We assessed the effectiveness of an educational intervention in reducing antibiotic prescribing in public primary care clinics in Malaysia. Twenty-nine medical officers in nine clinics received an educational intervention consisting of academic detailing from the resident Family Medicine Specialist, as well as an information leaflet. The antibiotic prescribing rates were assessed for six months - three months before and three months after the intervention. A total of 28,562 prescriptions were analyzed. Among participating doctors, general antibiotic prescribing rates for pre- and post-intervention phases were 14.3% and 11.0% (post-intervention vs pre-intervention RR 0.77, 95% CI 0.72 to 0.83). The URTI-specific antibiotic prescribing rates for pre- and post-intervention phases were 27.7% and 16.6%, respectively (post-intervention vs pre-intervention RR 0.60, 95% CI 0.54 to 0.66). No significant change in antibiotic prescribing rates was observed among primary care practitioners who did not participate in the study. This low cost educational intervention using both active and passive strategies focusing on URTI produced a statistically significant (and clinically important) reduction in antibiotic prescribing.
Study site: Klinik Kesihatan, Negeri Sembilan, Malaysia
Antibiotic prescribing by primary care doctors has received renewed interest due to the continuing emergence of antibiotic resistance and the attendant cost to healthcare. We examined the antibiotic prescribing rate in relation to selected socio-demographic characteristics of the prescribers at the Seremban Health Clinic, a large public primary care clinic, designated for teaching, in the state of Negeri Sembilan, Malaysia. Data were obtained from: (1) retrospective review of prescriptions for the month of June 2002 and (2) a questionnaire survey of prescribers. A total of 10667 prescriptions were reviewed. The overall antibiotic prescribing rate was 15%; the rate (16%) was higher for the general Outpatient Department (OPD) than the 3% for the Maternal & Child Health Clinic (MCH). The antibiotic prescription rates for upper respiratory tract infection (URTI) were 26% and 16%, respectively, for the OPD and MCH. Half of all the antibiotic prescriptions were for URTI making prescribing for URTI an appropriate target for educational intervention. The URTI-specific antibiotic prescription rate did not correlate with the prescribers' intention to specialise, patient load, perceived patient's expectation for an antibiotic, or the score for knowledge of streptococcal tonsillitis. Prescribing behaviours and record-keeping practices requiring correction were identified.
Study site: Klinik Kesihatan Seremban, Negeri Sembilan, Malaysia
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
INTRODUCTION: The aim of this study was to determine the extent to which primary care doctors assessed patients newly diagnosed with hypertension for the risk factors of cardiovascular disease (CVD) during the patients' first clinic visit for hypertension. The study also aimed to examine the trend of assessment for CVD risk factors over a 15-year period.
METHODS: This retrospective study was conducted between January and May 2012. Data was extracted from the paper-based medical records of patients with hypertension using a 1:4 systematic random sampling method. Data collected included CVD risk factors and a history of target organ damage (TOD), which were identified during the patient's first visit to the primary care doctor for hypertension, as well as the results of the physical examinations and investigations performed during the same visit.
RESULTS: A total of 1,060 medical records were reviewed. We found that assessment of CVD risk factors during the first clinic visit for hypertension was poor (5.4%-40.8%). Assessments for a history of TOD were found in only 5.8%-11.8% of the records, and documented physical examinations and investigations for the assessment of TOD and secondary hypertension ranged from 0.1%-63.3%. Over time, there was a decreasing trend in the percentage of documented physical examinations performed, but an increasing trend in the percentage of investigations ordered.
CONCLUSION: There was poor assessment of the patients' CVD risk factors, secondary causes of hypertension and TOD at their first clinic visit for hypertension. The trends observed in the assessment suggest an over-reliance on investigations over clinical examinations.
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