The use and reasons for use of Complementary Medicine (CM) amongst hypertensive patients attending the Hypertension/ Diabetes/ Asthma Clinic in Greentown Health Clinic, Ipoh was assessed. One hundred and twenty patients were selected by systematic random sampling (1:5) over a 2-week period commencing 26/04/04. Data was obtained from interviews, questionnaires and medical records. Twenty seven percent were on CM. Most commonly used CM was herbal medicine. Majority of those using CM for BP control were Malays. The Chinese and Indians were using CM mainly for other health problems. Ninety six percent were using both CM and conventional therapy concurrently. Therefore doctors should enquire about CM usage during patient assessment to prevent possible drug interactions.
Complementary Medicine (CM) usage amongst asthmatic patients was studied. Eighty-eight patients, selected by systematic random sampling in two public polyclinics in April/May 2004, were interviewed. They completed a structured pre-tested questionnaire. Forty-one percent were using CM, majority (64%) together with conventional therapy. Eighty-one percent did not inform their physicians of their CM usage. More Malays were using CM which included nutritional supplements, herbs, yoga, homoeopathy, reflexology and massage.
OBJECTIVES: This study aimed to determine the knowledge about asthma and the prevalence, disclosure and evaluation of the use of complementary and alternative medicine (CAM) among asthmatic patients.
METHODS: This cross-sectional study was conducted on 95 patients diagnosed with asthma in a primary healthcare centre in Kuala Lumpur, Malaysia using a self-administered questionnaire.
RESULTS: Ninety-five patients with a mean age of 47.06 years (±12.8) participated, the majority were female (66.7%), Malay (72.6%). The prevalence of ever-CAM use was 61.1%. The non-ever-CAM users' mean age was 51±13.9 years while the ever-CAM users' mean age was 44.5 ±11.5 years (P = 0.021). Sixty-three females (66.8%) used CAM compared to 14 males (43.8%) (P = 0.014). Thirty-six (62.1%) CAM users had not discussed use of CAM with their doctors. The main reason of non-disclosure was the doctor never asked (55.6%), and the main sources of information about CAM were family and relatives (46.6%). There was no significant difference between use of CAM and knowledge about asthma. The majority of asthmatic patients used rubs (39%), foods (16.9%) and herbs (16.9%). About 76% of asthmatic patients perceived CAM as good for their disease management. On linear multiple regression, Malay race (P = 0.026) and female gender (P = 0.006) were significant predictors of CAM use.
CONCLUSION: Use of CAM among asthmatic patients is relatively high, particularly among females. The majority of asthmatic patients valued the use of CAM. Non-disclosure was high in this study. Health education of asthmatic patients about CAM is highly recommended.
KEYWORDS: Asthma; Malaysia; complementary and alternative medicine; disclosure
Study site: Primary care clinic, Hospital Kuala Lumpur, Malaysia
Based on global cardiovascular (CV) risk assessment for example using the Framingham risk score, it is recommended that those with high risk should be treated and those with low risk should not be treated. The recommendation for those of medium risk is less clear and uncertain. We aimed to determine whether factoring in chronic kidney disease (CKD) will improve CV risk prediction in those with medium risk. This is a 10-year retrospective cohort study of 905 subjects in a primary care clinic setting. Baseline CV risk profile and serum creatinine in 1998 were captured from patients record. Framingham general cardiovascular disease risk score (FRS) for each patient was computed. All cardiovascular disease (CVD) events from 1998-2007 were captured. Overall, patients with CKD had higher FRS risk score (25.9% vs 20%, p = 0.001) and more CVD events (22.3% vs 11.9%, p = 0.002) over a 10-year period compared to patients without CKD. In patients with medium CV risk, there was no significant difference in the FRS score among those with and without CKD (14.4% vs 14.6%, p = 0.84) However, in this same medium risk group, patients with CKD had more CV events compared to those without CKD (26.7% vs 6.6%, p = 0.005). This is in contrast to patients in the low and high risk group where there was no difference in CVD events whether these patients had or did not have CKD. There were more CV events in the Framingham medium risk group when they also had CKD compared those in the same risk group without CKD. Hence factoring in CKD for those with medium risk helps to further stratify and identify those who are actually at greater risk, when treatment may be more likely to be indicated.
