Displaying publications 61 - 80 of 853 in total

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  1. Ong SM, Lim YMF, Sivasampu S, Khoo EM
    BMC Geriatr, 2018 02 23;18(1):59.
    PMID: 29471806 DOI: 10.1186/s12877-018-0750-2
    BACKGROUND: Polypharmacy is particularly important in older persons as they are more likely to experience adverse events compared to the rest of the population. Despite the relevance, there is a lack of studies on the possible association of patient, prescriber and practice characteristics with polypharmacy. Thus, the aim of this study was to determine the rate of polypharmacy among older persons attending public and private primary care clinics, and its association with patient, prescriber and practice characteristics.

    METHODS: We used data from The National Medical Care Survey (NMCS), a national cross-sectional survey of patients' visits to primary care clinics in Malaysia. A weighted total of 22,832 encounters of patients aged ≥65 years were analysed. Polypharmacy was defined as concomitant use of five medications and above. Multilevel logistic regression was performed to examine the association of polypharmacy with patient, prescriber and practice characteristics.

    RESULTS: A total of 20.3% of the older primary care attenders experienced polypharmacy (26.7%% in public and 11.0% in private practice). The adjusted odds ratio (OR) of polypharmacy were 6.37 times greater in public practices. Polypharmacy was associated with patients of female gender (OR 1.49), primary education level (OR 1.61) and multimorbidity (OR 14.21). The variation in rate of polypharmacy was mainly found at prescriber level.

    CONCLUSION: Polypharmacy is common among older persons visiting primary care practices. Given the possible adverse outcomes, interventions to reduce the burden of polypharmacy are best to be directed at individual prescribers.

    Matched MeSH terms: Ambulatory Care Facilities/standards; Ambulatory Care Facilities/trends
  2. Leong HS, Heng R, Emmanuel SC
    Singapore Med J, 2007 Jan;48(1):34-40.
    PMID: 17245514
    INTRODUCTION: Breast cancer is the commonest female cancer in Singapore. It is steadily rising with an incidence of 53.1 cases per 100,000 persons per year among women. Screening for detection of early lesions which are highly curable helps to reduce mortality.
    METHODS: Over three afternoon sessions in December 2003, 224 female patients aged 40-65 years, participated in interviews conducted by the National Healthcare Group Polyclinics, Singapore. The survey sought information on mammographic screening history, the time interval since the previous mammographic screening, and the reasons for not going for the screening.
    RESULTS: The survey found that only 26.4 percent (28 out of 106) among those aged 40 to 49 years had mammographic screening done within the past one year, and 43.2 percent (51 out of 118) among those aged 50 to 65 years had screening done within the last two years. Chinese women were twice more likely than Malay women to have a mammogram done. The commonest reasons for not wanting to have mammographic screening among women who did not have a mammogram done or had mammogram done more than two years ago, were lack of time (42.5 percent), fear of pain during the procedure (26.9 percent), and the belief that cancer would not happen to them (24.6 percent).
    CONCLUSION: Despite publicity on breast cancer being the commonest cancer among women in Singapore and cure being possible if the malignancy was detected early, close to half of the women aged 40-65 years old who attended the National Healthcare Group Polyclinics did not have mammographic screening done. One-quarter of the women who did not have mammogram screening did not do so as they did not think cancer would happen to them.
    Study site: NHG Polyclinics, Singapore
    Matched MeSH terms: Ambulatory Care/methods*; Ambulatory Care Facilities
  3. Cheong AT, Sazlina SG
    Malays Fam Physician, 2015;10(2):36-44.
    PMID: 27099659 MyJurnal
    INTRODUCTION: Hill-Bone compliance to high blood pressure therapy scale (HBTS) is one of the useful scales in primary care settings. It has been tested in America, Africa and Turkey with variable validity and reliability. The aim of this paper was to determine the validity and reliability of the Malay version of HBTS (HBTS-M) for the Malaysian population.
