OBJECTIVES: To compare the morbidity patterns in public and private primary care clinics; determine patients' reasons for encounter (RFE) and diagnoses using the ICPC-2, and compare ten commonest diagnoses and RFEs.
METHODS: A cross-sectional study on randomly selected clinics was conducted nationwide. Doctors completed the Patient Encounter Record (PER) for systematically selected encounters for a week.
RESULTS: Response rate was 82.0% (public clinic) and 33% (private clinic) with 4262 encounters and 7280 RFE. Overall, the three commonest disease categories encountered were respiratory (37.2%), general and unspecified (29.5%), and cardiovascular diseases (22.2%). Public and private clinics handled 27% versus 50% acute cases and 20.0% versus 3.1% chronic cases i.e. 33.7 and 5.6 chronic diseases per 100 RFE respectively.
CONCLUSION: Doctors in public clinics saw more chronic and complex diseases as well as pregnancy related complaints and follow-up cases while in private clinics more acute and minor illnesses were seen. Health services should be integrated and support given to co-manage chronic diseases in both sectors.
KEYWORDS: Malaysia; Primary practice; delivery of health care; morbidity pattern; reasons for encounter
BACKGROUND: Antibiotics are widely prescribed especially for upper respiratory tract infections (URTIs). Their irrational use can increase costs and resistance.
AIM: Assess knowledge, attitude and prescribing of antibiotics for URTIs in Selangor, Malaysia, using a cross-sectional survey among general practitioners (GPs) working in private clinics in 2011.
RESULTS: One hundred and thirty-nine physicians completed the questionnaire (response rate = 34.8%). 49.6% (n = 69) agreed antibiotics are helpful in treating URTIs, with most GPs agreeing antibiotics may reduce URTI duration and complications. The majority of GPs reported they felt patients expected antibiotics, with 36.7% (n = 51) agreeing patients would change doctors if they did not prescribe antibiotics and 21.6% (n = 30) agreeing when requested they prescribe antibiotics even if they believe them to be unnecessary. When assessed against six criteria, most GPs had a moderate level of knowledge of prescribing for URTIs. However, antibiotic prescriptions could be appreciably reduced.
CONCLUSION: Further programs are needed to educate GPs and patients about antibiotics building on current initiatives.
KEYWORDS: Malaysia; antibiotics; education programs; irrational use of medicines; patients; physicians; respiratory tract infections
The Covid-19 pandemic during its early phases posed significant psychological threats particularly for medical frontline personal. It is unclear whether the medical workforce with the passage of time has adapted to these threats or have generalized to wider medical settings. An online survey was conducted reaching 1476 physicians in Germany with valid data from 1327 participants. Depression and anxiety were screened with the PHQ-2 and the GAD-2. Among a subtotal of 1139 (86.6%) physicians reporting personal treatment experiences with Covid-19 patients, 553 (84.8%) worked in a private practice (PP) and 586 (88.3%) in a hospital (HP). Covid-19 provoked profound conflicts between professional and ethical values: more physicians in PPs than HPs reported external constraints on their medical care being in conflict with the code of medical ethics (39.1 vs. 34.4%, p
This survey was carried out to examine the habits of practising optometrists in private practice around Kuala Lumpur and the Klang Valley. A questionnaire survey was prepared that encompassed questions on ophthalmic intruments and appliances, services offered, eye examinatians carried aut and patient management, failure ta carry out comprehensive eye examination, community engagements and their opinion on optometrists as primary eyecare practitioners. The questionnaire was sent to 100 registered optometrists practising in Kuala Lumpur and the Klang Valley. About 64 optometrists responded and returned the questionnaire, but 3 of them were excluded because they were incomplete. The results showed almast all aptornetric practice has all the equipment related to optometry practice except for tonometer and visual field measurement. F orty~four percent ( 44%) of aptometrists undertook comprehensive eye examinatians and necessary referred patients far further examinations. Optometrists who did not perform comprehensive eye examinations give reasons of inadequate equipment and clients who want a quick examination. ln conclusion optometric practice provide almost all the equipments required for optometrists to practice as primary health care practioners but only 44% of optometrists carriedout comprehensive eye examinations. Optometrists in private practice need to practice all the skills they learned and play important roles in educating the public in an effort to improve the primary eyecare of society. Keywords: optometric practice, private practice, primary health eyecare
BACKGROUND: In Malaysia, doctors in private clinics (often called dispensing doctors) are permitted to dispense medicines. This potentially may compromise rational dispensing of medicines in general and antibiotics in particular.
