MyMedR

Fulltext Beliefs and behavior of deceivers in a randomized, controlled trial of anti-smoking advice at a primary care clinic in Kelantan, Malaysia

Jackson AA, Manan WA, Gani AS, Eldridge S, Carter YH

Southeast Asian J. Trop. Med. Public Health, 2004 Sep;35(3):748-55.

PMID: 15689099

Smoking deception is often ignored, but is important in health care. In this trial it was assessed at both study entry and outcome. At study entry, 1,044 males at a primary care clinic were asked smoking status and tested for breath carbon monoxide (CO). Of self-reported non-smokers, 57/402 (14%) were actually smokers, as were 59/251 (24%) of self-reported ex-smokers. The self-reported smokers (n=387) entered a randomized, controlled trial where the intervention comprised four questions on knowledge and beliefs about smoking, standardized verbal advice against smoking, and a leaflet. At follow-up, subjects were also questioned about beliefs. Follow-up was difficult, but 191/387 (49%) attended at three or six months. Of 27 who claimed to have quit, 6 (22%) were deceivers and 21 were confirmed quitters. Cessation did not differ between intervention and control groups. Overall confirmed cessation at six months was 16/387 (4.1 %). Confirmed quitters were significantly lighter smokers than deceivers and still smokers. There were non-significant trends between the outcome groups whereby deceivers had least knowledge and most lay beliefs, and quitters had most knowledge and fewest lay beliefs. The lay beliefs may prevent some smokers from quitting.

Study site: open-access outpatients
clinic (KPM) attached to the teaching hospital
(HUSM) of Universiti Sains Malaysia

Matched MeSH terms: Primary Health Care*

Fulltext Effectiveness of a culturally adapted biopsychosocial intervention (POHON SIHAT) in improving self-efficacy in patients with diabetes attending primary healthcare clinics in Putrajaya, Malaysia: study protocol of a randomised controlled trial

Suhaimi AF, Ibrahim N, Tan KA, Silim UA, Moore G, Ryan B, et al.

BMJ Open, 2020 02 16;10(2):e033920.

PMID: 32066607 DOI: 10.1136/bmjopen-2019-033920

INTRODUCTION: People with diabetes are often associated with multifaceted factors and comorbidities. Diabetes management frameworks need to integrate a biopsychosocial, patient-centred approach. Despite increasing efforts in promotion and diabetes education, interventions integrating both physical and mental health components are still lacking in Malaysia. The Optimal Health Programme (OHP) offers an innovative biopsychosocial framework to promote overall well-being and self-efficacy, going beyond education alone and has been identified as relevant within the primary care system. Following a comprehensive cultural adaptation process, Malaysia's first OHP was developed under the name 'Pohon Sihat' (OHP). The study aims to evaluate the effectiveness of the mental health-based self-management and wellness programme in improving self-efficacy and well-being in primary care patients with diabetes mellitus.

METHODS AND ANALYSIS: This biopsychosocial intervention randomised controlled trial will engage patients (n=156) diagnosed with type 2 diabetes mellitus (T2DM) from four primary healthcare clinics in Putrajaya. Participants will be randomised to either OHP plus treatment as usual. The 2-hour weekly sessions over five consecutive weeks, and 2-hour booster session post 3 months will be facilitated by trained mental health practitioners and diabetes educators. Primary outcomes will include self-efficacy measures, while secondary outcomes will include well-being, anxiety, depression, self-care behaviours and haemoglobin A1c glucose test. Outcome measures will be assessed at baseline, immediately postintervention, as well as at 3 months and 6 months postintervention. Where appropriate, intention-to-treat analyses will be performed.

ETHICS AND DISSEMINATION: This study has ethics approval from the Medical Research and Ethics Committee, Ministry of Health Malaysia (NMRR-17-3426-38212). Study findings will be shared with the Ministry of Health Malaysia and participating healthcare clinics. Outcomes will also be shared through publication, conference presentations and publication in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER: NCT03601884.

Matched MeSH terms: Primary Health Care

Mentoring for the Academy of Family Physicians of Malaysia

Ch'ng KS

Family Physician, 2000;11:16-7.

Matched MeSH terms: Primary Health Care

Assessing evidence of inequalities in access to medication for diabetic populations in low- and middle-income countries: a systematic review

Christiani Y, Dhippayom T, Chaiyakunapruk N

Glob Health Action, 2016 Dec;9(1):32505.