PURPOSE: We aimed to demonstrate the suitability of the Anatomical Therapeutic Chemical Classification (ATC) to describe duplicate drugs and duplicate drug classes in prescription data and describe the pattern of duplicates from public and private primary care clinics of Kuala Lumpur, Malaysia.
METHODS: We analyzed prescription data year 2005 from all 14 public clinics in Kuala Lumpur with 12,157 prescriptions, and a sample of 188 private clinics with 25,612 prescriptions. As ATC Level 5 code represents the molecule and Level 4 represents the pharmacological subgroup, we used repetitions of codes in the same prescription to describe duplicate drugs or duplicate drug classes and compared them between the public and private clinics.
RESULTS: At Level 4 ATC, prescriptions with duplicates drug classes were 1.46% of all prescriptions in private and 0.04% in public clinics. At Level 5 ATC, prescriptions with duplicate drugs were 1.81% for private and 0.95% for public clinics. In private clinics at Level 5, 73.3% of prescriptions with duplicates involved systemic combination drugs; at Level 4, 40.3% involved systemic combination drugs. In the public sector at Level 5, 95.7% of prescriptions with duplicates involved topical products.
CONCLUSIONS: Repetitions of the same ATC codes were mostly useful to describe duplicate medications; however, we recommend avoid using ATC codes for tropical products for this purpose due to ambiguity. Combination products were often involved in duplicate prescribing; redesign of these products might improve prescribing quality. Duplicates occurred more often in private clinics than public clinics in Malaysia.
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
This study aimed to evaluate the usability (ease of use) and utility (impact on user's decision-making process) of a web-based patient decision aid (PDA) among older-age users. A pragmatic, qualitative research design was used. We recruited patients with type 2 diabetes who were at the point of making a decision about starting insulin from a tertiary teaching hospital in Malaysia in 2014. Computer screen recording software was used to record the website browsing session and in-depth interviews were conducted while playing back the website recording. The interviews were analyzed using the framework approach to identify usability and utility issues. Three cycles of iteration were conducted until no more major issues emerged. Thirteen patients participated: median age 65 years old, 10 men, and nine had secondary education/diploma, four were graduates/had postgraduate degree. Four usability issues were identified (navigation between pages and sections, a layout with open display, simple language, and equipment preferences). For utility, participants commented that the website influenced their decision about insulin in three ways: it had provided information about insulin, it helped them deliberate choices using the option-attribute matrix, and it allowed them to involve others in their decision making by sharing the PDA summary printout.
Study site: urban tertiary teaching hospital outpatient clinic in Malaysia (primary care clinic, University Malaya Medical Centre, UMMC, Kuala Lumpur, Malaysia)
Background: Urinary excreton of low molecular weight proteins such as beta2-microglobulin and retinol binding protein (RBP), and enzymes such as N-acetyl-beta-D-glucosaminidase (NAG), may be useful as indicators of renal tubular dysfunction in diabetes mellitus.
Objective: To describe the profile of urinary protein and enzyme excretion in 240 Chinese patients with type 2 diabetes mellitus in Singapore.
Materials and Methodology: Cross-sectional study of consecutive patients presenting for follow-up at a Government primary care clinic. Information was obtained from interview, physical examination and laboratory analysis. Data analysis included descriptive statistics on urinary protein and enzyme excretion, comparison of unadjusted and adjusted means of these among patient subgroups, as well as correlation with control of diabetes and other clinical parameters.
Results: Albuminuria correlated with urine B2-microglobulin (r=0.34, p<0.01) and RBP (r=0.46,p<0.01). hypertensive patients had significantly higher mean urine albumin (geometric mean 15.13mg/gCr) and B2-microglobulin (363.18ug/gCr) levels compared to patients without hypertension (7.07mg/gCR; 219,20ug/gCr; p<0.05). Patients with complications of diabetes also had higher albumin (15.55 vs 6.20mg/gCr), B2-microglobulin (344.47 vs 288.83ug/gCr) and RBP excretion (152.02 vs 94.54mg/gCr). Two-hour postprandial sugar correlated with B2-microglobulin (r=0.33, p<0.01), RBP (r=0.35, p<0.01) and NAG (r=0.28, p<0.01). Urinary protein excretion did not correlate with HbA1c, fasting blood sugar, age of patient or duration since diagnosis.