AIM: This study explored, assessed and compared dispensing of antibiotics between Community Pharmacist (CP) and General Practitioners (GPs) regarding symptomatic diagnosis, antibiotic categories, adherence to therapeutic doses and promotion of generic antibiotics.
METHOD: The study used trained Simulated Patients (SPs), who used a scenario of common cold symptoms at GP private clinics and community pharmacies to observe and explore the practice of antibiotics dispensing. The study was conducted within the period of May to September 2011 in Penang, Malaysia. The data was analysed using descriptive statistics, Chi-square and Fisher's Exact Tests at alpha level of 0.05.
RESULTS: GPs dispensed more antibiotics than CPs (p= 0.001) for common cold symptoms. They dispensed more Amoxicillin (n = 14, 35%) than CPs (n = 11, 11%) (p < 0.001) and more Tetracycline (n = 3, 7.5%) while no CP dispensed this category (p = 0.022). On the other hand, CPs (n = 11, 11%) suggested brand antibiotics where as GPs dispensed only generic antibiotics (p < 0.001). Generally GPs comply better with the symptomatic diagnosis standard e.g. when asking SPs about the symptoms they had, all GPs (n = 40, 100%) complied better with this standard. Despite that, they dispensed more antibiotics (n = 26, 65%) than CPs (n = 29, 29%) (p = 0.001). GPs (n = 22, 55%) also are better than CPs (n = 16, 16%) in adherence to therapeutic doses (p< 0.001).
CONCLUSION: Findings showed poor adherence to rational dispensing of antibiotics by both providers. Although, GPs adhere better to symptomatic diagnosis and therapeutic dosing of antibiotics than CPs, they unnecessarily prescribe and dispense more antibiotics for Upper respiratory tract infection (URTI) symptoms. Establishing prescription guidance and regulatory actions, especially for URTIs treatment, and separating of medication dispensing are seemed to be crucial steps for the reform.
KEYWORDS: Community pharmacists; Dispensing doctors; Dispensing separation; General practitioners; Simulated patients ligament
A pilot study was conducted based on a questionnaire sent to Malaysian physicians surveying their opinions on 1) the value of traditional Malay medicine and 2) the role of auxiliary cosmopolitan health care practitioners-- Hospital Assistants (HA), in rural health care. The 98 responses (23%) can not be held representative of all Malaysian physicians, but emphasize the need for a more thorough survey. Three-fourths of the responding physicians found it of potential value to have their patients see a traditional Malay healer (bomoh) in certain circumstances and a majority supported closer contact between traditional Malay and cosmopolitan medical systems, particularly in the area of mental health care. The majority of physician respondants did not see the role of the HA as permanent and stated. that HAs should gradually be replaced by physicians. More general practitioners and physicians now practicing in rural areas held this opinion than physicians in other specialties. The issues of the appropriate roles and interrelationships of HAs and tradtional Malay folk healers within an overall health care system are complex, yet pertinent to the future of rural health care in Malaysia and warrant further study and consideration.
Data on bacterial resistance in patients seen by general practitioners are usually not readily available. The objective of this paper is to present the antimicrobial resistance pattern of bacteria isolated from patients seen by private practitioners in the Klang Valley. A total of 18 clinics participated in this study. From mid August 1991 to end of June 1993, 2,823 specimens were received. Throat swabs and urine specimens constituted 56% of all the specimens. A large proportion of the specimens (55%) yielded no growth or just normal flora. The common bacteria encountered were Staphylococcus aureus (18.4%), Escherichia coli (16.2%), Klebsiella spp (13.7%) and Neisseria gonorrhoeae (9.3%). The S. aureus strains were mainly isolated from wound, pus and ear swabs. Not one out of the 218 strains tested was resistant to methicillin. In vitro susceptibility tests showed that 91% were resistant to penicillin while 23% were resistant to tetracycline and 13% to erythromycin. Eighty-two percent of the E. coli were isolated from urine. It was also the most common isolate from urine. Fifty percent of these strains were resistant to ampicillin, 33% to cotrimoxazole, 17% to cephalothin, 21% to ampicillin-sulbactam, 18% to amoxycillin-clavulanic acid while only 2.3% were resistant to nalidixic acid and nitrofurantoin and none to cefuroxime. Generally the gram negative bacilli encountered in general practice are less resistant to the third generation cephalosporins and aminoglycosides when compared to the hospital strains.
