OBJECTIVES: The objective of this study was to evaluate the general practitioners' (GPs') knowledge and perceptions towards generic medicines in a northern state of Malaysia.
METHOD: A postal cross-sectional survey involving registered GPs in Penang, Malaysia was undertaken. A 23-item questionnaire was developed, validated and administered on the GPs. Eighty-seven GPs responded to the survey (response rate 26.8%).
RESULTS: The majority of the respondents (85.1%) claimed that they actively prescribed generic medicines in their practice. On the other hand, only 4.6% of the respondents correctly identified the Malaysia's National Pharmaceutical Control Bureau's bioequivalence standard for generic products. There were misconceptions among the respondents about the concepts of "bioequivalence", "efficacy", "safety", and "manufacturing standards" of generic medicines. GPs in this survey believed that a standard guideline on brand substitution process, collaboration with pharmacists, patient education and information on safety and efficacy of generic medicines were necessary to ensure quality use of generics. Furthermore, advertisements and product bonuses offered by pharmaceutical companies, patient's socio-economic factors as well as credibility of manufacturers were factors reported to influence their choice of medicine.
CONCLUSION: Although it appeared that GPs have largely accepted the use of generic medicines, they still have concerns regarding the reliability and quality of such products. GPs need to be educated and reassured about generic products approval system in Malaysia concerning bioequivalence, quality, and safety. The current findings have important implications in establishing generic medicines policy in Malaysia.
BACKGROUND: Managed care is one of the means advocated for health care reforms. The Malaysian government has proposed managed care for its citizens. In the Malaysian private health care sector, managed care is practised on a small scale with crude risk adjustment. The main determinant of an individual's health service utilization is their health status (HS). HS is used as a risk adjuster for capitation payment. Prescribed medications represent a useful source for HS estimation. We aimed to develop and validate a medication-based HS estimate and to incorporate it in the Andersen model of health service utilization. This is a preparatory step in studying the feasibility of developing a model for risk assessment in the Malaysian context.
METHODS: Data were collected retrospectively from an academic year from computerized databases in University Sains Malaysia (USM) about users of USM primary care services. A user is a USM health scheme beneficiary who made at least one visit in the academic year to USM-assigned primary care providers. Socio-demographic variables, enrolment period, medications prescribed and number of visits were also collected. Chronic illness medications and some non-chronic illness medications were used to calculate the Long-Term Therapeutic Groups Index (LTTGI) which is an estimate of the HS of users. Using a random 50% of users, weighted least square methods were used to develop a model that predicts a user's number of visits. The other 50% were used for validation.
RESULTS: Socio-demographic variables explained 15% of variability in number of primary care visits among users. Adding the LTTGI improved the explanatory power of the model to 36% (P < 0.001). A similar contribution of the LTTGI was noted in the validation.
CONCLUSIONS: The Long-Term Therapeutic Groups Index was successfully developed. Variability in number of primary care visits can be predicted by LTTGI-based models.
Introduction: This study aimed to assess the nutritional status of children below 24 months in the district of Pekan, Pahang, and identify the contributing factors. Methods: Using a cross-sectional methodology, a total of 910 children was selected by random sampling from four public health clinics. Anthropometric measurements were taken and weight-for-age, height-for-age, and weight-for- height were calculated in Z scores. Immediate caregivers of children were interviewed by using a pretested validated questionnaire to assess their socio- economic, demographic, educational and occupational status. Results: Of the 910 children who participated in the study, the majority were Malay (70.1%), while the remaining comprised indigenous or Orang-Asli (OA) children. Prevalence of wasting, stunting and underweight were 28.7 %, 15.6 % and 19.0% respectively. There were more underweight males than females. Wasting was most common among children aged below 6 months. Stunting was more prevalent in children between 12 to 24 months. Obesity was seen in 7.3% of the sample. Maternal education, employment and socio-economic status had a significant influence on wasting and underweight. Children were vulnerable to stunting as age advanced, whereas prevalence of wasting tended to decrease. Conclusion: Malnutrition exists in significant proportions among children below 24 months in the Pekan district. This study identified low birth weight along with age, race, gender, large family size and socio-economic status as important risk factors of malnutrition.