Conclusion: These results among 240 Chinese patients in Singapore were consistent with reports from other study populations.
Over a 2-week period, the management of upper respiratory tract infection by 24 medical officers and medical assistants in Seremban District was studied. Each practitioner recorded clinical data and prescription for twenty consecutive patients using a structured questionnaire. The extent to which the practitioners used "predictive features" (fever, absence of cough, cervical adenopathy, enlarged tonsils and exudates on tonsils) in clinical decision-making was analysed. The mean antibiotic prescription rate was 28.7% (95% CI: 24.6%, 33.0%). The antibiotic prescription rate of medical officers and medical assistants were similar. Five features were independently associated with antibiotic prescription (phlegm, fever, cervical adenopathy, red throat and tonsillar exudates). Antibiotics were prescribed for 22.1% of patients with 0-1 predictive features. High prescribers were 5 times more likely to prescribe antibiotics in this group of patients than low prescribers. To a large extent the clinical decision-making of practitioners in this study was evidence based. However, they were unduly influenced by purulent manifestation (phlegm) and redness of throat. The antibiotic prescription rate in these government health clinics is potentially reducible by means of educational intervention.
One hundred and twenty-four women from a semi-urban area who came for consultation for unplanned pregnancy during an eight month period are analysed. It is found that women with a high risk of unplanned pregnancy are mostly housewives, aged between 20 and 34, who have given birth to one or three children, the last of whom is usually below one or two years old. They belong to the lower socio-economic class and are lowly-educated. Most of them have not completed their families. Although most of them have either used or heard of contraceptives begore, the majority were not using any contraceptive at the time of consultation or were using an ineffective method. Their reasons for non-use or default are identified, many of which are related to the pill. Proper motivation of would-be contraceptive receptors and regular follow-up of acceptors by general practitioners or Family Planning Clinic Staff who are knwoledgable in all available methods of contraception are offered as a solutionto the problem of high rate of defaulting and consequent high rate of unplanned pregnancies.
Study site: private general practice clinic, Perak, Malaysia
INTRODUCTION: Annually, especially in poor resourced countries, significant amount of money is spent to treat chronic diseases. The money instead could be saved by spending on health promotion programs for preventing chronic diseases.
AIM: To conduct cost-effectiveness analysis of various intervention modules in the "Smoking Cessation" program conducted in Universiti Sains Malaysia (USM).
MATERIALS AND METHODS: This was an observational study design. Cost-effectiveness analysis was used to assess the costs and outcomes of the intervention. Data were collected retrospectively from medical records of all clients (n= 129) and then all the participants were followed-up for at least 6 months from the date of participation. Data were analysed descriptively using frequency (%) and mean (sd). Kolmogorov-Smirnov test was carried out to test for normality. Chi-square and Kruskal-Wallis tests were used at alpha level of 0.05. All analyses were done using SPSS version 19.
RESULTS: The findings of the study showed that the majority of participants were Malays (n= 108; 83.7%), males (n= 128; 99.2%), USM's staff (n= 71; 55.0%) and within an age group of 23 years or less (n= 38; 29.5%). Among those who successfully quit were male (n= 30; 100%), Malays (n= 29; 96.7%), staff (n= 19; 63.3%), moreover, their age ranged from 35 to 56-year-old (n= 15; 50.0%). Further analysis of data showed that there were significant associations between success rate and modules of intervention, occupation, motivation factors, and frequency of counselling. Total cost of the Smoking Cessation Program was MYR 38,634.66 (during a period of 34.5 months), with a success rate equal to 29.1%. The most cost-effective module of intervention was counselling alone (CE ratio equal to MYR360.00 per 1% of success rate). The study found counselling with patch was ineffective during the study period.
CONCLUSION: Counselling alone module was the most cost-effective in Smoking Cessation program conducted in USM, Malaysia.
KEYWORDS: Cost-effectiveness analysis; Health promotion; Nicotine replacement therapy (NRTs); Quit smoking clinic; Smoking cessation; University setting
Study site: Quit Smoking Clinic at the University Medical Clinic (Wellness Center), Universiti Sains Malaysia, Pulau Pinang, Malaysia
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.
