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Fulltext Awareness, knowledge and practice of dyslipidaemia management among postgraduate primary care trainees in Malaysia: a cross-sectional study

Said AH, Chia YC

BMJ Open, 2017 03 01;7(3):e013573.
PMID: 28249849 DOI: 10.1136/bmjopen-2016-013573

OBJECTIVES: Dyslipidaemia is one of the main risk factors for cardiovascular disease, the leading cause of death in Malaysia. This study assessed the awareness, knowledge and practice of lipid management among primary care physicians undergoing postgraduate training in Malaysia.
DESIGN: Cross sectional study.
SETTING: Postgraduate primary care trainees in Malaysia.
PARTICIPANTS: 759 postgraduate primary care trainees were approached through email or hard copy, of whom 466 responded.
METHOD: A self-administered questionnaire was used to assess their awareness, knowledge and practice of dyslipidaemia management. The total cumulative score derived from the knowledge section was categorised into good or poor knowledge based on the median score, where a score of less than the median score was categorised as poor and a score equal to or more than the median score was categorised as good. We further examined the association between knowledge score and sociodemographic data. Associations were considered significant when p<0.05.
RESULTS: The response rate achieved was 61.4%. The majority (98.1%) were aware of the national lipid guideline, and 95.6% reported that they used the lipid guideline in their practice. The median knowledge score was 7 out of 10; 70.2% of respondents scored 7 or more which was considered as good knowledge. Despite the majority (95.6%) reporting use of guidelines, there was wide variation in their clinical practice whereby some did not practise based on the guidelines. There was a positive significant association between awareness and the use of the guideline with knowledge score (p<0.001). However there was no significant association between knowledge score and sociodemographic data (p>0.05).
CONCLUSIONS: The level of awareness and use of the lipid guideline among postgraduate primary care trainees was good. However, there were still gaps in their knowledge and practice which are not in accordance with standard guidelines.

Matched MeSH terms: Primary Health Care/standards
Reasons for referral to Primary Care Clinics, University Hospital Kuala Lumpur

Chin CK, Chia YC

Family Physician, 1992;4:13-16.

The reasons for referral of 189 patients referred to the Primary Care Out-patient Clinics, University Hospital Kuala Lumpur, were studied. 55.6% of them were from private general practitioners. 51.0% of the referrals were for evaluation of symptoms and 46.5% were for management of diseases. The profile of the referrals helps in curriculum planning of Primary Care Medicine. Other applications of the results are discussed.
Study site: Primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Primary Health Care
Physical examination and basic haematological findings in a selected group of migrant workers in Malaysia

Chia YC

JUMMEC, 2002;7:40-43.

The aim of this study was to determine the prevalence and extent of diseases present among migrant workers. A total of 809 migrant workers were examined. The mean BMI (Body Mass Index) was 22.3 kg/m2. Only 4.9% of the respondents had blood pressure greater than 140/90 mmHg. Generally the migrant workers examined were healthy, except for subjects with abnormal eosinophilia coutns, which may indicate occult parasitic infestation. Non-communicable disease in particular hypertension and diabetes mellitus are not major problems among migrant workers. Perhaps the target to aim at are the illegal migrant workers where more illness could be detected.

Matched MeSH terms: Primary Health Care
Hepatocellular carcinoma: A local registry on risk factors, imaging patterns, treatment strategies and overall survival