This study was conducted to find out the psychiatric symptomatology in the patients and their families attending a primary health care facility. The most frequent symptoms found were of depression (13.2%), followed by hypochondriacal symptoms (8.2%), anxiety symptoms (6.1%) and psychotic symptoms. A large proportion (21.5%) of children had psychiatric symptoms. The common symptoms include enuresis, hostility, tantrums, problems of conduct and destructiveness. Surprisingly, concern for these symptoms was lacking in both the patient and their family members.
BACKGROUND: The outcomes of the physician-patient discussion intervene in the satisfaction of cardiovascular disease risk patients. Adherence to treatment, provision of continuous care, clinical management of the illness and patients' adjustment are influenced by satisfaction with physician-patient interaction. This study aims to determine the patient satisfaction with doctor-patient interaction and over six months after following prevention counselling, its associations with modifiable cardiovascular risk factors amongst moderately-high risk patients in a primary healthcare clinic in Kelantan, Malaysia.
METHODS: A prospective survey was conducted amongst patients with moderately-high cardiovascular risk. A total of 104 moderately-high risk patients were recruited and underwent structured prevention counselling based on the World Health Organization guideline, and their satisfaction with the doctor-patient interaction was assessed using 'Skala Kepuasan Interaksi Perubatan-11,' the Malay version of the Medical Interview Satisfaction Scale-21. Systolic blood pressure, total cholesterol and high-density lipoprotein cholesterol were measured at baseline and at a follow-up visit at six months. Descriptive analysis, paired t test and linear regression analyses were performed.
RESULTS: A total of 102 patients responded, giving a response rate of 98.1%. At baseline, 76.5% of the respondents were satisfied with the relation with their doctor, with the favourable domain of distress relief (85.3%) and rapport/confidence (91.2%). The unfavourable domain was interaction outcome, with satisfaction in only 67.6% of the respondents. Between the two visits, changes had occurred in total cholesterol (P = 0.022) and in systolic blood pressure (P
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.
This study investigates the views of general medical practitioners (GP) to the extended role of the community pharmacists (CP). A self-administered questionnaire was distributed to all private clinics (n=438) run by GPs in the state of Penang. The questionnaire asked GP's views on ideas for new services provided by community pharmacists. Three hundred and twenty-seven questionnaires were collected, giving a response rate of 74.5%. More than 50% of respondents were in favour of the community pharmacist involvement in activities of providing public health education (58.7%), contacting GPs on matters related to prescribing and prescription errors (56.0%), and referring patients who exhibit drug-related problems (53.0%). However, the respondents had a mixed opinion regarding the roles of CPs in smoking cessation programme (34.8%) and providing drug information to physicians (43.0%). Additional research is needed to explain GPs attitudes towards the acceptability of the new role of the pharmacist.
A demographic and obstetric profile of pregnant mothers attending antenatal clinics in Kelantan over period of one year was determined by a retrospective study of 10,032 registered pregnant mothers. The prevalence of risk factors related to the age of the mother, parity, weight, haemoglobin level, bad obstetric history and pregnancy related diseases were determined. Prevalence of teenage pregnancy and primigravida accounted for 4.3 and 17.2 percent respectively. Nearly 3.9 percent of the mothers weighed less than 40 kg and 44.5 percent of mothers were found to be anaemic (Hb less than 11g/d) at the first antenatal visit. Only 3.2 percent of the mothers did not have any designated risk factor. Previous bad obstetric history and pregnancy related disease accounted for 17.1 and 3.5 percent of mothers respectively.
Study site: Antenatal clinics, klinik kesihatan, Kelantan, Malaysia
Background : Foot ulcers and its complications are an important cause of morbidity and mortality in diabetes. The aim of this retrospective study is to determine the ulcer-free survival in diabetic foot and its relevant predictors in a cohort of diabetic patients in the primary health care setting.
Methods : Data of newly diagnosed diabetics (n=1121) who received treatment in five health centers in the district of Kuala Langat, Selangor between 1st January 1999 until the 30th June 2008 were studied. Information was gathered by reviewing patient’s medical records. All patients were followed until 31st December 2008. The duration of ulcer-free survival was measured from the date of being diagnosed as diabetic until the development of the ulcer.