Surveillance data on the burden of pertussis in Asian adults are limited. This cross-sectional study evaluated the prevalence of serologically confirmed pertussis in adults with prolonged cough in Malaysia, Taiwan and Thailand. Adults (⩾19 years) with cough lasting for ⩾14 days without other known underlying cause were enrolled from outpatient clinics of seven public and/or private hospitals. Single blood samples for anti-pertussis toxin antibodies (anti-PT IgG) were analysed and economic impact and health-related quality of life (EQ-5D) questionnaires assessed. Sixteen (5·13%) of the 312 chronically coughing adults had serological evidence of pertussis infection within the previous 12 months (anti-PT IgG titre ⩾62·5 IU/ml). Three of them were teachers. Longer duration of cough, paroxysms (75% seroconfirmed, 48% non-seroconfirmed) and breathlessness/chest pain (63% seroconfirmed, 36% non-seroconfirmed) were associated with pertussis (P < 0·04). Of the seroconfirmed patients, the median total direct medical cost per pertussis episode in public hospitals (including physician consultations and/or emergency room visits) was US$13 in Malaysia, US$83 in Taiwan (n = 1) and US$26 in Thailand. The overall median EQ-5D index score of cases was 0·72 (range 0·42-1·00). Pertussis should be considered in the aetiology of adults with a prolonged or paroxysmal cough, and vaccination programmes considered.
Study site in Malaysia: Klinik Kesihatan Seremban, Negeri Sembilan; Primary Care Clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
We have identified the beta-thalassemia mutations in 59 patients with thalassemia major and 47 patients with Hb E-beta-thalassemia, and the deletional and nondeletional alpha-thalassemia determinants in 23 out of 24 patients with Hb H disease. All persons were attending the Haematology Clinic at the National University of Malaysia in Kuala Lumpur (Malaysia). Most patients (76) were of Malay descent, while 52 patients were Chinese, and two came from elsewhere. The most frequently occurring beta-thalassemia alleles among the Malay patients were IVS-I-5 (G----C) and G----A at codon 26 (Hb E), while a few others were present at lower frequencies. The Chinese patients carried the mutation characteristic for Chinese [mainly codons 41/42 (-TTCT) and IVS-II-654 (C----T)]; Malay mutations were not observed among Chinese and Chinese mutations were virtually absent in the Malay patients. The large group of patients with Hb E-beta-thalassemia and different beta-thalassemia alleles offered the opportunity of comparing hematological data; information obtained for patients with Hb E-beta-thalassemia living in other countries was included in this comparison. Twenty-three patients with Hb H disease carried the Southeast Asian (SEA) alpha-thalassemia-1 deletion; 13 had the alpha CS alpha (Constant Spring) nondeletional alpha-thalassemia-2 determinant, while the deletional alpha-thalassemia-2 (-3.7 or -4.2 kb) was present in 10 subjects. The --/alpha CS alpha condition appeared to be the most severe with higher Hb H values. Both deletional and nondeletional types of alpha-thalassemia-2 were seen among Malay and Chinese patients.
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.
INTRODUCTION: Diabetes care at different healthcare facilities varied from significantly better at one setting to no difference amongst them. We examined type 2 diabetes patient profiles, disease control and complication rates at four public health facilities in Malaysia.
MATERIALS AND METHODS: This study analyzed data from diabetes registry database, the Adult Diabetes Control and Management (ADCM). The four public health facilities were hospital with specialist (HS), hospital without specialist (HNS), health clinics with family physicians (CS) and health clinic without doctor (CND). Independent risk factors were identified using multivariate regression analyses.
RESULTS: The means age and duration of diabetes in years were significantly older and longer in HS (ANOVA, p< 0.0001). There were significantly more patients on insulin (31.2%), anti-hypertensives (80.1%), statins (68.1%) and antiplatelets (51.2%) in HS. Patients at HS had significantly lower means BMI, HbA1c, LDL-C and higher mean HDL-C. A significant larger proportion of type 2 diabetes patients at HS had diabetes-related complications (2-5 times). Compared to the HS, the CS was more likely to achieve HbA1c ≤ 6.5% (adjusted OR 1.2) and BP target < 130/80 mmHg (adjusted OR 1.4), the HNS was 3.4 times more likely not achieving LDL-C target < 2.6 mmol/L.
CONCLUSION: Public hospitals with specialists in Malaysia were treating older male Chinese type 2 diabetes patients with more complications, and prescribed more medications. Patients attending these hospitals achieved better LDL-C target but poorer in attaining BP and lower HbA1c targets as compared to public health clinics with doctors and family physicians.
