A questionaire concerning various aspects of blood pressure measurement and hypertension was answered by 84 out of 98 (86%) doctors and 73 out of 100 (73%) nurses working in various parts of the state of Pahang. 59% and 85% of doctors and nurses respectively agreed that blood pressure should be measured routinely in all out-patients. 48% of medical staff were taught to use and 38% were actually using phase 4 as the diastolic blood pressure despite the general agreement that phase 5 should be used to denote diastolic pressure. 52% of doctors believed that hypertensive patients present with symptoms, the common symptoms cited were headache and dizziness, although it is well documented that hypertension is essentially asymptomatic. 93%, 80%, 69% and 82% of doctors believed that treatment of hypertension can prevent cerebrovascular disease, heart failure, renal failure and coronary artery disease respectively, although prevention of the last complication is yet unproven. Most doctors would begin treating a patient at rather low level of blood pressure, for example, for a man in the age group 40-49, 40% of doctors would begin drug treatment at diastolic pressure of 90 mmHg and 55% at diastolic pressure 95 mmHg. 79% of nurses and 55% of doctors were dissatisfied with the sphygmomanometer they have, the most common complaint was that the cuff-bladder 'blow up' on being inflated.
Study site: doctors and nurses at private general practice, klinik kesihatan, district hospitals, Pahang, Malaysia
This qualitative study aimed to explore the influence of social networks such as family members, friends, peers, and health care providers toward the help-seeking behaviour (HSB) of patients with type 2 diabetes mellitus in the public and private primary care settings. In-depth interviews of 12 patients, 9 family members, and 5 health care providers, as well as 3 focus groups among 13 health care providers were conducted. All interviews were audio-taped and transcribed verbatim for qualitative analysis. Social influences play a significant role in the help-seeking process; once diagnosed, patients source information from people around them to make decisions. This significant influence depends on the relationship between patients and social networks or the level of trust, support, and comforting feeling. Thus, the impacts on patients' help-seeking behavior are varied. However, the help-seeking process is not solely an individual's concern but a dynamic process interacting with the social networks within the health care system.
BACKGROUND: Hypertension is the number one cardiovascular risk factor in Malaysia. This study aimed to evaluate the effectiveness of a Community-Based Cardiovascular Risk Factors Intervention Strategies (CORFIS) in the management of hypertension in primary care.
METHODS: This is a pragmatic, non-randomized controlled trial. Seventy general practitioners (GPs) were selected to provide either CORFIS (44 GPs) or conventional care (26 GPs) for 6 months. A total of 486 hypertensive patients were recruited; 309 were in the intervention and 177 in the control groups. Primary outcome was the proportion of hypertensive patients who achieved target blood pressure (BP) of <140/90mmHg (for those without diabetes mellitus) and <130/80mmHg (with diabetes mellitus). Secondary outcomes include change in the mean/median BP at 6-month as compared to baseline.
RESULTS: The proportion of hypertensive patients who achieved target BP at 6-month was significantly higher in the CORFIS arm (69.6%) as compared to the control arm (57.6%), P=0.008. Amongst those who had uncontrolled BP at baseline, the proportion who achieved target BP at 6-month was also significantly higher in the CORFIS arm (56.6%) as compared to the control arm (34.1%), p<0.001. There was no difference in the patients who had already achieved BP control at baseline. There were significant reductions in SBP in the CORFIS arm (median -9.0mmHg; -60 to 50) versus control (median -2mmHg; -50 to 48), p=0.003; as well as in DBP (CORFIS arm: median -6.0mmHg; ranged from -53 to 30 versus control arm: median 0.0mmHg; ranged from -42 to 30), p<0.001.
CONCLUSIONS: Patients who received CORFIS care demonstrated significant improvements in achieving target BP.