Results : The total incidence of diabetic foot ulcer was 9.9% (n=111), with an average annual incidence of 1%. The total incidence of amputation was 1.2%. Mean age of being diagnosed having diabetic was 52+10.7 year old and mean age of being diagnosed having diabetic foot ulcer was 54.68+10.16 year old. The mean for overall ulcer-free survival was 99 months (95%CI:96-102). Male gender (LR=6.56; p=0.01), smokers (LR=3.94; p=0.04), low body mass index (LR=4.45; p=0.03), impaired renal function (LR=5.17; p=0.02) and long duration between follow-up (LR=25.10; p
Health impact related to smoking is a critical public health predicament especially in pregnancy. However there is not much data available to describe the magnitude of the problem. Hence this study was conducted to determine the prevalence of smoking and its socioeconomic factors among antenatal mother and their opinion related to tobacco control measures. A cross sectional study was carried out involving newly registered antenatal mothers attending all government health clinics in Penang. Prevalence of ever smoking among antenatal mother is 1.4%, of which 42.4% is still smoking at first antenatal visit. It was found that single mothers are more likely to smoke (OR, 14.23: C12.52-53.27). It was also noted that spouse smoking (OR, 5,14: CI 1.95-17.09), primigravida (OR, 2.7: C1 1.3-5.62), age group less than 30 years old (OR, 2.41; CI 1.03-6.09) and living in urban area (OR, 2.33; CI 1.01 — 6.47) have a higher risk to indulge in smoking behaviour. Muslim OR 0.29; C1 0.14 - 0.60) and Malay (OR 0.22; CI 0.10 - 0.47) pregnant mothers are noted to be less likely to smoke as compared to non Muslim and non Malay. More than 85% of them agreed with the tobacco control measures regardless of their smoking status. Most of respondents agreed the influential people in community L;11T · such as medical personnel, teachers and parents should not smoke.
Introduction: To determine association between occupational stress and personality characteristics among nurses at Maternal and Child Health Clinic in the state of Malacca, emphasizing on type of personality and personal perception of stress.
Methods : A cross sectional study was conducted among 152 nurses of Maternal and Child Health Clinics in Malacca using self administered questionnaires and selected via multistage sampling.
Results : This study showed that a total of 28.3% of the nurses were found to be stressed. Almost half (41.2%) of those who perceived that they were stressed were likely to be really stressed (p = 0.004). Therefore those who perceived themselves to be stressed should be referred for stress evaluation and further management if necessary. However selfperception of stress cannot be used as a screening tool for stress due to its lack of sensitivity (56.8%) and poor Positive Predictive Value (41.2%). Majority of the nurses were of Guardians Personality Type (98%) and 72.4% of them had extrovert trait. However there were no significant associations between stress with personality type or characteristic, most probably due to the preponderance of one personality type or characteristic. Other studied variables such as socio-demographic factors (age, gender, ethnicity, religion, marital status, educational level, body mass index, type of work place, position, duration of service and poverty level) and social factors (placement, chronic medical illness, chronic care taker, smoking status and alcohol drinker) were suggestive of an association between them and stress but were not statistically significant.
Conclusion : There is no association between occupational stress and personal characteristics among nurses in Malacca.
Introduction : Johor Bahru has one of the highest rates of dengue disease in this country in spite of the implementation of COMBI (Communication for Behavioural Impact) in 2001.
Methods : To identify factors contributing to this problem, a case control study was conducted, focusing on risk factors such as the weather (rainfall and temperature), environment and sociodemography. Cases were selected from confirmed dengue cases from January to June, 2006. Controls were selected from patients who had no past history of having dengue illness from Health Clinics in Johore Bahru. Both case group and control group were matched by age and sex. All risk factors were analysed using SPSS version 11.5.
Results : Results from time-series analysis indicated that the cases of dengue illness were related to changes in the minimum temperature (r =-0.149; p
OBJECTIVES: In developing countries out-of-pocket payments (OOP) are as high as 80% of healthcare spending. Generic medicines can be instrumental in reducing this expenditure. The current study is aimed to explore the knowledge, perception, and attitude of general practitioners towards generic medicines in Karachi, Pakistan.
METHODS: This exploratory, descriptive study was conducted on a sample of 289 randomly selected general practitioners who were dispensing at their private clinics in Karachi, Pakistan. The questionnaires were distributed and collected by hand. Data was entered to SPSS version 17. Fischer's exact test was applied to see the association between variables.
