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Fulltext Knowledge, attitude, and practice regarding atrial fibrillation among primary care physicians: the potential role of postgraduate training

Ooi PC, Ramayah G, Omar SR, Rajadorai V, Nadarajah T, Ting CH, et al.

Malays Fam Physician, 2021 Mar 25;16(1):39-49.
PMID: 33948141 DOI: 10.51866/oa0002

Introduction: Atrial fibrillation (AF) is known to lead to stroke and thromboembolism, causing a five-fold increase in the risk of stroke and almost doubling the mortality rate. Optimal anticoagulant therapy is effective in reducing AF-related death. However, prescription of anticoagulants in AF in East Asian countries has been low, ranging from 0.5% to 28%. This study aimed to determine whether vocational training in family medicine improves primary care physicians' knowledge, attitude, and practice in the management of AF.
Method: This investigation was a cross-sectional study carried out during centralized workshops for two groups of trainees using a validated questionnaire: (i) junior trainees were newly enrolled postgraduate trainees in the Graduate Certificate in Family Medicine (GCFM) program, and (ii) senior trainees were postgraduate trainees in Advance Training in Family Medicine (ATFM) programs of the Academy of Family Physicians of Malaysia (AFPM).
Results: A total of 223 trainees (127 junior and 96 senior) participated in this study. Only 55.2% of the trainees passed the knowledge test; senior trainees were more likely to pass the knowledge test compared to junior trainees (69.8% vs. 44.1%, p < 0.001). Female trainees were significantly more likely to pass the knowledge test than male trainees. While the attitude of senior and junior trainees was similar, more of the latter group worked in public clinic that provide better support where there is better support for outpatient anticoagulation treatment (e.g., same-day INR test, direct access echocardiogram, and warfarin in in-house pharmacy).
Conclusion: Vocational training in family medicine appears to improve primary care physicians' knowledge regarding the management of AF. Better knowledge will help vocationally trained primary care physicians to provide anticoagulation treatment for AF within primary care clinics. More optimal AF management within primary care can take place if the identified barriers are addressed and a shared care plan can be implemented.

Matched MeSH terms: Physicians, Family
Fulltext Family Practice: Is It For Me?

Teng CL

ISBN: 978-983-3909-42-1

Citation: Teng CL. Family Practice: Is It For Me? In: Ong HT (editor). The Life of a Doctor. Petaling Jaya: Unipress Medical & Healthcare; 2008, p115-119

Matched MeSH terms: Physicians, Family
Fulltext General practice consultations

Leong KC, Teng CL

Aust Fam Physician, 2007 Sep;36(9):679; author reply 680.
PMID: 17918303

Comment on: Cannon B, Usherwood TP. General practice consultations - how well do doctors
predict patient satisfaction? Aust Fam Physician. 2007 Mar;36(3):185-6, 192. PubMed PMID: 17339988. https://www.racgp.org.au/afp/200703/15394

Matched MeSH terms: Physicians, Family/psychology*
Fulltext Audit of hypertension in general practice

Chan SC, Chandramani T, Chen TY, Chong KN, Harbaksh S, Lee TW, et al.

Med J Malaysia, 2005 Oct;60(4):475-82.
PMID: 16570710

An audit of hypertension management was done in October 2004 in nine general practice (GP) clinics. Two structure, ten process and two outcome indicators were assessed. Results showed that targets were achieved in only four indicators, i.e., weight recording (89%), BP monitoring (85.8%), follow-up interval not exceeding 6 months (87.9%) and mean diastolic BP (73.9%). The other indicators (hypertension registry, reminder mechanisms for defaulters, recording of smoking, height, fundoscopy, monitoring of lipid profile, blood sugar, ECG, renal function and achievement of target mean systolic pressure) showed adequacy percentages varying from 22.1 to 68.7. Out of the 1260 patients assessed, 743 (59%) achieved a mean BP < or = 140/90 (or < or = 130/80 mmHg with diabetes mellitus / renal insufficiency) in the last 3 recorded readings. There was a vast difference between individual clinics. Reasons for not achieving targets were discussed and remedial measures for implementation were recommended.

