women with complications in pregnancy for risk of later T2DM.

    Study site: two hospital outpatient clinics, PutraJaya Hospital and Tuanku Jaa'far Hospital Seremban, and one health clinic at Seremban, Negeri Sembilan, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  11. Fulltext Psychometric properties of the 'Skala Kepuasan Interaksi Perubatan-11' to measure patient satisfaction with physician-patient interaction in Malaysia
    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
  12. Fulltext Factors influencing insulin acceptance among type 2 diabetes mellitus patients in a primary care clinic: a qualitative exploration
    Abu Hassan H, Tohid H, Mohd Amin R, Long Bidin MB, Muthupalaniappen L, Omar K
    BMC Fam Pract, 2013;14:164.
    PMID: 24164794 DOI: 10.1186/1471-2296-14-164
    BACKGROUND: Many Type 2 Diabetes Mellitus (T2DM) patients refuse insulin therapy even when they require this modality of treatment. However, some eventually accept insulin. This study aimed to explore the T2DM patients' reasons for accepting insulin therapy and their initial barriers to use insulin.
    METHODS: This qualitative study interviewed twenty-one T2DM patients at a primary care clinic who had been on insulin for more than a year through three in-depth interviews and three focus group discussions. A semi structured interview protocol was used and the sessions were audio-recorded. Subsequently, thematic analysis was conducted to identify major themes.
    RESULTS: The participants' acceptance of insulin was influenced by their concerns and beliefs about diabetes and insulin. Concerns about complications of poorly controlled diabetes and side effects of other treatment regime had resulted in insulin acceptance among the participants. They also had a strong belief in insulin benefits and effectiveness. These concerns and beliefs were the results of having good knowledge about the diabetes and insulin, experiential learning, as well as doctors' practical and emotional support that helped them to accept insulin therapy and become efficient in self-care management. These factors also allayed their negative concerns and beliefs towards diabetes and insulin, which were their barriers for insulin acceptance as it caused fear to use insulin. These negative concerns were related to injection (self-injection, needle phobia, injection pain), and insulin use (inconvenience, embarrassment, lifestyle restriction, negative social stigma, and poor self-efficacy), whereas the negative beliefs were 'insulin could cause organ damage', 'their diabetes was not serious enough', 'insulin is for life-long', and 'insulin is for more severe disease only'.
    CONCLUSIONS: Exploring patients' concerns and beliefs about diabetes and insulin is crucial to assist physicians in delivering patient-centered care. By understanding this, physicians could address their concerns with aim to modify their patients' misconceptions towards insulin therapy. In addition, continuous educations as well as practical and emotional support from others were found to be valuable for insulin acceptance.
    TRIAL REGISTRATION: Universiti Kebangsaan Malaysia FF-214-2009.
    Study site: Primary Care clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  13. Fulltext Retinopathy in type 2 diabetic patients with microalbuminuria
    Reddy SC, Kihn YM, Nurjahan MI, Ramil A
    Nepal J Ophthalmol, 2013;5(1):69-74.
    PMID: 23584650 DOI: http://dx.doi.org/10.3126/nepjoph.v5i1.7830
    OBJECTIVE: To determine the prevalence of retinopathy in type 2 diabetic patients with micoalbuminuria and to evaluate the association of risk factors with prevalence of retinopathy in these patients.
    MATERIAL AND METHODS: A fundus examination of 137 patients suffering from type 2 diabetes mellitus with microalbuminuria was done, with direct ophthalmoscope/ binocular indirect ophthalmoscope after dilating the pupils with 1 % tropicamide eye drops. Retinal changes were graded as no retinopathy, non-proliferative retinopathy, proliferative retinopathy and maculopathy. The association of the duration of diabetes, control of diabetes, hypertension, hyperlipidemia, smoking, obesity and peripheral neuropathy was assessed with the prevalence of retinopathy in these patents.
    RESULTS: The mean age of the patients was 58 years (range 35 - 79 years); 62 % were females, and 49.6 % were Chinese. Diabetic retinopathy was seen in 36.5 % of the patients - non proliferative in 29.2 %, proliferative in 7.3 % and maculopathy in 5.1 % of patients. A longer duration of diabetes (p = 0.002), poor control of diabetes (p = 0.002), presence of hypertension (p = 0.03), and presence of peripheral neuropathy (p = 0.001) were significantly associated with the prevalence of retinopathy; while hyperlipidemia (p = 0.29), smoking (p = 0.43) and obesity (p = 0.43) were not associated with retinopathy.
