Displaying publications 21 - 40 of 93 in total

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  1. Hanafi NS, Ng CJ
    Asia Pac Fam Med, 2006;5(2).
    Aim: To explore primary care practitioners' experiences and feelings about treating their own family members. Methods: A qualitative study was carried out using focus group discussions. Five sessions were held among 22 primary care practitioners (five academic staff members and 17 medical officers). Results: Most participants treated their family members, especially their immediate families. They considered factors such as duration and severity of illness before seeking consultation with other doctors. Some participants felt satisfied knowing that they were able to treat their own families. However, most felt burdened and uncomfortable in doing so, mainly due to the fear of error in diagnosis and management. They were concerned that strong emotions may make them lose objectivity. Many were aware that negative outcomes resulting from their treatment may affect future relationships. Conclusions: While some doctors were comfortable about treating their own families, some faced significant conflict in doing so. Their decisions depended on the interplay of factors including the doctor, the family member and the relationship they share. A doctor needs to consider the potential conflict that may arise when carrying out one's professional role and at the same time being a concerned family member. Key words: doctors, family, Malaysia, primary care, self-treat.
    Matched MeSH terms: Physicians, Family
  2. Rohana, D., Wan Norlida, W.l., Nor Azwany, Y., Mazlan, A., Zawiyah, D., Che Karrialudin, C.A., et al.
    MyJurnal
    Public health care programme evaluation includes determining the programme effectiveness (outcome assessment), efficiency (economic evaluation), accessibility (reachability of services) and equity (equal provision for equal needs). The purpose of this study was to make comparison on cost·( efficiency and costeffectiveness in managing type 2 diabetes between the Ministry of Health (MOH) health clinics with family medicine specialist (FMS) and health clinics without FMS. A costeffectiveness analysis was conducted alongside across-sectional study at two government health clinics in Machang, Kelantan, one with FMS and the other without FMS. A total of 300 patients, of which 155 from the health clinic without FMS and 145 from the other group were evaluated for sociodemographic and clinical characteristics from August 2005 to May 2006. HbA1c
    analysis was measured for each patient during the study period. Macrocosting and microcosting were used to determine costs. The provider cost for diabetic management ranged from RM270.56 to RM4533.04 per diabetic patient per year, withla mean cost of RM1127.91(t906.08) per diabetic patient per year in health clinic with FMS. In health clinic without FMS, the provider cost ranged from RM225.93 to RM4650.13, with a mean cost of RM802.15 (:626.26). Proportion ofgood HbA1c was 17.2% for health clinic with FMS and 10.3% for the health clinic without FMS. The annual mean provider cost per proportion of good HbA1c control (< 7%) (Costefkctiveness ratio/ CER) was RM6557.65.for health clinic with FMS and RM7787.88 for health clinic without FMS. This provider cost-epfectiveness ratio was not different statistically between the health clinic with FMS and health clinic without FMS (p=0.063). The cost of building, equipments, overheads, staff and consumables were higher for FMS group. Sensitivity analysis was performed for three discount rates (0, 5 and 7%). Relative cost-effectiveness of diabetes management in health clinic with FMS and health clinic without FMS was unchanged in all sensitivity scenarios. Even though, there was no significantly difference in provider CER in type 2 diabetes management at Malaysian MOH health clinics, but the provider CER in health clinic with FMS was lower compared to health clinic without FMS. Therefore, we can conclude that the presence of FMS in the health clinic will effectively improved the management of type 2 diabetes.
    Matched MeSH terms: Physicians, Family
  3. Md Shajahan MY
    Family Physician, 1993;5:3-4.
    Matched MeSH terms: Physicians, Family
  4. Sreenivasan BR
    Family Practitioner, 1974;1(3):3-10.
    Matched MeSH terms: Physicians, Family
  5. Han GS, Davies C
    Ethn Health, 2006 Nov;11(4):409-30.
    PMID: 17060035 DOI: 10.1080/13557850600824054
    This paper investigates the use and provision of biomedicine among Korean-Australian men on the basis of interview data from all of the eight Korean-speaking doctors practising in the Korean community in Sydney in 1995. From the viewpoint of these general practitioners, an analysis is made of the processes Korean men go through in adjusting to a new country, being involved in constant hard manual work and long working hours, and explores how they make use of all available resources to stay healthy. The Korean men have fully utilized the 'freely' available medical services under government-subsidized Medicare, bearing in mind that health is a capacity to work under the current environment, although illegal migrants restrained themselves from using it until they obtained legal status. Korean-speaking medical practitioners have been able to provide their fellow Koreans with 'culturally appropriate' health care, with the key factor being the absence of a language barrier. The level of patient satisfaction is high, possibly due to the excellent understanding the doctors have of the social aspects of illnesses, although the doctors do not go beyond curative medicine in their practice. However, the increasing number of Korean-speaking doctors in the small Korean community means that there is competition for patients. Consequently, the medical care is highly entrepreneurial. Referral by Korean doctors to practitioners of Korean herbal medicine is also a notable feature of the health care sector of the Korean community, especially as this offers Korean patients 'satisfactory' health relief for problems that are not easily relieved by doctors in the biomedical system.
    Matched MeSH terms: Physicians, Family/psychology*
  6. Robinson PH
    Family Practitioner, 1977;2:28-30.
    Matched MeSH terms: Physicians, Family
  7. Ang KT, Ho BK, Mimi O, Salmah N, Salmiah MS, Noridah MS
    Malays Fam Physician, 2014;9(3):2-11.
    PMID: 26425299 MyJurnal
    Primary care providers play an important gatekeeping role in ensuring appropriate referrals to secondary care facilities. This cross-sectional study aimed to determine the level, pattern and rate of referrals from health clinics to hospitals in the public sector, and whether the placement of resident family medicine specialist (FMS) had made a significant difference. The study was carried out between March and April in 2012, involving 28 public primary care clinics. It showed that the average referral rate was 1.56% for clinics with resident FMS and 1.94% for those without resident FMS, but it was not statistically significant. Majority of referred cases were considered appropriate (96.1%). Results of the multivariate analysis showed that no prior consultation with senior healthcare provider and illnesses that were not severe and complex were independently associated with inappropriate referrals. Severity, complexity or uncertain diagnosis of patients' illness or injury significantly contributed to unavoidable referrals. Adequate facilities or having more experienced doctors could have avoided 14.5% of the referrals. The low referral rate and very high level of appropriate referrals could indicate that primary care providers in the public sector played an effective role as gatekeepers in the Malaysian public healthcare system.
    Matched MeSH terms: Physicians, Family
  8. ISBN: 978-967-0538-17-4
    Citation: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare & Society: Essays By Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019