Matched MeSH terms: Physicians, Family
Fulltext The APEC Digital Hub-WONCA Collaborative Framework on Integration of Mental Health into Primary Care in the Asia Pacific

Dowrick C, Kassai R, Lam CLK, Lam RW, Manning G, Murphy J, et al.

J Multidiscip Healthc, 2020;13:1693-1704.
PMID: 33268991 DOI: 10.2147/JMDH.S271070

Mental ill health affects individual well-being and national economic prosperity and makes up a substantial portion of the burden of disease globally, especially in the Asia-Pacific region. Integrating mental health into primary care is widely considered a key strategy to improve access to mental health care. Integration, however, is a complex process that needs to be addressed at multiple levels. A collaboration between the Asia-Pacific Economic Cooperation (APEC) Digital Hub for Mental Health and the World Organization of Family Doctors (WONCA) is described in this paper, which outlines a framework and next steps to improve the mental health of communities in APEC economies. This paper notes gaps related to the integration of mental health into primary care across the region and identifies enablers and current best practices from several APEC economies. The potential of digital technology to benefit primary mental health care for populations in the APEC region, including delivery of training programs for healthcare staff and access to resources for patients, is described. Finally, key next steps are proposed to promote enhanced integration into primary care and improve mental health care throughout the APEC region.

Matched MeSH terms: Physicians, Family
Fulltext Attitude and knowledge of family medicine practitioners towards the association between periodontal disease and obesity

Akram Z, Abduljabbar T, Hanif A, Khan A, Vohra F

Niger J Clin Pract, 2017 05;20(5):595-599.
PMID: 28513519 DOI: 10.4103/1119-3077.197017

OBJECTIVES: To assess the attitude and knowledge of family medicine practitioners (FMPs) towards the association between periodontal disease and obesity.
MATERIALS AND METHODS: A cross-sectional study was performed and a 13-item survey questionnaire was given to FMPs practicing in 12 different teaching hospitals in Karachi, Pakistan. The questions were aimed at exploring the knowledge of FMP's regarding the association of obesity and periodontal disease and their attitude towards the association of obesity and periodontal disease. Chi-square and Spearman co-efficient were conducted to compare subgroups and correlate factors with the knowledge score of FMPs.
RESULTS: A total of 314 questionnaires were completed (response rate = 92%). Median age of participants was 41 years and 57% were females. Almost 61% of FMPs answered all the knowledge questions correctly and 64% reported moderate understanding of the association between periodontal health and obesity. Nearly 73% FMPs inquired from obese patients regarding the periodontal disease and more than half (58%) refer patients to a dentist for evaluation. More than half of FMPs perform periodontal disease screening. Nearly all FMPs considered informing obese patients regarding periodontal disease as one of their roles.
CONCLUSIONS: FMP's play an important role in the early diagnosis, prevention and treatment of periodontal conditions in obese patients. More than two thirds of FMPs showed good knowledge of the association of obesity and periodontal disease. The attitudes of FMPs towards assessing and referring obese patients at a risk of having periodontal disease were reassuring.

Matched MeSH terms: Physicians, Family/statistics & numerical data*
Noncardiac chest pain--an Asia-Pacific survey on the views of primary care physicians

Cheung TK, Lim PW, Wong BC

Dig Dis Sci, 2007 Nov;52(11):3043-8.
PMID: 17436083 DOI: 10.1007%2Fs10620-007-9764-x