RESULTS: A total of 206 questionnaires were included in the study. A response rate of 71.3% was achieved. Out of 206 respondents, 139 (67.5%) were male while 67 (32.5%) respondents were female. Close to three quaters of the respondents (n= 148; 71.8%) showed correct knowledge about generic medicines being a 'copy of the brand name medicines' and 'interchangeable with brand name medicines' (n= 148; 71.8%). In terms of safety, the majority of respondents (n=85; 41.26%) incorrectly understood that the generic medicines are less safe than brand name medicines. The total percentage of correct responses was seen in 53% of the respondents. More than half of the respondents agreed that locally manufactured medicines are of the same effectiveness as brand name medicines (n=114; 55.4%). Male practitioners with practice experience of 11-15 years showed positive perception towards the quality of multinational products. The Majority of respondents believed that their prescribing decision is influenced by medical representatives (n=117; 56.8%). More than three-quarters of the respondents expressed their wish to prescribe low cost medicines in their practice (n=157; 76.2%). More than one third of the respondents expressed their uneasiness to prescribe products from all local manufacturers (n=72; 35%).
CONCLUSION: There were gaps identified in the knowledge of respondents. Although good perception and attitude were noted among the respondents, dissemination of information regarding generic medicines may perhaps strengthen generic prescribing. There is a need to introduce 'Quality by Design' concept in local manufacturing units. This, in turn, can inculcate confidence in prescribers towards locally manufactured generic medicines.
KEYWORDS: Karachi; Pakistan; attitude; dispensing doctor; general practitioner; generic medicines; perception
Introduction: Marital satisfaction is vital to the wellbeing and functioning of the individual and family. Marital dissatisfaction can lead to detrimental effects on mental, physical and family health. The study aimed to determine the proportion of marital dissatisfaction in outpatient setting and its association with sexual functioning and psychiatric morbidity in Kuala Lumpur, Malaysia.
Materials & Methods: A cross-sectional study was conducted in selected primary care using purposive sampling. Data collection was done using socio-demographic questionnaire and several validated Malay version of self-administered questionnaires. Marital satisfaction was measured by the Malay version of Golombok-Rust Inventory of Marital State (Mal-GRIMS).
Results: The prevalence of marriage dissatisfaction in sample population was about 37.3% with almost equal prevalence in both, 36.5% (male) and 37.8% (female). Using a regression analysis, the significant factors that affect marital dissatisfaction were respondent's age group between 31- 40 years old (Adjusted Odds Ratio, AOR. =11.4, 95% Confidence Interval, CI. =1.2-110.9), spouse's salary of RM1000-RM2000 (lower income category) (AOR=7.3, 95% CI= 1.9-28.1), anxiety case (AOR= 4.8, 95% CI=1.1- 21.5), depression case (AOR= 4.8, 95% CI=1.0-22.8), female sexual dysfunction in term of arousal function (AOR= 0.01, 95% CI=0.0-0.7), satisfaction dysfunction (AOR= 9.4, 95% CI= 1.5-58) and pain function (AOR=43.7, 95% CI=1.28 - 1489.2).
Conclusion: Marital dissatisfaction can be influenced by financial factor, sexual dysfunction and presence of psychiatric morbidity. Hence, in management of marital discord, thorough screening of these factors should be prioritized in clinical setting.
Introduction: Marital satisfaction is vital to the wellbeing and functioning of the individual and family. Marital dissatisfaction can lead to detrimental effects on mental, physical and family health. The study aimed to determine the proportion of marital dissatisfaction in outpatient setting and its association with sexual functioning and psychiatric morbidity in Kuala Lumpur, Malaysia.
Materials & Methods: A cross-sectional study was conducted in selected primary care using purposive sampling. Data collection was done using socio-demographic questionnaire and several validated Malay version of self-administered questionnaires. Marital satisfaction was measured by the Malay version of Golombok–Rust Inventory of Marital State (Mal-GRIMS).
Results: The prevalence of marriage dissatisfaction in sample population was about 37.3% with almost equal prevalence in both, 36.5% (male) and 37.8% (female). Using a regression analysis, the significant factors that affect marital dissatisfaction were respondent’s age group between 31-40 years old (Adjusted Odds Ratio, AOR. =11.4, 95% Confidence Interval, CI. =1.2-110.9), spouse’s salary of RM1000-RM2000 (lower income category) (AOR=7.3, 95% CI= 1.9-28.1), anxiety case (AOR= 4.8, 95% CI=1.1-21.5), depression case (AOR= 4.8, 95% CI=1.0-22.8), female sexual dysfunction in term of arousal function (AOR= 0.01, 95% CI=0.0-0.7), satisfaction dysfunction (AOR= 9.4, 95% CI= 1.5-58) and pain function (AOR=43.7, 95% CI=1.28 - 1489.2).