    CONCLUSION: Retinopathy was seen in 36.5 % of type 2 diabetic patients with microalbuminuria; 7.3 % had proliferative retinopathy and 5.1 % maculopathy (both sight threatening changes). All diabetic patients with microalbuminuria should be screened for retinopathy so that treatment can be instituted in the required patients to prevent ocular morbidity/ blindness.
    Matched MeSH terms: Ambulatory Care Facilities
  14. Fulltext Morbidity profiles at three primary care clinics in Perlis, Malaysia
    Kamarudin MF, Mohamad Noh K, Jaafar S
    Med J Malaysia, 2012 Aug;67(4):363-8.
    PMID: 23082442 MyJurnal
    Matched MeSH terms: Ambulatory Care Facilities
  15. Influence of health providers on pediatrics' immunization rate
    Al-lela OQ, Baidi Bahari M, Al-abbassi MG, Salih MR, Basher AY
    J Trop Pediatr, 2012 Dec;58(6):441-5.
    PMID: 22538210 DOI: 10.1093/tropej/fms014
    To identify the immunization providers' characteristics associated with immunization rate in children younger than 2 years. A cohort and a cluster sampling design were implemented; 528 children between 18 and 70 months of age were sampled in five public health clinics in Mosul-Iraq. Providers' characterizations were obtained. Immunization rate for the children was assessed. Risk factors for partial immunization were explored using both bivariate analyses and multi-level logistic regression models. Less than half of the children had one or more than one missed dose, considered as partial immunization cases. The study found significant association of immunization rate with provider's type. Two factors were found that strongly impacted on immunization rate in the presence of other factors: birthplace and immunization providers' type.
    Matched MeSH terms: Ambulatory Care Facilities
  16. Fulltext How can insulin initiation delivery in a dual-sector health system be optimised? A qualitative study on healthcare professionals' views
    Lee PY, Lee YK, Ng CJ
    BMC Public Health, 2012;12:313.
    PMID: 22545648 DOI: 10.1186/1471-2458-12-313
    BACKGROUND: The prevalence of type 2 diabetes is increasing at an alarming rate in developing countries. However, glycaemia control remains suboptimal and insulin use is low. One important barrier is the lack of an efficient and effective insulin initiation delivery approach. This study aimed to document the strategies used and proposed by healthcare professionals to improve insulin initiation in the Malaysian dual-sector (public-private) health system.
    METHODS: In depth interviews and focus group discussions were conducted in Klang Valley and Seremban, Malaysia in 2010-11. Healthcare professionals consisting of general practitioners (n = 11), medical officers (n = 8), diabetes educators (n = 3), government policy makers (n = 4), family medicine specialists (n = 10) and endocrinologists (n = 2) were interviewed. We used a topic guide to facilitate the interviews, which were audio recorded, transcribed verbatim and analysed using a thematic approach.
    RESULTS: Three main themes emerged from the interviews. Firstly, there was a lack of collaboration between the private and public sectors in diabetes care. The general practitioners in the private sector proposed an integrated system for them to refer patients to the public health services for insulin initiation programmes. There could be shared care between the two sectors and this would reduce the disproportionately heavy workload at the public sector. Secondly, besides the support from the government health authority, the healthcare professionals wanted greater involvement of non-government organisations, media and pharmaceutical industry in facilitating insulin initiation in both the public and private sectors. The support included: training of healthcare professionals; developing and disseminating patient education materials; service provision by diabetes education teams; organising programmes for patients' peer group sessions; increasing awareness and demystifying insulin via public campaigns; and subsidising glucose monitoring equipment. Finally, the healthcare professionals proposed the establishment of multidisciplinary teams as a strategy to increase the rate of insulin initiation. Having team members from different ethnic backgrounds would help to overcome language and cultural differences when communicating with patients.