    MATERIALS AND METHODS: HBTS comprises three subscales assessing compliance to medication, appointment and salt intake. The content validity of HBTS to the local population was agreed through consensus of expert panel. The 14 items used in the HBTS were adapted to reflect the local situations. It was translated into Malay and then back-translated into English. The translated version was piloted in 30 participants. This was followed by structural and predictive validity, and internal consistency testing in 262 patients with hypertension, who were on antihypertensive agent(s) for at least 1 year in two primary healthcare clinics in Kuala Lumpur, Malaysia. Exploratory factor analyses and the correlation between HBTS-M total score and blood pressure were performed. The Cronbach's alpha was calculated accordingly.
    RESULTS: Factor analysis revealed a three-component structure represented by two components on medication adherence and one on salt intake adherence. The Kaiser-Meyer-Olkin statistic was 0.764. The variance explained by each factors were 23.6%, 10.4% and 9.8%, respectively. However, the internal consistency for each component was suboptimal with Cronbach's alpha of 0.64, 0.55 and 0.29, respectively. Although there were two components representing medication adherence, the theoretical concepts underlying each concept cannot be differentiated. In addition, there was no correlation between the HBTS-M total score and blood pressure.
    CONCLUSION: HBTS-M did not conform to the structural and predictive validity of the original scale. Its reliability on assessing medication and salt intake adherence would most probably to be suboptimal in the Malaysian primary care setting.
    Matched MeSH terms: Ambulatory Care Facilities
  4. Aina Mariana AM, Yap SH
    Med J Malaysia, 2014 Aug;69(4):178-83.
    PMID: 25500846 MyJurnal
    The aim of this study was to evaluate the management and clinical outcome of transfusion-dependent thalassaemia children receiving care in the Paediatric Ambulatory Care Centre, Hospital Tuanku Ja'afar Seremban in comparison to The Malaysian Clinical Practice Guidelines. The demography, management and clinical outcome of the patients were documented using a checklist. Information on compliance to chelation agents was obtained through interview. There were twenty-six patients recruited in this study out of thirty seven patients registered in the centre. This study showed that more effort and vigilance should be given to ensure that the management of these patients adheres to the guidelines and clinical outcome of these patients monitored closely.

    Study site: Paediatric Ambulatory Care Centre, Hospital Tunku Ja'afar, Seremban.
    Matched MeSH terms: Ambulatory Care
  5. Shima R, Farizah MH, Majid HA
    Patient Prefer Adherence, 2014;8:1597-609.
    PMID: 25484577 DOI: 10.2147/PPA.S69680
    PURPOSE: The aim of this study was to explore patients' experiences with their illnesses and the reasons which influenced them in not following hypertensive care recommendations (antihypertensive medication intake, physical activity, and diet changes) in primary health clinic settings.
    PATIENTS AND METHODS: A qualitative methodology was applied. The data were gathered from in-depth interviews with 25 hypertensive patients attending follow-up in nine government primary health clinics in two districts (Hulu Langat and Klang) in the state of Selangor, Malaysia. The transcribed data were analyzed using thematic analysis.
    RESULTS: There was evidence of lack of patient self-empowerment and community support in Malaysian society. Most of the participants did not take their antihypertensive medication or change their physical activity and diet after diagnosis. There was an agreement between the patients and the health care professionals before starting the treatment recommendation, but there lacked further counseling and monitoring. Most of the reasons given for not taking antihypertensive medication, not doing physical activity and not following diet recommendations were due to side effects or fear of the side effects of antihypertensive medication, patients' attitudes, lack of information from health care professionals and insufficient social support from their surrounding environment. We also observed the differences on these reasons for nonadherence among the three ethnic groups.
    CONCLUSION: Health care professionals should move toward supporting adherence in the management of hypertensive patients by maintaining a dialogue. Patients need to be given time to enable them to overcome their inhibition of asking questions and to accept the recommendations. A self-management approach must be responsive to the needs of individuals, ethnicities, and communities.