Raja M, Yaacob Y, Wong Z, Chik I

Med J Malaysia, 2021 03;76(2):151-156.
PMID: 33742621

INTRODUCTION: Hepatocellular carcinoma (HCC) is among the common death-causing cancers worldwide. This liver malignancy is primarily diagnosed using radiological imaging techniques. Most of the patients in Malaysia present late and were diagnosed at an intermediate or advanced stage of Barcelona Clinic of Liver Cancer (BCLC). This causes a limitation on the treatment options for the patients.
MATERIALS AND METHODS: We performed a retrospective crosssectional study of HCC cases within a five-year period in our center with data collected from Hospital Canselor Tunku Mukhriz (HCTM). This study examines the HCC risk factors, the pattern of diagnosis, treatment options and overall survival.
RESULTS: The findings from this study showed that viral hepatitis was the highest risk factor in which most of the patients were elderly males who presented with abdominal distension. In addition, given the high prevalence of metabolic diseases Malaysia, it is predicted that the number of non-alcoholic steatohepatosis (NASH)-related HCC cases might increase. Alpha-fetoprotein (AFP) proved to have no significant role in the detection of the disease. The number of patients detected at early BCLC was minimal, resulting in limited options of treatment. Overall survival of our HCC patients was poor at 17 months.
CONCLUSION: We conclude that HCC patients in HCTM mostly presented at late stage to hospital, hence limiting the treatment options and resulted in poor survival rate. Disease awareness should be implemented at primary care level to detect HCC at its early stage. Subsequently, a multidisciplinary hospital team is required to manage the disease at its different stages of presentation.

Matched MeSH terms: Primary Health Care
Fulltext Prevalence of non-dengue thrombocytopaenia among adult patients presenting with acute febrile illness in primary outpatient clinics

Tong SF, Aziz NA, Chin GL

Medicine & Health, 2006;1(1):25-30.
MyJurnal

A proportion of patients with acute viral fever with thrombocytopaenia does not necessary have dengue infection. Managing them indiscriminately as dengue infection may not be appropriate. The prevalence of this problem is not exactly known. The objective of this study is to determine the prevalence of acute non-dengue febrile thrombocytopaenia among adult patients presenting with acute non-specific febrile illness in an outpatient setting. This was a clinic-based cross sectional study. Consecutive patients presenting with non-specific febrile illness of less than two weeks were selected from the Primary Care Centre of Hospital Universiti Kebangsaan Malaysia (HUKM) and the Batu 9 Cheras Health Clinic. Full blood count was done on the day of visit and dengue serology was done on day five of illness for all patients enrolled. Seventy three patients participated in this study from May to November 2003. Among the patients, 35 (47.9%) were noted to have thrombocytopaenia. Fourteen (40%) patients with thrombocytopaenia were serologically negative. The prevalence of non-dengue febrile thrombocytopaenia was 19.2%. A significant number of patients with acute non-specific febrile illness with thrombocytopaenia were negative for dengue serology. These patients should be differentiated from those with acute febrile thrombocytopaenia, as they might differ in their natural history from those with dengue infection, and hence require different management strategies.

Study site: Primary Care Centre of Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)

Matched MeSH terms: Primary Health Care
Fulltext Depression, anxiety and stress symptoms among diabetics in Malaysia: a cross sectional study in an urban primary care setting

Kaur G, Tee GH, Ariaratnam S, Krishnapillai AS, China K

BMC Fam Pract, 2013;14:69.
PMID: 23710584 DOI: 10.1186/1471-2296-14-69

Diabetes mellitus is a highly prevalent condition in Malaysia, increasing from 11.6% in 2006 to 15.2% in 2011 among individuals 18 years and above. Co-morbid depression in diabetics is associated with hyperglycemia, diabetic complications and increased health care costs. The aims of this study are to determine the prevalence and predictors of depression, anxiety and stress symptoms in Type II diabetics attending government primary care facilities in the urban area of Klang Valley, Malaysia.

Matched MeSH terms: Primary Health Care
Fulltext Does use of pooled cohort risk score overestimate the use of statin?: a retrospective cohort study in a primary care setting