A study was conducted to determine the feasibility of establishing a sentinel human immunodeficiency virus (HIV) surveillance system involving patients with sexually transmitted diseases attending private clinics and a government sexually transmitted disease clinic in Kuala Lumpur, Malaysia. Information on risk behaviours for HIV infection were also collected. A total of 84 female and 91 male patients were interviewed and tested for HIV infection; 41.7% of the women reported working as prostitutes, other occupations included masseuses, hairdressers, waitresses, salesgirls, receptionists, factory workers, and others. The most common diagnosis was gonorrhoea. Other diagnoses included non-specific genital infection, pelvic inflammatory disease, genital herpes and syphilis. 58.3% of the women had a hundred or more sex partners during the previous month; 99% had 6 or more sex partners. Only 4.8% of female patients had their male partners using condoms most of the time, 11.9% hardly used condoms at all. Of the males, 93.3% were heterosexual, while 6.7% were bisexuals, 41.1% had between 6-20 different partners in the previous year. 78.0% of them had prostitutes as their sex partners most of the time. 41.8% had experiences in Thailand and the Philippines. 73.6% never used condoms, while 19.8% only used condoms rarely. Although all patients were tested negative for HIV antibodies, lot quality assurance sampling methods indicate that the upper limits of prevalences for females and males were 3.5% and 3.3% respectively, at a 5% type I error. The study has shown that it is feasible to carry out a sentinel surveillance programme among STD patients and provided useful baseline data for future comparisons.(ABSTRACT TRUNCATED AT 250 WORDS)
This Diabcare-Asia project was initiated to study the status of diabetes care and prevalence of diabetic complications in Asia and this study was done to evaluate the above in primary private healthcare in Malaysia. A total of 49 private clinics participated in this study from which a total of 438 patients were included and analysed. The majority of patients (96.5%) had type 2 diabetes mellitus and 81.4% had BMI > or =23 kg/m2. Only 12.0% of the patients had their HbA1c measured in the preceding 12 months. As for glycaemic control only 20% of the patients had HbA1c <7% and 11% had FPG < 6.7 mmol/L. As for lipid levels, only 12.3% of the patients had total cholesterol < 4.8 mmol/L; 30.9% had HDL-cholesterol > 1.2 mmol/L and 49.8% had triglycerides < 1.7 mmol/L. Despite the high proportion of patients having dyslipidaemia. only 12.4% of the patients were on lipid lowering therapy. As for blood pressure, 55.9% of the patients had systolic pressure > or =140 mmHg and 40.9% had diastolic pressure > or =90 mmHg. However, only 32.4% of the patients were on antihypertensive medication. Only 37.4% of the patients admitted to adhering to diabetic diet regularly and 32.0% exercised regularly. As for glucose monitoring only 6.9% of the patients did home blood glucose monitoring and 6.2% did home urine glucose. There was also a high complication rate with the commonest being neuropathy (30.1%) followed by background retinopthy (23.5%), albuminuria (22.9%) and microalbuminuria (20.4%). In conclusion, the majority of diabetic patients treated at the primary care level were not satisfactorily controlled and this was associated with a high prevalence of complications. There is an urgent need to educate both patients and health care personnel on the importance of achieving the clinical targets and greater effort must be made to achieve these targets.
Two hundred and six patients attending an urban general practice were surveyed using a self-rating questionnaire, the 30-item version of the General Health Questionnaire. At a cut-off score of 6/7, 34.5% of the respondents were found to be high-scorers which gives a corrected estimate of psychiatric morbidity of 29.9% in this clinic. Among those who presented with general complaints, such as aches and pains for which no organic cause was found, a significant proportion (70%) were high-scorers. There were no significant differences in the sex and age distribution of the high-scorers. However the mean score of Malays was significantly higher than that of Chinese.
Five hundred and sixty-two consecutive attenders at an urban general practice were studied using the Consumption Index which has been successfully used in a general hospital sample. Seventy per cent of Chinese, 11% of Malays and 42% of Indians have used or are currently using alcohol-a vast majority of them were social drinkers. Among those who ever drank, 6% of Chinese and 22% of Malays drank more than 14 units per week. The hypotheses that more Indians used alcohol and used it more heavily were not supported in this urban sample. Possible explanations for these findings and the limitations of this study are discussed.
The prescriptions of all patients who attended an urban general practice from September 1987 to December 1987 were studied. Of the 111 patients (60 females and 51 males) who received a psychotropic prescription the commonest presenting complaint was insomnia (56 patients or 50.5%). This was followed by tension, headache and unexplained aches and pains (19 patients or 17.1%), and anxiety (nine patients or 8.1%). Consistent with these presentations a vast majority (92.8%) received a benzodiazepine. The commonest drugs prescribed were Lorazepam and Bromazepam whereas the longer acting benzodiazepines were rarely used. Polypharmacy was rare.
This paper considers the subject of managed care in Malaysia, providing a questionnaire-based analysis of the position adopted by private medical practitioners. Managed care is now seen as the dominant health care system in the United States, with many other countries around the world including Malaysia beginning to selectively use component parts to tackle particular health care problems. In this survey it was found that three out of four respondents have concerns regarding the implementation of managed care. The survey was used to identify and categorise these concerns. At the same time, three out of four respondents held the opinion that principles of managed care were already a reality or would be in the next 5 years. This group expressed an eagerness to be trained in managed care principles and be given the opportunity to be part of managed care organisations. It is argued that clinicians' knowledge and interest perceptions are an important influence on the implementation of managed care based systems. The survey-based evidence presented in this article is intended as a measure of current understandings and beliefs, in relation to clinical micro-management process associated with managed care.
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
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
The objective of this study was to explore the roles and perceptions of general practitioners (GPs) in the management of erectile dysfunction (ED). This qualitative study used focus group discussions and in-depth interviews. This study was conducted based on 28 GPs from an urban area in Malaysia who had managed patients with ED and prescribed anti-ED drugs. Main outcome measures included the roles of GPs in managing patients with ED (active or passive), perceptions regarding ED and the treatment, and factors influencing their decision to prescribe. Majority of the GPs assumed a passive role when managing patients with ED. This was partly due to their perception of the disease being nonserious. Some also perceived ED as mainly psychological in nature. The anti-ED drugs were often viewed as a lifestyle drug with potentially serious side effects. The fear of being perceived by patients as 'pushing' for the drug and being blamed if the patients were to develop serious side effects also hampered the management of this disease. GPs who participated in this study remained passive in identifying and treating patients with ED and this was attributed to their perception of the disease, drug treatment and patient's background.