Ultimately, the majority of our medical graduates ends up in primary health care either in private practice or in the government service. It would be appropriate that their education and training should meet not only the requirements of their eventual vocation, but just as importantly, the expectations of a more discerning community at large. Rising pressures on the profession to provide more cost-effective and affordable health services of good quality would put an increasing emphasis on the development and promotionof primary health care to higher standards. Primary health care workers would be hard-pressed to provide more health information and to actively participate in disease prevention and control as part of their professional duties. As medical specialisation and technology contibute towards more fragmented, complex and dehumanising forms of practice, the greater will be the need for the integrative skills of the primary physician providing personal and continuing care. The future nature of medical care will have to respond to this community demand.
Antibiotic resistance of urinary tract pathogens has increased worldwide. The purpose of this study is to provide information regarding local resistance pattern of urinary pathogens to the commonly used antibiotics. One hundred and seventeen cases of community-acquired urinary tract infections were studied. The most common group of patients was the uncomplicated acute cystitis in women. E. coli was the most common isolate. Overall, antimicrobial susceptibility test on the organisms isolated showed a resistance of 63.0% to ampicillin, 40.1% to sulfamethoxazole-trimethoprim (S-T), 14.3% to pipemidic acid, 8.6% to norfloxacin, 3.8% to cephalexin, 3.7% to amoxicillin-clavulanate, 1.0% to cefuroxime, and 1.0% to fosfomycin. Three out of five patients on ampicillin as well as two out of five patients on S-T were likely to be inadequately treated.
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.
1171 urban general practices in East and West Malaysia were compared regarding their service profiles and practice facilities. In general, practices in both parts put important emphasis on preventive health care. More practices in East Malaysia were providing hormone replacement therapy and sexually transmitted diseases services but less were providing intrapartum care, counselling services including sexual and marital counselling and problems associated with social deviance such as alcohol and drug abuse. Although most practices in East Malaysia were solo practices, they were more comprehensive in terms of the provision of practice facilities when compared to those in West Malaysia. A greater number of them had ultrasound facilities, peak flow meters, ECG machines, computers and blood biochemistry facilities.
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.
The Australian and Malaysian systems of general practice were examined and compared. The issues of similarity and difference identified are discussed in this paper. Quality clinical practice and the importance of compulsory vocational training prior to entry into general practice and continuing professional development is one important area. A move towards preventive health care and chronic disease management was observed in both countries. Practice incentive programmes to support such initiatives as improved rates of immunisation and cervical smear testing and the implementation of information technology and information management systems need careful implementation. The Medicare system used in Australia may not be appropriate for general practitioners in Malaysia and, if used, a pharmaceutical benefit scheme would also need to be established. In both countries the corporatisation of medical practice is causing concern for the medical profession. Rural and aboriginal health issues remain important in both countries. Graduate medical student entry is an attractive option but workforce requirements mean that medical education will need individual tailoring for each country. Incorporating nurses into primary health care may provide benefits such as cost savings. The integration model of community centres in Malaysia involving doctors, nurses and allied health professionals, such as physiotherapists, in a single location deserves further examination.
The prevalence of pain complaints as a reason for patient-doctor encounters in the local primary care setting is unknown. We performed a cross-sectional survey of such encounters in one public primary care clinic (KK) and 17 general practice clinics (GP), from the city of Seremban, Negeri Sembilan, Malaysia. Reasons for visits were recorded by doctors in KK and medical students in GP using a structured questionnaire. Morbidity data was coded using the International Classification of Primary Care (ICPC-2). A total of 2234 encounters were recorded (80.9% from KK, 19.1% from GP). The overall prevalence of pain complaints was 31.9% with a significant difference between the two cohorts (KK 28.7% and GP 45.2%, p<0.001). Musculoskeletal pain complaints were more common in KK than GP (40.9% versus 29.7%, p<0.05). Of the 3 main ethnic groups in Malaysia (Malay, Chinese and Indian) the Indian patients at KK had the highest prevalence of pain complaints and the Chinese at the GP had the lowest. Thus pain was a common complaint in the two different primary care settings studied. Some of the differences observed are probably due to the differences in the healthcare seeking behaviour of patients consulting at these two settings as well as differences in the payment systems.
BACKGROUND: Little is known about how primary care physicians (PCPs) in Asia diagnose and manage prostatitis-like symptoms. This study investigated the clinical diagnosis of and care provided for prostatitis-like symptoms by PCPs in a Malaysian population, and compared these findings to reports from other areas.
METHODS: All members of the Penang Private Medical Practitioners' Society were asked to complete a self-administered survey. Nonresponders were contacted after 3 weeks and received a telephone request after 6 weeks.