Chia YC, Lim HM, Ching SM

BMC Fam Pract, 2014;15:172.
PMID: 25388219 DOI: 10.1186/s12875-014-0172-y

BACKGROUND: Initiation of statin therapy as primary prevention particularly in those with mildly elevated cardiovascular disease risk factors is still being debated. The 2013 ACC/AHA blood cholesterol guideline recommends initiation of statin by estimating the 10-year atherosclerotic cardiovascular disease (ASCVD) risk using the new pooled cohort risk score. This paper examines the use of the pooled cohort risk score and compares it to actual use of statins in daily clinical practice in a primary care setting.
METHODS: We examined the use of statins in a randomly selected sample of patients in a primary care clinic. The demographic data and cardiovascular risk parameters were captured from patient records in 1998. The pooled cohort risk score was calculated based on the parameters in 1998. The use of statins in 1998 and 2007, a 10-year interval, was recorded.
RESULTS: A total of 847 patients were entered into the analysis. Mean age of the patients was 57.2 ± 8.4 years and 33.1% were male. The use of statins in 1998 was only 10.2% (n = 86) as compared to 67.5% (n = 572) in 2007. For patients with LDL 70-189 mg/dl and estimated 10-year ASCVD risk ≥7.5% (n = 190), 60% (n = 114) of patients were on statin therapy by 2007. There were 124 patients in whom statin therapy was not recommended according to ACC/AHA guideline but were actually receiving statin therapy.
CONCLUSIONS: An extra 40% of patients need to be treated with statin if the 2013 ACC/AHA blood cholesterol guideline is used. However the absolute number of patients who needed to be treated based on the ACC/AHA guideline is lower than the number of patients actually receiving it in a daily clinical practice. The pooled cohort risk score does not increase the absolute number of patients who are actually treated with statins. However these findings and the use of the pooled cohort risk score need to be validated further.
Study site: Primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Primary Health Care*
Fulltext Validation of the pooled cohort risk score in an Asian population - a retrospective cohort study

Chia YC, Lim HM, Ching SM

BMC Cardiovasc Disord, 2014 Nov 20;14:163.
PMID: 25410585 DOI: 10.1186/1471-2261-14-163

BACKGROUND: The Pooled Cohort Risk Equation was introduced by the American College of Cardiology (ACC) and American Heart Association (AHA) 2013 in their Blood Cholesterol Guideline to estimate the 10-year atherosclerotic cardiovascular disease (ASCVD) risk. However, absence of Asian ethnicity in the contemporary cohorts and limited studies to examine the use of the risk score limit the applicability of the equation in an Asian population. This study examines the validity of the pooled cohort risk score in a primary care setting and compares the cardiovascular risk using both the pooled cohort risk score and the Framingham General Cardiovascular Disease (CVD) risk score.
METHODS: This is a 10-year retrospective cohort study of randomly selected patients aged 40-79 years. Baseline demographic data, co-morbidities and cardiovascular (CV) risk parameters were captured from patient records in 1998. Pooled cohort risk score and Framingham General CVD risk score for each patient were computed. All ASCVD events (nonfatal myocardial infarction, coronary heart disease (CHD) death, fatal and nonfatal stroke) occurring from 1998-2007 were recorded.
RESULTS: A total of 922 patients were studied. In 1998, mean age was 57.5 ± 8.8 years with 66.7% female. There were 47% diabetic patients and 59.9% patients receiving anti-hypertensive treatment. More than 98% of patients with pooled cohort risk score ≥7.5% had FRS >10%. A total of 45 CVD events occurred, 22 (7.2%) in males and 23 (3.7%) in females. The median pooled cohort risk score for the population was 10.1 (IQR 4.7-20.6) while the actual ASCVD events that occurred was 4.9% (45/922). Our study showed moderate discrimination with AUC of 0.63. There was good calibration with Hosmer-Lemeshow test χ2 = 12.6, P = 0.12.
CONCLUSIONS: The pooled cohort risk score appears to overestimate CV risk but this apparent over-prediction could be a result of treatment. In the absence of a validated score in an untreated population, the pooled cohort risk score appears to be appropriate for use in a primary care setting.

Matched MeSH terms: Primary Health Care
Fulltext Prevalence and predictors of resistant hypertension in a primary care setting: a cross-sectional study

Chia YC, Ching SM

BMC Fam Pract, 2014;15:131.
PMID: 24997591 DOI: 10.1186/1471-2296-15-131

Patients with resistant hypertension are subjected to a higher risk of getting stroke, myocardial infarction, congestive heart failure and renal failure. However, the exact prevalence of resistant hypertension in treated hypertensive patients in Malaysia is not known. This paper examines the prevalence and determinants of resistant hypertension in a sample of hypertensive patients.