    First edition: 2008

    Contents of second edition:
    Preface to the Second Edition iii
    Acknowledgements iv
    Contents vi
    Foreword by Dr Harbaskh Singh vii
    Foreword by Professor Chris van Weel (in the First Edition) viii
    Foreword by Datuk Dr D M Thuraiappah (in the First Edition) ix
    Section 1: Primary Health Care and Family Medicine 1
    1 Put not New Wine into Old Bottles 3
    2 The Importance of Primary Care 6
    3 Primary Health for all the People 11
    4 The Evolution of General Practice 16
    5 Future of Family Medicine in Developing Countries 23
    6 Family Practice: Uniting Across Frontiers 27
    Section 2: Training for Family Medicine 31
    7 Specialisation in Primary Healthcare training for the new General Practice in Malaysia [summary] 32
    8 A Proposal for the Training of Physicians in Primary Care for the Rural Areas of Malaysia 34
    9 The Family Physician in Asia: Looking to the 21st Century 40
    10 Training Family Doctors in a Developing Country 46
    Section 3: Family Medicine journals 51
    11 Family Physician [inaugural issue of Family Physician] 52
    12 Our journal [inaugural issue of Malaysian Family Physician] 56
    Section 4: Healthcare Improvement 58
    13 The Future of the Health Services in Malaysia. [summary] 59
    14 Quality in Family Practice 68 15 Foreword, In: Chee HL, Barraclough S (ed). Health Care in Malaysia 75 Section 5: Ethics and Professionalism 81
    16 Ethical Consequences of Technological Change 83
    17 Dr Sun Yat Sen Oration. Between Faith and Reason 91
    18 Ethics, Professionalism and the “Trade” 99
    19 Rural Health and Global Equity: Am I My Brother’s Keeper? 103
    20 Achieving Equity Through a Primary Care-Led Health System 108 Section 6: Civil Society 112
    21 Looking Back, Looking Forward 113
    Appendix 1: Dr M K Rajakumar: A brief curriculum vitae 120
    Appendix 2: Books and articles about Dr M K Rajakumar 124
    Appendix 3: Reflections and comments 125
    Matched MeSH terms: Physicians, Family
  9. Kabir MJ, Hassanzadeh-Rostami Z, Ashrafian Amiri H, Nasrollapour Shirvani SD, Keshavarzi A, Hosseini S
    Malays Fam Physician, 2019;14(3):28-36.
    PMID: 32175038
    Background and objective: A successful family physician program needs ongoing and full cooperation between people and the organizations in charge. Ensuring the satisfaction of family physicians through improvement of the underlying factors could motivate them to provide high-quality services. This study aimed to determine the family physicians' satisfaction level with the factors affecting the dynamism of the urban family physicians program in the Fars and Mazandaran provinces of Iran.