    KEYWORDS: adherence; hypertension; in-depth interview; qualitative research
    Study site: Klinik kesihatan, Selangor, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  6. Chow EP, Hassali A
    Value Health, 2014 Nov;17(7):A746.
    PMID: 27202698 DOI: 10.1016/j.jval.2014.08.171
    Objectives
    To evaluate the impact of home medication review programme (HMR) towards Type 2 Diabetes patients from public primary centre in Penang, Malaysia.

    Methods
    A prospective randomised control study was conducted at Primary Clinic in Bukit Minyak, Penang. Eligible Type 2 diabetes patients with HbA1c > 6.5% and taking ≥ 3 medications who stayed at their own house were recruited and randomly allocated into control and intervention group by coin tossing. Control group patients received usual care from the clinic whereas intervention group patients received additional 2 visits at their home by pharmacist. During both visits, education on quality use of medications and life-style modifications were performed.Blood pressure monitoring, point of care for sugar and total cholesterol levels were conducted in each visit. Patients adherence and knowledge were assessed using validated questionnaire. Pill count was conducted and excessive medications were collected to calculate the costing component. Primary outcomes were medication adherence and level of knowledge. Secondary outcomes included HbA1c, FBS and total cholesterol changes as well as patients’ satisfactions towards HMR and direct cost saving from the programme.

    Results
    A total of 150 patients were recruited and randomly assigned in two groups (n=75 each group). Fifty patients in the intervention group completed the study. After 2 home visits there were significant improvements in the adherence score for the intervention group (mean score=6.90,SD=0.94) compared to the control group (mean score=4.05, SD=1.51). There was a significant improvement in knowledge score after HMR programme, intervention group (mean score=10.04, SD=1.75) and the control group (mean score=5.45, SD=1.89). A direct cost analysis of the medication wasted reveals that HMR can help to save RM 2805.50 (USD 855.34) throughout the eight months period.

    Conclusions
    Pharmacist-led HMR have improved patients’ adherence and knowledge as well as helping the policy makers to save money on excessive medication wastage.
    Matched MeSH terms: Ambulatory Care Facilities
  7. Chong MC, Francis K, Cooper S, Abdullah KL
    Nurs Res Pract, 2014;2014:126748.
    PMID: 24523961 DOI: 10.1155/2014/126748
    Nurses need to participate in CPE to update their knowledge and increase their competencies. This research was carried out to explore their current practice and the future general needs for CPE. This cross-sectional descriptive study involved registered nurses from government hospitals and health clinics from Peninsular Malaysia. Multistage cluster sampling was used to recruit 1000 nurses from four states of Malaysia. Self-explanatory questionnaires were used to collect the data, which were analyzed using SPSS version 16. Seven hundred and ninety-two nurses participated in this survey. Only 80% (562) of the nurses had engaged in CPE activities during the past 12 months. All attendance for the various activities was below 50%. Workshops were the most popular CPE activity (345, 43.6%) and tertiary education was the most unpopular activity (10, 1.3%). The respondents did perceive the importance of future CPE activities for career development. Mandatory continuing professional education (MCPE) is a key measure to ensure that nurses upgrade their knowledge and skills; however, it is recommended that policy makers and nurse leaders in the continuing professional development unit of health service facilities plan CPE activities to meet registered nurses' (RNs) needs and not simply organizational requirements.
    Matched MeSH terms: Ambulatory Care Facilities
  8. 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: Ambulatory Care Facilities
  9. Omar R, Knight VF, Hussin DA
    Med J Malaysia, 2013 Jun;68(3):245-8.