In a prospective, observational study, 380 women attending a family planning (LPPKN) clinic and Sexually Transmitted Diseases (STD) clinic in Kuala Lumpur between January 2008 and November 2008 were enrolled. Patient information was obtained from the medical records and patients voluntarily completed questionnaires. Three vaginal swabs from the posterior fornix were taken from each patient examined. Different staining methods and cultivation in Diamonds medium were performed on the collected samples. Study subjects recruited in this survey were mostly young, with a geometric mean ages of 37.31 years (LPPKN clinic) and 32.06 years (STD clinic). Malay, Chinese, Indians and others ethnic groups accounted for 91, 4, 2 and 3%, respectively, at the LPPKN clinic. At the STD clinic, almost all subjects were Chinese. The prevalence rate of trichomoniasis was 0.36% at the LPPKN clinic and 0.0% at the STD clinic. Our findings suggested no association between contraceptive methods used and trichomoniasis infection at the LPPKN clinic. At the STD clinic, it was found a high risk for STD acquisition was not associated with trichomoniasis positivity. The data demonstrated the prevalence of trichomoniasis was very low at LPPKN clinic and absent at STD clinic. The high prevalence rates of other STD among sex workers found in this survey suggest the need for more active interventions focused on this group.
AIM: This study aims to investigate the medical expenditure of people with type 2 diabetes mellitus in Chongqing, China; to explore factors that contribute to the expenditure; and to examine the financial burden placed on households, particularly poor households.
METHODS: A cross sectional survey was conducted with a sample of people diagnosed with Type 2 diabetes mellitus in 2014. Of the 664 people eligible, 76% were interviewed. Descriptive statistics and log-linear regression were used to examine respondents' age, sex and level education, location of residence, income and type of health insurance associated with out-of-pocket expenditure on accessing diabetes mellitus care.
RESULTS: In a year, average out-of-pocket expenditure on the purchase of drugs from pharmacies and having outpatient care were US $333 and US $310, respectively. The average out-of-pocket expenditure on accessing inpatient care was 3.7 times (US $1159) that of accessing outpatient care. After adjusting for age and sex, out-of-pocket expenditure on diabetes care was significantly higher for people covered by the Urban Employee Basic Medical Insurance programme and those enrolled in the identified priority diseases reimbursement programme, which provided higher reimbursement rates for outpatient and (or) inpatient care. Out-of-pocket expenditures on the purchase of drugs from pharmacies, having outpatient and inpatient care, respectively, were 9.8%, 16.2% and 62.6% of annual household income in low-income group.
CONCLUSION: Even with health insurance coverage, poor people with Type 2 diabetes mellitus suffered from significant financial hardship. This has significant implications for models of care and healthcare financing in China with the growing burden of diabetes.
Study site: Township or community health centres, Chongqing, China
Objectives: We sought to determine the prevalence of traditional and complementary medicine (TCM) use for knee osteoarthritis and its associated factors among patients attending a referral hospital in an eastern coastal state of Malaysia.
Methods: This cross-sectional study included 214 patients with knee osteoarthritis. A universal sampling method was applied to patients who attended the outpatient clinic in Hospital Universiti Sains Malaysia from May 2013 to October 2013. Participants were given a questionnaire to determine their sociodemographic information and a validated Bahasa Malaysia version of the Western Ontario and McMaster Universities Arthritis Index (WOMAC). This questionnaire was used to assess the severity of knee osteoarthritis (i.e., pain, stiffness, and disturbances in daily activity).
Results: Over half (57.9%) of patients reported using TCM to treat knee osteoarthritis. Factors associated with TCM use were gender (odd ratio (OR) = 2.47; 95% confidence interval (CI): 1.28-4.77), duration of knee osteoarthritis (OR = 1.51; 95% CI: 1.03-2.23), and the severity of knee pain (OR = 2.56; 95% CI: 1.71-3.86).
Conclusions: The prevalence of TCM use among eastern Malaysian patients with knee osteoarthritis was high. Physicians caring for these patients should be aware of these findings so that inquiries regarding TCM use can be made and patients can be appropriately counseled.
Study site: Primary care clinic, Hospital Universiti Sains Malaysia, Kelantan, Malaysia