RESULTS: Of the 786 practitioners contacted, 669 considered themselves to be PCPs, including 279 (42%) who responded to the survey. Adult males with prostatitis-like symptoms typically constitute <1% of the patients seen by PCPs. Most PCPs (72%) believe that prostatitis-like symptoms are caused by bacterial infection. 61% of PCPs base their diagnosis of prostatitis-like symptoms on clinical history, a physical examination and dipstick urinalysis. Standard management was to prescribe 1 or 2 courses of antimicrobials.
CONCLUSIONS: Despite the 8.7% prevalence found in a previous survey in this population, prostatitis remains underdiagnosed in Malaysia. In contrast to many other clinical settings, urologists in Malaysia see a large proportion of newly diagnosed and treatment-naive prostatitis patients, providing an opportunity for clinical diagnostic and treatment studies.
The laboratory test results for visceral larva migrans (VLM) using ELISA for Toxocara canis antibodies employed by the Institute for Medical Research, Kuala Lumpur, is described. A total of 331 serum samples received from hospitals and general practitioners all over Malaysia were tested. The test utilises excretory-secretory antigens obtained from in vitro culture of second stage T. canis larvae. The overall seropositivity rate was 19.6%, the highest positive rate being in Indians (35.5%), followed by the Malays (14.8%), Chinese (10.9%) and others (29.4%). Seropositivity rate was highest in children below the age of 10; 89% of patients presented with eosinophilia and 93% with VLM syndrome were children.
This study investigated the sociodemographic profiles of patients attending public and private dental clinics and the types of treatment received. Patients (n=454) were interviewed using a structured questionnaire at two public and four private clinics in Sibu District, Sarawak. Generally, Chinese (74.7%), females (60.0%) and urban dwellers (83.7%) were more likely to visit the dentist. Both clinics had more females and more Chinese but private clinics had a lower percentage of female attendees (53.1% versus 67.0%) but a higher percentage of Chinese (85.0% versus 64.5%). Private attendees were younger (mean age of 31.0 years compared to 41.0 years) and from higher income households (median value of MR 2,000 versus MR 900) than public attendees. Treatments were mostly curative and a third of the visits were associated with painful conditions. Age (p=0.006), gender (p=0.003), ethnicity (p<0.001) and household income (p<0.001) were associated with the type of clinic visited. Choice of clinic was not related to having painful conditions (p=0.970). To ensure a more affordable and equitable distribution of oral healthcare, health planners need to identify disparities in the utilization of services and differences between public and private attendees.
On review of 3117 patients' records (all were female Indonesian foreign workers over the span of eight years (1997 to 2004 in a private clinic in Johor Bahru, 223 cases (7.2%) were found to have various medical problems. These 3117 foreigners were to be employed as domestic helpers in Malaysia. They were examined upon arrival in Johor Bahru even though our government did not require this pre-requisite (before 1st August 2005) as they were examined and certified fit in their country of origin before embarking to Malaysia. The proportion of female Indonesian foreign workers who were afflicted with category 1 conditions was 55.6% (which rendered them unfit for employment) and category 2 conditions was 44.4%. The medical problem detected most frequently was hypertension. Sixty-one (80.3%) out of 76 workers had stage 2 hypertension (JNC 7 report). Pulmonary tuberculosis ranked second in this review and is a category 1 condition. This paper supports the recent move by the Malaysian Ministry of Health to implement mandatory medical examinations for all foreign workers arriving in Malaysia within one month of arrival regardless of whether or not they are certified fit in their countries of origin.
INTRODUCTION: Cardiovascular disease is a major cause of morbidity and mortality. Primary care doctors as general practitioners (GPs) play a central role in prevention, as they are in contact with a large number of patients in the community through provision of first contact, comprehensive and continuing care. This study aims to assess the adequacy of cardiovascular disease preventive care in general practice through a medical audit.
METHODS: Nine GPs in Malaysia did a retrospective audit on the records of patients, aged 45 years and above, who attended the clinics in June 2005. The adequacy of cardiovascular disease preventive care was assessed using agreed criteria and standards.
RESULTS: Standards achieved included blood pressure recording (92.4 percent), blood sugar screening (72.7 percent) and attaining the latest blood pressure of equal or less than 140/90 mmHg in hypertensive patients (71.3 percent). Achieved standards ranged from 11.1 percent to 66.7 percent in the maintenance of hypertension and diabetic registries, recording of smoking status, height and weight, screening of lipid profile and attaining target blood sugar levels in diabetics.
CONCLUSIONS: In the nine general practice clinics audited, targets were achieved in three out of ten indicators of cardiovascular preventive care. There were vast differences among individual clinics.