    PMID: 23749015 MyJurnal
    This study determined the outcome of combining home based and clinic based amblyopia therapy among preschool children. A total of 479 preschool children were randomly selected for vision screening. Amblyopic therapy was prescribed to children whose visual acuity (VA) could not be improved to <0.1 LogMAR after a 6 week adaptation period with glasses. Intensive near work activities were conducted daily at home for 12 weeks, monitored by parents while weekly therapy was conducted at the optometry clinic by an optometrist. Six preschool children were diagnosed with refractive amblyopia, spherical equivalent (SE) was -11.25D to +0.75D. Significant improvement was found in the VA of right eye, t(6) = 3.07, left eye t(6) = 3.07 and both eyes t(6) = 3.42) p<0.05, at the end of the 12 week therapy. Combining home based and clinic based amblyopia therapy among preschool children showed a positive improvement in VA after 12 weeks of therapy.
    Study site: kindergarten, optometry clinic, Perak (site unclear)
    Matched MeSH terms: Ambulatory Care Facilities
  10. Paranthaman V, Satnam K, Lim JL, Amar-Singh HS, Sararaks S, Nafiza MN, et al.
    Asian J Psychiatr, 2010 Dec;3(4):206-12.
    PMID: 23050889 DOI: 10.1016/j.ajp.2010.07.002
    Background: Psychoeducation has shown promising benefits in managing patients with schizophrenia. In Malaysia, the use of psychoeducation is rather limited and its impact indeterminate.
    Aims: To assess the effectiveness of a structured psychoeducation programme for the community in improving caregiver knowledge, decreasing caregivers’ burden, reducing patients’ readmission and defaulter follow up rates.
    Method: In a controlled interventional study, 109 caregivers were included, 54 and 55 in the intervention and control groups respectively. Caregivers were assessed at baseline, 3 and 6 months post-intervention for knowledge and burden. Patients were monitored for relapse and defaulting follow up in the clinic.
    Results: Caregivers in the intervention group showed significant improvement in knowledge, reduction in burden in assistance in daily living (severity) and a reduced defaulter rate was seen in the patients’ follow up.
    Conclusion: The findings shows that structured psychoeducation programme among caregivers has the potential to improve outcome of care for patients with schizophrenia.
    Keywords: Schizophrenia; Psychoeducation; Community; Caregiver Questionnaire: Family Burden Interview Schedule–Short Form (FBIS/SF)
    Matched MeSH terms: Ambulatory Care Facilities
  11. Khoo SB
    Malays Fam Physician, 2011;6(2-3):51-7.
    PMID: 25606223 MyJurnal
    Delirium in the elderly is a challenging and under-recognized problem in the community. Early detection and management improves outcomes and quality of life for the elders with delirium at home.1 Family physicians (FP) play a key role in the assessments, early identification, and management of delirium and in the support and education of patients and their family caregivers.1 Clinical analysis of this case illustrates the bio-psychosocial spiritual model of approach to management of delirium in an elderly patient in the home setting.
    Matched MeSH terms: Ambulatory Care Facilities
  12. Chong MC, Sellick K, Francis K, Abdullah KL
    PMID: 25029948 DOI: 10.1016/S1976-1317(11)60012-1
    PURPOSE: A cross sectional descriptive study, which involved government hospitals and health clinics from Peninsular Malaysia sought to identify the continuing professional education (CPE) needs and their readiness for E-learning. This paper focuses on the first phase of that study that aimed to determine the factors that influence nurses' participation in CPE.
    METHODS: Multistage cluster sampling was used to recruit 1,000 nurses randomly from 12 hospitals and 24 health clinics from four states in Peninsular Malaysia who agreed to be involved. The respondent rate was 792 (79.2%), of which 562 (80%) had participated in CPE in the last 12 months.
    RESULTS: Findings suggested that updating knowledge and providing quality care are the most important factors that motivate participation in CPE, with respective means of 4.34 and 4.39. All the mean scores for educational opportunity were less than 3.0. Chi-square tests were used to test the association of demographic data and CPE participation. All demographical data were significantly associated with CPE participation, except marital status.
    CONCLUSIONS: Implementation of mandatory CPE is considered an important measure to increase nurse's participation in CPE. However, effective planning that takes into consideration the learning needs of nurses is recommended.