    CONCLUSION: The challenges faced by a dual-sector health system in delivering insulin initiation may be addressed by greater collaborations between the private and public sectors and governmental and non-government organisations, and among different healthcare professionals.
    Study site: Healthcare professionals from three states (Wilayah Federal Territory, Negeri Sembilan and Selangor) and from both urban and semi-rural locations (including Klinik Kesihatan), Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  17. Fulltext The impact of a disease management program (COACH) on the attainment of better cardiovascular risk control in dyslipidaemic patients at primary care centres (The DISSEMINATE Study): a randomised controlled trial
    Selvaraj FJ, Mohamed M, Omar K, Nanthan S, Kusiar Z, Subramaniam SY, et al.
    BMC Fam Pract, 2012;13:97.
    PMID: 23046818 DOI: 10.1186/1471-2296-13-97
    BACKGROUND: To evaluate the efficacy of Counselling and Advisory Care for Health (COACH) programme in managing dyslipidaemia among primary care practices in Malaysia. This open-label, parallel, randomised controlled trial compared the COACH programme delivered by primary care physicians alone (PCP arm) and primary care physicians assisted by nurse educators (PCP-NE arm).
    METHODS: This was a multi-centre, open label, randomised trial of a disease management programme (COACH) among dyslipidaemic patients in 21 Malaysia primary care practices. The participating centres enrolled 297 treatment naïve subjects who had the primary diagnosis of dyslipidaemia; 149 were randomised to the COACH programme delivered by primary care physicians assisted by nurse educators (PCP-NE) and 148 to care provided by primary care physicians (PCP) alone. The primary efficacy endpoint was the mean percentage change from baseline LDL-C at week 24 between the 2 study arms. Secondary endpoints included mean percentage change from baseline of lipid profile (TC, LDL-C, HDL-C, TG, TC: HDL ratio), Framingham Cardiovascular Health Risk Score and absolute risk change from baseline in blood pressure parameters at week 24. The study also assessed the sustainability of programme efficacy at week 36.
    RESULTS: Both study arms demonstrated improvement in LDL-C from baseline. The least squares (LS) mean change from baseline LDL-C were -30.09% and -27.54% for PCP-NE and PCP respectively. The difference in mean change between groups was 2.55% (p=0.288), with a greater change seen in the PCP-NE arm. Similar observations were made between the study groups in relation to total cholesterol change at week 24. Significant difference in percentage change from baseline of HDL-C were observed between the PCP-NE and PCP groups, 3.01%, 95% CI 0.12-5.90, p=0.041, at week 24. There was no significant difference in lipid outcomes between 2 study groups at week 36 (12 weeks after the programme had ended).
    CONCLUSION: Patients who received coaching and advice from primary care physicians (with or without the assistance by nurse educators) showed improvement in LDL-cholesterol. Disease management services delivered by PCP-NE demonstrated a trend towards add-on improvements in cholesterol control compared to care delivered by physicians alone; however, the improvements were not maintained when the services were withdrawn.
    TRIAL REGISTRATION:
    National Medical Research Registration (NMRR) Number: NMRR-08-287-1442Trial Registration Number (ClinicalTrials.gov Identifier): NCT00708370.
    Matched MeSH terms: Ambulatory Care Facilities
  18. Fulltext Somatisation disorder and its associated factors in multiethnic primary care clinic attenders
    Khoo EM, Mathers NJ, McCarthy SA, Low WY
    Int J Behav Med, 2012 Jun;19(2):165-73.
    PMID: 21562781 DOI: 10.1007/s12529-011-9164-7
    Background Somatisation disorder (SD) has been reported as common in all ethnic groups, but the estimates of its prevalence have varied and the evidence for its associated factors has been inconsistent.
    Purpose This study seeks to determine the prevalence of SD and its associated factors in multiethnic primary care clinic attenders.
    Methods This cross-sectional study was on clinic attenders aged 18 years and above at three urban primary care clinics in Malaysia. The operational definition of SD was based on ICD-10 criteria for SD for research, frequent attendance, and excluded moderate to severe anxiety and depression. The instruments used were the ICD-10 symptom list, the Hospital Anxiety and Depression Scale, a semi-structured questionnaire, and SF-36.