In a survey of 5233 patients seen in the clinics of three general practitioners, 339 patients were found to be doctor hoppers (6.48 per cent). Respiratory symptoms and fever were the commonest presentation affecting mainly the paediatric age group. No improvement in the symptoms was quoted as the most common reason for switching to another doctor. Many factors contributed to doctor hopping and these were best considered in relation to the illness, the patient and the doctor: From the point of prevention, the doctor himself has a significant role to play, particularly in improving the doctor-patient relationship and patient compliance.
Study site: Johor (Johor Bahru, Batu Pahat, Muar)
The objective of this survey was to understand the current trend of readership of professional dental journals among Malaysian dentists. A total of 225 questionnaires were sent out to Malaysian dentists who attended various dental related conferences throughout Peninsular Malaysia from February 2006 to July 2006. Questionnaires comprised of questions relating to dentists’ socio-demographic status and a list of journal(s) read by them. Malaysian dentists’ view on the content and quality of a particular dental journal, i.e. the Malaysian Dental Journal (MDJ) was also enquired. The details of this finding are highlighted in Part II of this study. A total of 156 questionnaires were returned; the respondents were made up of 61 male and 91 female dentists. Almost 80% of the respondents aged between 20-49 year-old and most respondents (n= 132; 84.62%) only had a basic Bachelor of Dental Surgery or equivalent degree while another 19 (12.18%) had in addition, a post-graduate degree. Almost equal numbers of respondents were working in the Ministry of Health (MOH) or Armed Force (n=73; 46.8%) and private practice (n=74; 47.4%). Also, equal number of respondents (n=67; 42.95%) were found to be working as single-handed practitioner and in a partnership/assistant/working-with-other specialties type of practice Almost two-thirds (n=103; 66%) of the respondents read more than one professional journal, and a majority of them worked in the private sector. The percentage of readers reading more than one journal from the private practice (n=67, 60.0%) was close to twice of that from the MOH (n=36, 35.0%). No specific age-group pattern was present but the least number of subscribers were from those 60 year-old and above (n=3), whereby none of them subscribed to any professional dental journal/magazine. The highest percentage of subscribers were from those in the age group of 40-49 year-old, whereby 86.49% (n=32) of dentists in this age-group subscribed to at least one professional dental journal/magazine. Out of the list of journals/magazines provided, it was found that the MDJ has the most number of readers. The MDJ was most read by dentists in the private practice while the Annals of Dentistry of the University of Malaya was most read by dentists in the MOH. In conclusion, it was found that almost two-third of the respondents read more than one professional journal, with the MDJ receiving the most number of readers. More dentists in the private practice read professional dental journals than dentists in the MOH.
BACKGROUND: The indiscriminate use of cough and cold medicines (CCMs) in children has become a public health concern. The study evaluates the prescription pattern of CCMs in primary care setting.
METHODS: Analysis of CCMs prescription data among children aged 12 years and below who had participated in the National Medical Care Survey (NMCS) 2010. Data was extracted from NMCS 2010, a cross-sectional survey on the primary healthcare service which was carried out from December 2009 to April 2010 in public and private primary care clinics in Malaysia.
RESULT: Of 21,868 encounters for NMCS 2010, 3574 (16.3%) were children 12 years old and below; 597 (17%) were from public clinics and 2977 (83%) were from private clinics. Of these 3574 encounters, 1748 (49%) children were prescribed with CCM with total of 2402 CCMs. On average, CCMs were prescribed at a rate of 1.3 CCMs per encounter in public clinics and 1.4 CCMs per encounter in private clinics. CCMs containing single ingredient constituted 77% of the prescriptions while 23% were of multiple ingredient preparations. There were 556 (23%) CCMs prescribed to children younger than 2 years. Majority (65%) were prescribed with one CCM per visit, 32% received two CCMs and 3% of the children received three or more CCMs per visit.
CONCLUSION: Prescription of CCMs to children is common. Prevalence of CCM prescriptions among young children is of concern, in view of concerns about the safety and adverse effects related to the use of CCMs in this age group. Firmer policies and greater effort is needed to monitor the prescriptions of CCMs to children.
Malaria is still a very real threat to health in S.E. Asia including Malaysia. While there has been a dramatic fall in the number of cases and also the number of deaths from the disease in Malaysia cases are still occurring and there has actually been a rise in the number of deaths in the past year. Parts of Perak and the East Coast states are still high risk areas in Peninsular Malaysia. While 95 percent of the population of Peninsular Malaysia is now malaria-free there has also been a concomitant loss of herd immunity which means that if a non-immune person contracts falciparum malaria he stands a greater chance of a fatal outcome. Doctors and other health personnel should be more malaria conscious and make a practice of making blood films of all cases of fever. This is especially important in the rural areas and Estate Hospital Assistants must be encouraged to look for malaria parasites in their fever patients. The younger generation of EHAs have little experience of malaria and a definite policy of education to bring them up to date in antimalarial work and microscopic detection of the parasite should be under taken by the industry. Some problems of chemotherapy and drug resistance are discussed.
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.