    Matched MeSH terms: Ambulatory Care Facilities
  13. Ramli AS, Miskan M, Ng K, Ambigga D, Nafiza M, Mazapuspavina M, et al.
    Malays Fam Physician, 2010;5(1):36-40.
    PMID: 25606184
    Large population surveys in Malaysia have consistently shown minimal improvement of blood pressure control rates over the last 10 years. Poor adherence to antihypertensive medication has been recognized as a major reason for poor control of hypertension. This study aimed to describe the prescribing pattern of antihypertensive agents in 2 public primary care clinics and assess its appropriateness in relation to current evidence and guidelines.
    Matched MeSH terms: Ambulatory Care Facilities
  14. Rosdina AK, Leelavathi M, Zaitun A, Lee VKM, Noor Azimah M, Majmin SH, et al.
    Malays Fam Physician, 2010;5(2):91-4.
    PMID: 25606194 MyJurnal
    A cross-sectional study was conducted on patients attending a primary care facility to determine the prevalence of self reported hearing loss using a single question, "Do you have hearing loss?" Pure tone audiometry was performed to compare the accuracy of the self report. A total of 111 patients were recruited. The prevalence of self reported hearing loss using a single question and pure tone audiometry was 24.3% and 36.9% respectively. By using pure tone audiometry at a cut-off-level of 25 dBHL (decibels Hearing level), the single question yielded a sensitivity of 41.4% and specificity of 85.0%.The single question performed better at 40 dBHL pure tone audiometry with sensitivity of 55.0% and specificity of 82.0%. In conclusion, the prevalence of hearing loss in elderly was high and the single question self reported hearing loss performed satisfactorily with moderate hearing loss.
    Matched MeSH terms: Ambulatory Care Facilities
  15. Man CN, Fathelrahman AI, Harn GL, Lajis R, Samin AS, Omar M, et al.
    Environ Toxicol Pharmacol, 2009 Jul;28(1):92-6.
    PMID: 21783987 DOI: 10.1016/j.etap.2009.03.003
    The objective of this study was to correlate, differentiate and validate the self-reported smoking status of educated young adults with urinary biomarkers (i.e. nicotine and cotinine). Freshmen students were recruited on voluntary basis. They filled-up self-administered questionnaire and their urine samples were collected for analysis. The urinary nicotine (UN) and cotinine (UC) were measured by gas chromatograph-mass spectrometry. Smokers, non-smokers and ex-smokers were found to be both significantly correlated and different in their UN and UC levels. UC level of 25ng/ml was the optimal cut-off to differentiate smokers from non-smokers. Using this cut-off value, the prevalence of smoking among the students was found to be higher (15.4%) than the self-reported data (14.3%). UC is useful in validating individual recent smoking history and the cut-off could serve as a marker for assessing the clinical impact of smoking and environmental tobacco smoke (ETS) exposure on human health.
    Study site: university health centre, Universiti SainsMalaysia (USM), Pulau Pinang, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  16. Mastura I, Teng CL
    Med J Malaysia, 2008 Oct;63(4):315-8.
    PMID: 19385492
    The quality of physician prescribing is suboptimal. Patients are at risk of potentially adverse reaction because of inappropriate or writing error in the drug prescriptions. We assess the effect of "group academic detailing" to reduce writing drug name using brand name and short form in the drug prescriptions in a controlled study at two primary health care clinics in Negeri Sembilan. Five medical officers in Ampangan Health Clinic received an educational intervention consisting of group academic detailing from the resident Family Medicine Specialist, as well as a drug summary list using generic names. The academic detailing focused on appropriate prescribing habit and emphasized on using the full generic drug name when writing the drug prescription. Analyses were based on 3371 prescriptions that were taken from two clinics. The other health clinic was for comparison. The prescribing rates were assessed by reviewing the prescriptions (two months each for pre- and post-intervention phase). Statistically significant reduction in writing prescription using brand name and using short form were observed after the educational intervention. Writing prescription using brand name for pre- and postintervention phase were 33.9% and 19.0% (postintervention vs pre-intervention RR 0.56, 95% CI 0.48 to 0.66) in the intervention clinic. Prescription writing using any short form for pre- and post-intervention phase were 49.2% and 29.2% (post-intervention vs pre-intervention RR 0.59, 95% CI 0.53 to 0.67). This low cost educational intervention focusing on prescribing habit produced an important reduction in writing prescription using brand name and short form. Group detailing appears to be feasible in the public health care system in Malaysia and possibly can be used for other prescribing issues in primary care.