    Method: This cross-sectional study was carried out in urban areas in the Fars and Mazandaran provinces in 2016. The sample consisted of 143 and 96 family physicians, respectively, in Fars and Mazandaran provinces and was selected using the stratified random sampling method. Data were collected using a questionnaire and included both sociodemographic variables and factors assessing the family physicians' satisfaction levels. Each factor was scored based on a Likert scale from 0 to 5 points, and any satisfaction level higher than 3 out of 5 was equated with being satisfied.

    Results: The overall satisfaction levels among family physicians in Fars and Mazandaran provinces were 2.77±0.53 and 3.37±0.56, respectively, revealing a statistically significant difference between provinces (p<0.001). Moreover, the mean satisfaction scores for the performances of healthcare centers, insurance companies, specialists, healthcare workers, and the population covered were 2.78±0.1, 2.54±0.9, 2.52±0.8, 4.24±0.07, and 2.96±0.8, respectively. The family physicians' levels of satisfaction were significantly correlated with population size (p=0.02, r= -0.106), and willingness to stay in an urban family physician program (p<0.001, r= +0.398).

    Conclusion: This study revealed that family physicians exhibited a low level of satisfaction with the urban family physician program. Given the direct association between family physicians' satisfaction levels and retention in the program, it is expected that family physicians will no longer stay in the program, and it is likely to have subsequent executive problems.

    Matched MeSH terms: Physicians, Family
  10. Teng CL
    ISBN: 978-983-3909-42-1
    Citation: Teng CL. Family Practice: Is It For Me? In: Ong HT (editor). The Life of a Doctor. Petaling Jaya: Unipress Medical & Healthcare; 2008, p115-119
    Matched MeSH terms: Physicians, Family
  11. Yong Rafidah AR
    Family Physician, 2003;12:1-1.
    Matched MeSH terms: Physicians, Family
  12. Muthupalaniappen L
    Malays Fam Physician, 2008;3(1):64-5.
    PMID: 25606117
    Matched MeSH terms: Physicians, Family
  13. Ong HT
    Malays Fam Physician, 2006;1(2):65-66.
    PMID: 27570590 MyJurnal
    Evidence thus far still supports the contention that fish derived omega-3 fatty acids, EPA and DHA, are good for heart patients. But this controversy tells us something about the medical research, and the acquisition and application of medical knowledge. Being scientists, doctors try to perform studies as rigorously as possible with randomised, placebo-controlled trials and using tests of statistical significance. But since the studies are on humans, with all their individual differing habits and inconsistencies, different results are produced by different researchers. And so while medicine is a science, in that the trials are scientifically conducted, the interpretation of the results, and in particular its application for the individual patient, is very much an art. A good doctor, like the good artist, must spend much time, energy and effort sieving through the good from the not so good data before coming out with the correct picture. Only by keeping an unbiased, inquisitive mind can the evidence be reviewed to solve the problem at hand. Almost always, the balance of data will favour a particular stand. In this day when newspapers are full of medical articles, a family physician has to be educated, interested and inquisitive to be a source of accurate and relevant information for the patients.
    Matched MeSH terms: Physicians, Family
  14. Param Palam S
    Family Practitioner, 1973;1(1):9-12.
    Matched MeSH terms: Physicians, Family
  15. Teng CL, Achike FI, Phua KL, Norhayati Y, Nurjahan MI, Nor AH, et al.
    Int J Antimicrob Agents, 2004 Nov;24(5):496-501.
    PMID: 15519484 DOI: 10.1016/j.ijantimicag.2004.06.015
    Antibiotic prescribing by primary care doctors has received renewed interest due to the continuing emergence of antibiotic resistance and the attendant cost to healthcare. We examined the antibiotic prescribing rate in relation to selected socio-demographic characteristics of the prescribers at the Seremban Health Clinic, a large public primary care clinic, designated for teaching, in the state of Negeri Sembilan, Malaysia. Data were obtained from: (1) retrospective review of prescriptions for the month of June 2002 and (2) a questionnaire survey of prescribers. A total of 10667 prescriptions were reviewed. The overall antibiotic prescribing rate was 15%; the rate (16%) was higher for the general Outpatient Department (OPD) than the 3% for the Maternal & Child Health Clinic (MCH). The antibiotic prescription rates for upper respiratory tract infection (URTI) were 26% and 16%, respectively, for the OPD and MCH. Half of all the antibiotic prescriptions were for URTI making prescribing for URTI an appropriate target for educational intervention. The URTI-specific antibiotic prescription rate did not correlate with the prescribers' intention to specialise, patient load, perceived patient's expectation for an antibiotic, or the score for knowledge of streptococcal tonsillitis. Prescribing behaviours and record-keeping practices requiring correction were identified.
    Study site: Klinik Kesihatan Seremban, Negeri Sembilan, Malaysia
    Matched MeSH terms: Physicians, Family
  16. Leong KC, Teng CL
    Aust Fam Physician, 2007 Sep;36(9):679; author reply 680.
    PMID: 17918303
    Comment on: Cannon B, Usherwood TP. General practice consultations - how well do doctors
    predict patient satisfaction? Aust Fam Physician. 2007 Mar;36(3):185-6, 192. PubMed PMID: 17339988. https://www.racgp.org.au/afp/200703/15394
    Matched MeSH terms: Physicians, Family/psychology*
  17. Md Shajahan MY
    Family Physician, 1994;6:3-3.
    Matched MeSH terms: Physicians, Family
  18. Khoo SB
    Malays Fam Physician, 2011;6(1):7-14.
    MyJurnal
    Anaemia is the most common haematological problem in the elderly population. Using WHO criteria for anaemia (Hb of <12 g/dL in women and <13 g/dL in men), the prevalence of anaemia in the elderly has been found to range from 8-44% with the highest prevalence in men 85 years and older. Anaemia must not be considered simply as part of ageing because in 80% of cases, there is an underlying cause for Hb
    levels of <12 g/dL in the elderly. Anaemia has negative impacts on the quality of life for the elderly and there is evidence of improved morbidity and
    mortality after correction of anaemia. Chronic disease and thalassaemia may also cause microcytic anaemia besides iron deficiency and not all vitamin B12 and folate deficiency present with macrocytic megaloblastic anaemia. Nutritional deficiency anaemias are common, easily diagnosed, treatments are simple, inexpensive and effective. Tests for nutritional anaemia have to be given priority in the assessment before a patient is subjected to invasive tests to look for less common causes of anaemia. Serum ferritin which is the best non-invasive test for the diagnosis of iron deficiency anaemia may be increased in the elderly while serum iron and transferrin decrease with ageing. Serum methylmalonic acid (MMA) and homocysteine (HC) levels are sensitive for detecting subclinical vitamin B12 and folate deficiency. Routine iron therapy in non-anaemic elderly or in those without iron deficiency anaemia is of no use and may be detrimental to their health. Folate therapy may improve anaemia but may mask the signs and symptoms of neurological damage due to concomitant
    vitamin B12 deficiency. Blood transfusion offers prompt symptom relief of anaemia in patients with terminal malignancy irrespective of the causes for the anaemia.
    Matched MeSH terms: Physicians, Family
  19. Cahir C, Wallace E, Cummins A, Teljeur C, Byrne C, Bennett K, et al.
    Ann Fam Med, 2019 Mar;17(2):133-140.
    PMID: 30858256 DOI: 10.1370/afm.2359
    PURPOSE: To evaluate a patient-report instrument for identifying adverse drug events (ADEs) in older populations with multimorbidity in the community setting.