Conclusion: Marital dissatisfaction can be influenced by financial factor, sexual dysfunction and presence of psychiatric morbidity. Hence, in management of marital discord, thorough screening of these factors should be prioritized in clinical setting.
The study reported served 2 purposes: 1) to assess the amount of sexual information posessed by a sample of staff nurses working for the National Family Planning Board and the Public Health Dept., and 2) to gather local normative data on the Information Subtest of the Derogatis Sexual Functioning Inventory (DSFI). The subjects for the this study were 2 groups of staff nurses. 10 were employees of the National Family Planning Board currently working in 1 of its clinics and 25 were public health nurses who were at a 1 week training at the clinic. The research was a questionnaire type study. Each subject was given the DSFI. On the Information Subtest of the DSFI the subjects obtained a mean score of 12.7 with a standard deviation of 4.2. This score is much lower than the normative mean (American population) and the sexually dysfunctional women mean. The nurses had inadequate and inaccurate knowledge about anatomy, physiology and psychology of sexual relations. Error analysis revealed that as a group they had poor understanding about male sexuality, the effect of aging on sexuality fertility and menopause, and difficulty in accepting oral-genital sex and sexual fantasies. This study recommends that these nurses, in order to more effective in their work, should be trained in the area of human sexuality. This training must include not only the physiology of sex but also the human aspects of sexual union.
Clinical Practice Guideline (CPG) provides evidence-based guidance for the management of Dengue Infection in adult patients. A cross sectional study was conducted to evaluate awareness and utilization of CPG among doctors in public or private hospitals and clinics in Malaysia. Doctors practicing only at hospital Medical and Emergency Departments were included, while private specialist clinics were excluded in this study. A multistage proportionate random sampling according to region (Central, Northern, Southern, Eastern, Sabah and Sarawak) was performed to select study participants. The overall response rate was 74% (84% for public hospitals, 82% for private hospitals, 70% for public clinics, and 64% for private clinics). The CPG Awareness and Utilization Feedback Form were used to determine the percentage in the study. The total numbers of respondent were 634 with response rate of 74%. The mean lengths of service of the respondent were 13.98 (11.55).A higher percentages of doctors from public facilities (99%) were aware of the CPG compared to those in private facilities (84%). The percentage of doctors utilising the CPG were also higher (98%) in public facilities compared to private facilities (86%). The percentage of Medical Officer in private facilities that utilizing the CPG were 84% compares to Medical Officer in public facilities 98%. The high percentage of doctors using the CPG in both public (97%) and private (94%) hospitals were also observed. However, only 69% of doctors in private clinics utilised the CPG compared to doctors in public clinics (98%). Doctors in both public and private facilities were aware of the dengue CPG. However, most doctors in private clinic were less likely to utilise the CPG. Therefore, there is a need to increase the level of CPG utilisation especially in private clinics.
Study site: primary care and hospital from Medical and Emergency Department, public and private health facilities in Malaysia
The pattern and incidence of cardiovascular disease was studied in a general practice in an urban-rural area in the west coast of West Malaysia. Hypertension, rheumatic heart disease and congenital heart disease accounted for 85% of the 476 patients with evidence of cardiovascular disease. Ischaemic heart disease, arteriosclerotic heart disease and other conditions accounted for the rest. Emphasis is laid on the salient features of incidence in general practice. Comparison is made with previous clinical and pathological studies from this region.
Study site: General practjce clinic, Telok Anson [Teluk Intan], District of Lower Perak, Malaysia
312 diabetics were seen in a multiracial urban general practice in Peninsular Malaysia during a five-year period. Of these, 210 (67%) were Indians, confirming the higher prevalence of diabetes among Indians reported in other studies. 67 were newly found diabetics. The sex, age, family history, of the diabetics, duration and complications of diabetes, are reviewed and compared with similar studies. The larger number of diabetics may partly be attributed to the presence in the community of a large number of Indians born in India. Stress also may contribute to the high prevalence of the disease in Indians, who are prone to diabetes by virtue of heredity.
Study site: General practice clinic, Kelang, Selangor, Malaysia