    Results We recruited 1,763 patients (response rate 63.8%). The mean age of respondents was 44.7±15.8 years, 807 (45.8%) were male; there were 35.3% Malay, 30.1% Chinese and 34.6% Indian. SD prevalence was 3.7%; the prevalence in Malay was 5.8%, Indian 3.0% and Chinese 2.1%. Significant associations were found between SD prevalence and ethnicity, family history of alcoholism, blue-collar workers and the physical component summary (PCS) score of SF-36. Multivariate analysis showed that SD predictors were Malay ethnicity (OR 2.7, 95% CI 1.6, 4.6), blue-collar worker (OR 2.0, 95% CI 1.2, 3.5) and impaired PCS score of SF-36 (OR 0.92, 95% CI 0.90, 0.95).
    Conclusion The prevalence of SD was relatively uncommon with the stringent operational criteria used. SD preponderance in blue-collar workers may be attributable to secondary gain from getting sickness certificates and being paid for time off work.
    Keywords Somatisation disorder . Associated factors . Primary care . Ethnic groups . Prevalence Questionnaire: ICD-10 symptom list; Hospital Anxiety Depression Scale; HADS; SF-36
    Matched MeSH terms: Ambulatory Care Facilities
  19. Fulltext Prevalence of anxiety among women attending a primary care clinic in Malaysia
    Mohd Sidik S, Arroll B, Goodyear-Smith F
    Br J Gen Pract, 2011 Jun;61(587):e326-32.
    PMID: 21801511 DOI: 10.3399/bjgp11X577990
    Background: This is the first study investigating Anxiety among women attending a primary care clinic
    in Malaysia.
    Aim: The objective was to determine the factors associated with anxiety among these women.
    Design: This cross-sectional study was conducted in a government-funded primary care clinic in Malaysia. Consecutive female patients attending the clinic during the data-collection period were invited to participate in the study.
    Method: Participants were given self-administered questionnaires, which included the validated Generalised Anxiety Disorder-7 questionnaire (GAD-7) Malay version to detect anxiety.
    Results: Of the 1023 patients who were invited, 895 agreed to participate (response rate 87.5%). The prevalence of anxiety in this study was 7.8%, based on the GAD-7 (score ≥8). Multiple logistic regression analysis found that certain stressful life events and the emotional aspect of domestic violence were significantly associated with anxiety (P<0.05).
    Conclusion: The prevalence of anxiety among women in this study is similar to that found in other countries.
    Factors found to be associated with anxiety, especially issues on domestic violence, need to be addressed andmanaged appropriately.
    Keywords: anxiety; Malaysia; prevalence; primary care; women.
    Questionnaire: Generalized Anxiety Disorder scale; GAD-7 (Malay version); Hark questionnaire
    Matched MeSH terms: Ambulatory Care Facilities
  20. Fulltext Antibiotics for URTI and UTI -- prescribing in Malaysian primary care settings
    Teng CL, Tong SF, Khoo EM, Lee V, Zailinawati AH, Mimi O, et al.
    Aust Fam Physician, 2011 May;40(5):325-9.
    PMID: 21597554
    Background: Overprescription of antibiotics is a continuing problem in primary care. This study aims to assess the antibiotic prescribing rates and antibiotic choices for upper respiratory tract infections (URTI) and urinary tract infections (UTI) in Malaysian primary care.
    Method: Antibiotic prescribing data for URTI and UTI was extracted from a morbidity survey of randomly selected primary care clinics in Malaysia.
    Results: Analysis was performed of 1163 URTI and 105 UTI encounters. Antibiotic prescribing rates for URTI and UTI were 33.8% and 57.1% respectively. Antibiotic prescribing rates were higher in private clinics compared to public clinics for URTI, but not for UTI. In URTI encounters, the majority of antibiotics prescribed were penicillins and macrolides, but penicillin V was notably underused. In UTI encounters, the antibiotics prescribed were predominantly penicillins or cotrimoxazole.
    Discussion: Greater effort is needed to bring about evidence based antibiotic prescribing in Malaysian primary care, especially for URTIs in private clinics.
    Keywords: general practice, prescriptions, drug; upper respiratory tract infection; urinary tract infection; antibiotics, guideline; evidence based medicine
    Study site: Klinik Kesihatan, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
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