Noncardiac chest pain (NCCP) is common and has a significant impact on health care. Primary care physicians (PCPs)' attitudes, clinical approach, preference of diagnostic tests, referral patterns, and comfort in managing patients with NCCP in the Asia-Pacific region are not known. Consequently, we performed this survey in the Asia-Pacific region. The self-completed questionnaire was sent to PCPs in the Asia-Pacific region. A 28-item questionnaire contained questions on demographic information, characteristics of practice, preferences of diagnostic tests, referral patterns, treatment plans, and opinion on Helicobacter pylori and NCCP. A total of 108 (74%) PCPs returned the questionnaire. A mean of 18% of the patients were diagnosed with NCCP by PCPs in the past 6 months. Ninety-four percent of PCPs had treated NCCP patients in the last 6 months. Only 38% of the PCPs were comfortable in diagnosing NCCP but 85.2% believed that they should manage NCCP patients. PCPs in Malaysia and Philippines were more likely to refer patients to subspecialists. Fifty-seven and four-tenths percent of PCPs believed that H. pylori infection plays a role in the development of NCCP. The study demonstrates clearly that the understanding, diagnostic strategies, and treatment strategies of NCCP in the Asia-Pacific region are suboptimal and thus highlights the importance of educational and training programs tailored for PCPs in NCCP.

Matched MeSH terms: Physicians, Family*
Congratulatory message from the Singapore College

Wong HS

Family Practitioner, 1973;1(1):6.

Matched MeSH terms: Physicians, Family
Fulltext Peritonsillar swelling is not always quinsy

Mohamad I, Yaroko A

Malays Fam Physician, 2013;8(2):53-5.
PMID: 25606284 MyJurnal

Quinsy is a common encounter in family physician practice. It is defined as a collection of purulent material in the peritonsillar space, giving appearance of unilateral palatal bulge. Presenting symptoms include trismus, muffled voice, odynophagia, and ipsilateral otalgia. When the diagnostic needle aspiration reveals no pus, the diagnosis is changed into peritonsillar cellulitis or also known as perintonsillitis. Peritonsillitis is sufficiently treated with antibiotics unlike a quinsy which warrants surgical incision and drainage.

Matched MeSH terms: Physicians, Family
Fulltext Continuity of care of diabetic patients in a family practice clinic: How important is it?

Hanafi NS, Teng CL, Yasin S

Asia Pac Fam Med, 2003;2(1):10-15.

Aim: To assess the importance of continuity of care among diabetic patients attending a primary care clinic and to correlate degree of continuity of care with diabetic control. Methods: A cross sectional survey was carried out among diabetic patients (n = 166) attending follow-up consultations in a family practice clinic of a teaching hospital. Face-to-face interviews were carried out on patients' perception of continuity of care and various aspects related to diabetes. Diabetic control was assessed by glycosylated hemoglobin. Retrospective chart audits of each patient over the previous 28 months were done to assess the degree of continuity of care, measured with the Usual Provider Continuity Index (UPCI). Results: The UPCI ranged from 0.18 to 1.00 with a mean value of 0.60. The average number of visits per patient over the 28-month period was 11.7 visits. The majority of patients saw five different doctors for all their visits. There were no statistically significant associations between the degree of provider continuity with diabetic control (r = 0.054) and diabetic self-care behavior (r = 0.065). The majority of patients (89%) felt that it was important to have a regular doctor. The main reason given was that a regular doctor would know the patient's problems. Conclusions: Continuity of care was highly valued by diabetic patients attending a hospital-based family practice clinic. Even though the degree of continuity was not associated with the degree of diabetic control, patients felt that it was important to have doctors who are aware of their problems.

Matched MeSH terms: Physicians, Family
Family physicians and medical writing

Yong Rafidah AR

Family Physician, 2003;12:1-1.

Matched MeSH terms: Physicians, Family
Management of Dyslipidemia in Individuals with Low-to-Moderate Cardiovascular Risk: Role of Nutraceuticals

Dolzhenko MM, Barnett OY, Grassos C, Dragomiretska NV, Goloborodko BI, Ilashchuk TO, et al.