    Matched MeSH terms: Ambulatory Care Facilities
  17. Chew BH
    Malays Fam Physician, 2010;5(2):101-4.
    PMID: 25606197 MyJurnal
    This case reports a 57-year-old lady presented with cough of two months duration despite repeated treatments from multiple general practitioners. It took her another two months to know her diagnoses and a further couple of months to be relieved of her cough and became asymptomatic. Chronic cough management in primary care often needs an empiric integrative approach and requires good doctor-patient rapport with informed follow ups and continuity of care to be successful.
    Matched MeSH terms: Ambulatory Care Facilities
  18. Muthupalaniappen L, Tong SF, Hazizi H, Hamidon AH
    Malays Fam Physician, 2006;1(1):25-6.
    PMID: 26998206 MyJurnal
    A healthy 27 year old Para 3 presenting with abnormal menstruation without a period of amenorrhoea was diagnosed to have left tubal ectopic pregnancy after vaginal examination and abdominal ultrasonography. The case illustrates the need for careful history taking and the need for considering ectopic pregnancy in women in the reproductive age group, who have abnormal menstruation even if they are on contraception.
    Matched MeSH terms: Ambulatory Care Facilities
  19. Norfazilah A, Samuel A, Law PT, Ainaa AA, Nurul Ain Z, Syahnaz MH, et al.
    Malays Fam Physician, 2013;8(3):19-25.
    PMID: 25893053 MyJurnal
    Hypertension is one of the chronic diseases with a rising trend globally, including Malaysia. Patients' own perception of their illness is a strong factor that determines their health-seeking behaviour. The objective of this study was to evaluate the illness perception of hypertensive patients and the associated factors.
    Matched MeSH terms: Ambulatory Care Facilities
  20. Chew BH, Mastura I, Bujang MA
    Malays Fam Physician, 2013;8(3):11-8.
    PMID: 25893052 MyJurnal
    AIM: We examined disease profiles of patients with type 2 diabetes mellitus (T2D) at four different public health facilities in Malaysia to determine which site would be the most suitable for early and intensive diabetes care against diabetes-related complications.
    METHODS: This study analysed 57,780 T2D patients in the Adult Diabetes Control and Management registry database in the year 2009. The four public health facilities were hospital with specialists (HS), hospital without specialists (HNS), health clinics with family medicine specialists (CS) and health clinic without doctors (CND). Descriptive analyses were used to examine age, duration of diseases, intervals from the onset of diabetes to co-morbidities (hypertension and dyslipidaemia) and complication of T2D patients at the four public health facilities.
    RESULTS: Patients were significantly older in HS. Patients with T2D at HS had significantly longer duration of diabetes, hypertension and dyslipidaemia. Health clinics, both the CS and the CND, were seeing T2D patients with shorter duration of macrovascular and microvascular complications.
    CONCLUSION: Public health clinics in this country managed T2D patients who were younger and at the early stage of diabetes, hypertension, dyslipidaemia and complications. Thus, primary care physicians are best positioned to provide early and intensive diabetes care for this group of T2D patients to prevent the development of diabetes-related complications.
    KEYWORDS:
    diabetes complications; disease management; health facilities; primary health care; type 2 diabetes mellitus
    Study name: Adult Diabetes Control and Management (ADCM) 2009
    Matched MeSH terms: Ambulatory Care Facilities
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