PMID: 28795917 DOI: 10.3402/gha.v9.32505

Background Inequalities in access to medications among people diagnosed with diabetes in low- and middle-income countries (LMICs) is a public health concern since untreated diabetes can lead to severe complications and premature death. Objective To assess evidence of inequalities in access to medication for diabetes in adult populations of people with diagnosed diabetes in LMICs. Design We conducted a systematic review of the literature using the PRISMA-Equity guidelines. A search of five databases - PubMed, Cochrane, CINAHL, PsycINFO, and EMBASE - was conducted from inception to November 2015. Using deductive content analysis, information extracted from the selected articles was analysed according to the PRISMA-Equity guidelines, based on exposure variables (place of residence, race/ethnicity, occupation, gender, religion, education, socio-economic status, social capital, and others). Results Fifteen articles (seven quantitative and eight qualitative studies) are included in this review. There were inconsistent findings between studies conducted in different countries and regions although financial and geographic barriers generally contributed to inequalities in access to diabetes medications. The poor, those with relatively low education, and people living in remote areas had less access to diabetes medications. Furthermore, we found that the level of government political commitment through primary health care and in the provision of essential medicines was an important factor in promoting access to medications. Conclusions The review indicates that inequalities exist in accessing medication among diabetic populations, although this was not evident in all LMICs. Further research is needed to assess the social determinants of health and medication access for people with diabetes in LMICs.

Matched MeSH terms: Primary Health Care

Fulltext Dr M K Rajakumar: On primary care (and population health)

Chan C K

CenPRIS Working Paper No. 129/10 (July 2010)
Republished in: An Uncommon Hero. p308-320
Dr M K Rajakumar fought the good fight on many fronts. In the 1970s, with domestic left-wing politics on the ebb, Dr Rajakumar shifted his energies to another arena of human endeavor he was passionate about, health and medical care for the needful. Throughout the 1980s and 1990s, Dr Rajakumar worked tirelessly to advance primary care medicine and to raise the standard of its practice in Malaysia and in the region. This article explores his writings on primary care within the context of an emerging population health perspective. KEYWORDS: MK Rajakumar, primary care, population health, biomedical sciences, politics

Matched MeSH terms: Primary Health Care

Fulltext Utility and usability of an automated COVID-19 symptom monitoring system (CoSMoS) in primary care during COVID-19 pandemic: A qualitative feasibility study

Lim HM, Abdullah A, Ng CJ, Teo CH, Valliyappan IG, Abdul Hadi H, et al.

Int J Med Inform, 2021 Nov;155:104567.

PMID: 34536808 DOI: 10.1016/j.ijmedinf.2021.104567

BACKGROUND: COVID-19 telemonitoring applications have been developed and used in primary care to monitor patients quarantined at home. There is a lack of evidence on the utility and usability of telemonitoring applications from end-users' perspective.

OBJECTIVES: This study aimed to evaluate the feasibility of a COVID-19 symptom monitoring system (CoSMoS) by exploring its utility and usability with end-users.

METHODS: This was a qualitative study using in-depth interviews. Patients with suspected COVID-19 infection who used CoSMoS Telegram bot to monitor their COVID-19 symptoms and doctors who conducted the telemonitoring via CoSMoS dashboard were recruited. Universal sampling was used in this study. We stopped the recruitment when data saturation was reached. Patients and doctors shared their experiences using CoSMoS, its utility and usability for COVID-19 symptoms monitoring. Data were coded and analysed using thematic analysis.

RESULTS: A total of 11 patients and 4 doctors were recruited into this study. For utility, CoSMoS was useful in providing close monitoring and continuity of care, supporting patients' decision making, ensuring adherence to reporting, and reducing healthcare workers' burden during the pandemic. In terms of usability, patients expressed that CoSMoS was convenient and easy to use. The use of the existing social media application for symptom monitoring was acceptable for the patients. The content in the Telegram bot was easy to understand, although revision was needed to keep the content updated. Doctors preferred to integrate CoSMoS into the electronic medical record.

CONCLUSION: CoSMoS is feasible and useful to patients and doctors in providing remote monitoring and teleconsultation during the COVID-19 pandemic. The utility and usability evaluation enables the refinement of CoSMoS to be a patient-centred monitoring system.

Matched MeSH terms: Primary Health Care

A systematic review of anxiety prevalence in adults within primary care and community settings in Malaysia

Wong CH, Sultan Shah ZU, Teng CL, Lin TQ, Majeed ZA, Chan CW

Asian J Psychiatr, 2016 Dec;24:110-117.