Adv Ther, 2020 11;37(11):4549-4567.
PMID: 32979190 DOI: 10.1007/s12325-020-01490-z

Cardiovascular diseases (CVDs) are the leading cause of premature deaths globally and in Ukraine. Dyslipidemia is a recognized risk factor for the development of CVD. Therefore, early detection and appropriate management of dyslipidemia are essential for the primary prevention of CVDs. However, currently, there is a lack of Ukraine-specific guideline recommendations focusing on the management of dyslipidemia in individuals with low-to-moderate CV risk, thus creating an urgent need for structured and easily implementable clinical recommendations/guidelines specific to the country. An expert panel of cardiologists, endocrinologists, and family physicians convened in Ukraine in March 2019. The expert panel critically reviewed and analyzed the current literature and put forth the following recommendations for the management of dyslipidemia in individuals with low-to-moderate risk of CVDs specific to Ukraine: (1) family physicians have the greatest opportunities in carrying out primary prevention; (2) lipid-lowering interventions are essential for primary prevention as per guidelines; (3) a number of nutraceuticals and nutraceutical combinations with clinically established lipid-lowering properties can be considered for primary prevention; they also have a suggested role as an alternative therapy for statin-intolerant patients; (4) on the basis of clinical evidence, nutraceuticals are suggested by guidelines for primary prevention; (5) red yeast rice has potent CV-risk-lowering potential, in addition to lipid-lowering properties; (6) in patients with low-to-moderate cardiovascular risk, a nutraceutical combination of low-dose red yeast rice and synergic lipid-lowering compounds can be used as integral part of guideline-recommended lifestyle interventions for effective primary prevention strategy; (7) nutraceutical combination can be used in patients aged 18 to 75+ years; its use is particularly appropriate in the age group of 18-44 years; (8) it is necessary to attract the media (websites, etc.) to increase patient awareness on the importance of primary prevention; and (9) it is necessary to legally separate nutraceuticals from dietary supplements. These consensus recommendations will help physicians in Ukraine effectively manage dyslipidemia in individuals with low-to-moderate CV risk.

Matched MeSH terms: Physicians, Family
Fulltext Family Medicine, Healthcare & Society: Essays By Dr M K Rajakumar, Second Edition

ISBN: 978-967-0538-17-4

Citation: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare & Society: Essays By Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019

First edition: 2008

Contents of second edition:
Preface to the Second Edition iii
Acknowledgements iv
Contents vi
Foreword by Dr Harbaskh Singh vii
Foreword by Professor Chris van Weel (in the First Edition) viii
Foreword by Datuk Dr D M Thuraiappah (in the First Edition) ix
Section 1: Primary Health Care and Family Medicine 1
1 Put not New Wine into Old Bottles 3
2 The Importance of Primary Care 6
3 Primary Health for all the People 11
4 The Evolution of General Practice 16
5 Future of Family Medicine in Developing Countries 23
6 Family Practice: Uniting Across Frontiers 27
Section 2: Training for Family Medicine 31
7 Specialisation in Primary Healthcare training for the new General Practice in Malaysia [summary] 32
8 A Proposal for the Training of Physicians in Primary Care for the Rural Areas of Malaysia 34
9 The Family Physician in Asia: Looking to the 21st Century 40
10 Training Family Doctors in a Developing Country 46
Section 3: Family Medicine journals 51
11 Family Physician [inaugural issue of Family Physician] 52
12 Our journal [inaugural issue of Malaysian Family Physician] 56
Section 4: Healthcare Improvement 58
13 The Future of the Health Services in Malaysia. [summary] 59
14 Quality in Family Practice 68 15 Foreword, In: Chee HL, Barraclough S (ed). Health Care in Malaysia 75 Section 5: Ethics and Professionalism 81
16 Ethical Consequences of Technological Change 83
17 Dr Sun Yat Sen Oration. Between Faith and Reason 91
18 Ethics, Professionalism and the “Trade” 99
19 Rural Health and Global Equity: Am I My Brother’s Keeper? 103
20 Achieving Equity Through a Primary Care-Led Health System 108 Section 6: Civil Society 112
21 Looking Back, Looking Forward 113
Appendix 1: Dr M K Rajakumar: A brief curriculum vitae 120
Appendix 2: Books and articles about Dr M K Rajakumar 124
Appendix 3: Reflections and comments 125

Matched MeSH terms: Physicians, Family

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