Study site: Primary care clinic, Universiti Malaya Medical Centre

Matched MeSH terms: Primary Health Care*
Fulltext Hypertension and the development of new onset chronic kidney disease over a 10 year period: a retrospective cohort study in a primary care setting in Malaysia

Chia YC, Ching SM

BMC Nephrol, 2012 Dec 24;13:173.
PMID: 23259489 DOI: 10.1186/1471-2369-13-173

BACKGROUND: Little is known about the rate of progression to chronic kidney disease (CKD) among hypertensive patients, particularly at the primary care level. This study aims to examine risk factors associated with new onset CKD among hypertensive patients attending a primary care clinic.
METHODS: This is a 10-year retrospective cohort study of 460 patients with hypertension who were on treatment. Patient information was collected from patient records. CKD was defined as a glomerular filtration rate <60 ml/min per 1.73 m2 (Cockcroft-Gault equation). Multiple logistic regression statistics was used to test the association in newly diagnosed CKD.
RESULTS: The incidence of new CKD was 30.9% (n = 142) with an annual rate of 3%. In multivariate logistic regression analysis, factors associated with development of new onset of CKD among hypertensive patients were older age (odds ratio [OR] 1.123, 95% confidence interval [CI] 1.078-1.169), presence of diabetes (OR 2.621, 95% CI 1.490-4.608), lower baseline eGFR (OR 1.041, 95% CI 0.943-0.979) and baseline hyperuricaemia (OR 1.004, 95% CI 1.001-1.007).
CONCLUSIONS: The progression to new onset CKD is high among urban multiethnic hypertensive patients in a primary care population. Hence every effort is needed to detect the presence of new onset CKD earlier. Hypertensive patients who are older, with underlying diabetes, hyperuricaemia and lower baseline eGFR are associated with the development of CKD in this population.

Matched MeSH terms: Primary Health Care/methods; Primary Health Care/trends*
Fulltext Validation of the Framingham general cardiovascular risk score in a multiethnic Asian population: a retrospective cohort study

Chia YC, Gray SY, Ching SM, Lim HM, Chinna K

BMJ Open, 2015;5(5):e007324.
PMID: 25991451 DOI: 10.1136/bmjopen-2014-007324

OBJECTIVE: This study aims to examine the validity of the Framingham general cardiovascular disease (CVD) risk chart in a primary care setting.
DESIGN: This is a 10-year retrospective cohort study.
SETTING: A primary care clinic in a teaching hospital in Malaysia.
PARTICIPANTS: 967 patients' records were randomly selected from patients who were attending follow-up in the clinic.
MAIN OUTCOME MEASURES: Baseline demographic data, history of diabetes and smoking, blood pressure (BP), and serum lipids were captured from patient records in 1998. Each patient's Framingham CVD score was computed from these parameters. All atherosclerotic CVD events occurring between 1998 and 2007 were counted.
RESULTS: In 1998, mean age was 57 years with 33.8% men, 6.1% smokers, 43.3% diabetics and 59.7% hypertensive. Median BP was 140/80 mm Hg and total cholesterol 6.0 mmol/L (1.3). The predicted median Framingham general CVD risk score for the study population was 21.5% (IQR 1.2-30.0) while the actual CVD events that occurred in the 10 years was 13.1% (127/967). The median CVD points for men was 30.0, giving them a CVD risk of more than 30%; for women it is 18.5, a CVD risk of 21.5%. Our study found that the Framingham general CVD risk score to have moderate discrimination with an area under the receiver operating characteristic curve (AUC) of 0.63 [c-statistic or c-index]. It also discriminates well for Malay (AUC 0.65, p=0.01), Chinese (AUC 0.60, p=0.03), and Indians (AUC 0.65, p=0.001). There was good calibration with Hosmer-Lemeshow test χ(2)=3.25, p=0.78.
CONCLUSIONS: Taking into account that this cohort of patients were already on treatment, the Framingham General CVD Risk Prediction Score predicts fairly accurately for men and overestimates somewhat for women. In the absence of local risk prediction charts, the Framingham general CVD risk prediction chart is a reasonable alternative for use in a multiethnic group in a primary care setting.
Study site: Primary care clinic,University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia.

Matched MeSH terms: Primary Health Care*
Fulltext Development and validation of the Evidence Based Medicine Questionnaire (EBMQ) to assess doctors' knowledge, practice and barriers regarding the implementation of evidence-based medicine in primary care

Hisham R, Ng CJ, Liew SM, Lai PSM, Chia YC, Khoo EM, et al.