PMID: 27931891 DOI: 10.1016/j.ajp.2016.08.020

BACKGROUND: Anxiety disorders are common mental health disorders with significant impact on the individual as well as burden on the country as a whole.
METHODS: A systematic review of databases, reference lists, internet sources, and input from content experts revealed 42 studies that documented the prevalence of anxiety symptoms or disorders. 12 of these studies specifically evaluated anxiety disorders.
RESULTS: 4 studies looked at the prevalence of anxiety disorders in the general population, whilst the remainder focused on selected population groups: university students (4 studies); substance abuse (3 studies); and victims of abuse (1 study). Studies in the general population showed that the prevalence of generalised anxiety disorder was 0.4-5.6%, mixed anxiety and depression were 3-5%, panic without agoraphobia 0.4%, phobia unspecified 0.5-%, and anxiety not-otherwise-specified 0.3-6.5%. We found significant variability in anxiety disorders in the studies in selected population groups. The variability could also have been affected by methodological factors within each study.
CONCLUSION: This study provides a broad overview of the prevalence of anxiety disorders in Malaysia. More research is required to develop diagnostic instruments that are validated for local use and comparable with international standards. Reliable prevalence estimates are lacking within certain groups, e.g. those in rural, indigenous, migrant population groups and those exposed to natural disasters.

Matched MeSH terms: Primary Health Care/statistics & numerical data*

Fulltext Type 2 diabetes mellitus with hypertension at primary healthcare level in Malaysia: are they managed according to guidelines?

Chan GC

Singapore Med J, 2005 Mar;46(3):127-31.

PMID: 15735877

A study was conducted at primary healthcare level in the Melaka Tengah district of Malaysia to determine whether hypertension in patients with type 2 diabetes mellitus were managed according to guidelines.

Matched MeSH terms: Primary Health Care/methods; Primary Health Care/standards*

Fulltext Notes for the primary care teacher: quality assurance in teaching

Chan SC

Malays Fam Physician, 2008;3(2):104-6.

PMID: 25606128

Matched MeSH terms: Primary Health Care

Fulltext Use of complementary medicine amongst hypertensive patients in a public primary care clinic in Ipoh

Mahfudz AS, Chan SC

Med J Malaysia, 2005 Oct;60(4):454-9.

PMID: 16570707

The use and reasons for use of Complementary Medicine (CM) amongst hypertensive patients attending the Hypertension/ Diabetes/ Asthma Clinic in Greentown Health Clinic, Ipoh was assessed. One hundred and twenty patients were selected by systematic random sampling (1:5) over a 2-week period commencing 26/04/04. Data was obtained from interviews, questionnaires and medical records. Twenty seven percent were on CM. Most commonly used CM was herbal medicine. Majority of those using CM for BP control were Malays. The Chinese and Indians were using CM mainly for other health problems. Ninety six percent were using both CM and conventional therapy concurrently. Therefore doctors should enquire about CM usage during patient assessment to prevent possible drug interactions.

Matched MeSH terms: Primary Health Care/utilization*

Fulltext Use of complementary medicine amongst asthmatic patients in primary care

Mokhtar N, Chan SC

Med J Malaysia, 2006 Mar;61(1):125-7.

PMID: 16708752 MyJurnal

Complementary Medicine (CM) usage amongst asthmatic patients was studied. Eighty-eight patients, selected by systematic random sampling in two public polyclinics in April/May 2004, were interviewed. They completed a structured pre-tested questionnaire. Forty-one percent were using CM, majority (64%) together with conventional therapy. Eighty-one percent did not inform their physicians of their CM usage. More Malays were using CM which included nutritional supplements, herbs, yoga, homoeopathy, reflexology and massage.

Matched MeSH terms: Primary Health Care*

Fulltext Knowledge and practice of complementary medicine amongst public primary care clinic doctors in Kinta district, Perak

Ismail IA, Chan SC

Med J Malaysia, 2004 Mar;59(1):4-10.

PMID: 15535328 MyJurnal

The knowledge and practice of doctors (n=40) towards complementary medicine (CM) in 16 health clinics in the Kinta District were assessed by questionnaire. Thirty-four (85%) responded. More than half felt that acupuncture (73.50), homeopathy (59%) and herbal medicine (59%) were occasionally harmful. Forty-four percent felt manipulative therapy was frequently harmful. Relaxation technique (79%) and nutritional therapy (44%) were considered most frequently useful. 59% used some form of CM. There were no significant differences found in usage rates by gender, age group and exposure to CM during undergraduate training. Sixty-seven percent had encouraged patients to seek CM. Seventy-three percent perceived an increasing demand for CM. Eighty-eight percent were in favour of a hospital based CM referral center. Only 6% were trained in CM.
Study site: Klinik kesihatan, Perak, Malaysia

Matched MeSH terms: Primary Health Care/standards*

Fulltext Primary care--directions we should be taking

Chan SC

Med J Malaysia, 2005 Jun;60(2):127-9.

PMID: 16114150

Matched MeSH terms: Primary Health Care/trends*

Fulltext Appropriateness of medical admissions from a Malaysian public primary care clinic

Chan SC

Med J Malaysia, 1999 Sep;54(3):329-37.