    METHODS: This was a retrospective cohort study of 859 community-dwelling patients aged ≥70 years treated at 15 primary care practices. Patients were asked if they had experienced any of a list of 74 symptoms classified by physiologic system in the previous 6 months and if (1) they believed the symptom to be related to their medication, (2) the symptom had bothered them, (3) they had discussed it with their family physician, and (4) they required hospital care due to the symptom. Self-reported symptoms were independently reviewed by 2 clinicians who determined the likelihood that the symptom was an ADE. Family physician medical records were also reviewed for any report of an ADE.

    RESULTS: The ADE instrument had an accuracy of 75% (95% CI, 77%-79%), a sensitivity of 29% (95% CI, 27%-31%), and a specificity of 93% (95% CI, 92%-94%). Older people who reported a symptom had an increased likelihood of an ADE (positive likelihood ratio [LR+]: 4.22; 95% CI, 3.78-4.72). Antithrombotic agents were the drugs most commonly associated with ADEs. Patients were most bothered by muscle pain or weakness (75%), dizziness or lightheadedness (61%), cough (53%), and unsteadiness while standing (52%). On average, patients reported 39% of ADEs to their physician. Twenty-six (3%) patients attended a hospital outpatient clinic, and 32 (4%) attended an emergency department due to ADEs.

    CONCLUSION: Older community-dwelling patients were often not correct in recognizing ADEs. The ADE instrument demonstrated good predictive value and could be used to differentiate between symptoms of ADEs and chronic disease in the community setting.

    Matched MeSH terms: Physicians, Family
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