PMID: 11045059

Appropriateness of medical admissions from a Malaysian public primary care clinic (Outpatient Department, Hospital Ipoh) was assessed by two physicians using a modified appropriateness evaluation protocol. Of 122 admissions between 16/6/96 and 15/7/96, 107 records (88%) could be traced from the records office. Eighty percent (86/107) were found to be appropriate and 20% (21/107) inappropriate admissions. Inappropriate admissions included admissions to the wrong discipline and patients who could be investigated and stabilised as outpatients or could be referred to specialist clinics. Protocols, provisions for urgent referrals and medical updates for doctors are recommended.

Study site: Outpatient Department, Hospital Ipoh

Matched MeSH terms: Primary Health Care*

Fulltext A Malaysian Well Person's Clinic--review of patients seen between April and December 1995

Chan SC

Med J Malaysia, 1997 Mar;52(1):53-9.

PMID: 10968053

The Well Man & Well Woman's Clinic in Ipoh Hospital provides screening for coronary risk factors and early detection of cancer. This retrospective review of 1095 patients screened between April and December 1995 showed 48% had one or more coronary risk factors--1 risk (29%), 2 risks (14%), 3 or more risks (5%). Modifiable risks included hypertension (10%), obesity (9%), diabetes mellitus (8%) and smoking (7%). Sixteen abnormal Papanicolaou smears and six cancers (three cervical, two breast and one ovarian) were detected. Public response was good. There is a need for clinics offering comprehensive screening in Malaysian primary health care.

Study site: The Well Man & Well Woman's Clinic in Ipoh Hospital

Matched MeSH terms: Primary Health Care*

Fulltext Morbidity patterns in elderly patients presenting to a family practice

Teoh LC, Chan SC

Family Physician, 2003;12(1):24-28.

The morbidity patterns of elderly patients presenting to a family physician clinic was studied by the attending physician completing a questionnaire on all elderly patients aged 60 and above attending the clinic between 1st January to 31st March 2000. 612 elderly patients registered during the study period. The most common presentations included upper respiratory tract infections (21.6%), hypertension and diabetes mellitus (18%), gastritis/dyspepsia (5.0%) and injuries (5.0%), Musculoskeletal complaints (backache, gout, osteoarthritis) and anxiety were also among the top 10 most common presenting complaints. Injuries were mainly soft tissue injuries and sprains sustained at home. Some were preventable.

Matched MeSH terms: Primary Health Care

The demographic and morbidity patterns seen in an outpatient department in a Malaysian General Hospital

Chan SC

Family Physician, 1995;7:3-10.

This study aimed to established baseline data on patients' demographic and morbidity patterns over three months in the Outpatients Department (OPD) Ipoh Hospital. Entry of the first ten thousand patients into a computerised database for analysis showed that the majority were unemployed and from the low income group. There were more Malays and Indians, less Chinese. Respiratory infections accounted for 18.5 % while major chronic diseases (hypertension, diabetes mellitus, asthma) were common. Overall a wide spectrum of illnesses were seen. A career structure for OPD doctors and incorporation of Family Medicine concepts were proposed to improve primary care in OPD.
Study site: Outpatients Department (OPD), Hospital Ipoh, Perak, Malaysia

Matched MeSH terms: Primary Health Care

Fulltext Comparing organization and management in private & public primary care clinics in Kinta district

Chan SC

Family Physician, 2003;12(2&3):36-40.

Between 2/10/2000 and 30/1/2001, the organizational structure and management in 4 general practice (GP) clinics & 2 health centers (HC) in Kinta District were studied by 14 Level 4 medical students of Perak College of Medicine. Data collected from work process files and staff interviews / shadowing showed that GPs in the study had more working experience with postgraduate qualifications than HC doctors. All HC nurses but only one GP clinic nurse had formal training. HC organization was more complex with documentation. GP organization was simple and lacked documentation. HC management was by a group while GPs handled all management aspects. This study enhanced students' understanding of Malaysian primary care system.

Matched MeSH terms: Primary Health Care

Fulltext Research Notes. 1. Why research? What research?

Chan SC

Family Physician, 2005;13(3):23-24.

Matched MeSH terms: Primary Health Care

Fulltext Comparing morbidity patterns in two government health centers and four private GP clinics in the Kinta district

Ding HJ, Chan SC

Family Physician, 2003;12(2&3):25-29.

The morbidity patterns and demographics of patients presenting to two government health centers and four private general practice clinics were studied over one week. Results showed little difference in the morbidity patterns but a significant difference in the demographics of the patients. The commonest illnesses seen were minor ones like upper respiratory tract infection and chronic ones like hypertension and diabetes mellitus. A wide spectrum of illnesses was seen in all the clinics. Both places handled few emergencies and referred only occasionally. There was an equal percentage of patients from both sexes. Ages of the patients varied from place to place and the racial distribution was influenced by several factors, including the existing patient population and the race of the doctor.

Matched MeSH terms: Primary Health Care

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