BMC Fam Pract, 2018 06 23;19(1):98.
PMID: 29935527 DOI: 10.1186/s12875-018-0779-5

BACKGROUND: Evidence-Based Medicine (EBM) integrates best available evidence from literature and patients' values, which then informs clinical decision making. However, there is a lack of validated instruments to assess the knowledge, practice and barriers of primary care physicians in the implementation of EBM. This study aimed to develop and validate an Evidence-Based Medicine Questionnaire (EBMQ) in Malaysia.
METHODS: The EBMQ was developed based on a qualitative study, literature review and an expert panel. Face and content validity was verified by the expert panel and piloted among 10 participants. Primary care physicians with or without EBM training who could understand English were recruited from December 2015 to January 2016. The EBMQ was administered at baseline and two weeks later. A higher score indicates better knowledge, better practice of EBM and less barriers towards the implementation of EBM. We hypothesized that the EBMQ would have three domains: knowledge, practice and barriers.
RESULTS: The final version of the EBMQ consists of 80 items: 62 items were measured on a nominal scale, 22 items were measured on a 5 point Likert-scale. Flesch reading ease was 61.2. A total of 343 participants were approached; of whom 320 agreed to participate (response rate = 93.2%). Factor analysis revealed that the EBMQ had eight domains after 13 items were removed: "EBM websites", "evidence-based journals", "types of studies", "terms related to EBM", "practice", "access", "patient preferences" and "support". Cronbach alpha for the overall EBMQ was 0.909, whilst the Cronbach alpha for the individual domain ranged from 0.657-0.940. The EBMQ was able to discriminate between doctors with and without EBM training for 24 out of 42 items. At test-retest, kappa values ranged from 0.155 to 0.620.
CONCLUSIONS: The EBMQ was found to be a valid and reliable instrument to assess the knowledge, practice and barriers towards the implementation of EBM among primary care physicians in Malaysia.

Matched MeSH terms: Primary Health Care*
Fulltext Number of blood pressure measurements needed to estimate long-term visit-to-visit systolic blood pressure variability for predicting cardiovascular risk: a 10-year retrospective cohort study in a primary care clinic in Malaysia

Lim HM, Chia YC, Ching SM, Chinna K

BMJ Open, 2019 Apr 20;9(4):e025322.
PMID: 31005918 DOI: 10.1136/bmjopen-2018-025322

OBJECTIVE: To determine the reproducibility of visit-to-visit blood pressure variability (BPV) in clinical practice. We also determined the minimum number of blood pressure (BP) measurements needed to estimate long-term visit-to-visit BPV for predicting 10-year cardiovascular (CV) risk.
DESIGN: Retrospective study SETTING: A primary care clinic in a university hospital in Malaysia.
PARTICIPANTS: Random sampling of 1403 patients aged 30 years and above without any CV event at baseline.
OUTCOMES MEASURES: The effect of the number of BP measurement for calculation of long-term visit-to-visit BPV in predicting 10-year CV risk. CV events were defined as fatal and non-fatal coronary heart disease, fatal and non-fatal stroke, heart failure and peripheral vascular disease.
RESULTS: The mean 10-year SD of systolic blood pressure (SBP) for this cohort was 13.8±3.5 mm Hg. The intraclass correlation coefficient (ICC) for the SD of SBP based on the first eight and second eight measurements was 0.38 (p<0.001). In a primary care setting, visit-to-visit BPV (SD of SBP calculated from 20 BP measurements) was significantly associated with CV events (adjusted OR 1.07, 95% CI 1.02 to 1.13, p=0.009). Using SD of SBP from 20 measurement as reference, SD of SBP from 6 measurements (median time 1.75 years) has high reliability (ICC 0.74, p<0.001), with a mean difference of 0.6 mm Hg. Hence, a minimum of six BP measurements is needed for reliably estimating intraindividual BPV for CV outcome prediction.
CONCLUSION: Long-term visit-to-visit BPV is reproducible in clinical practice. We suggest a minimum of six BP measurements for calculation of intraindividual visit-to-visit BPV. The number and duration of BP readings to derive BPV should be taken into consideration in predicting long-term CV risk.

Matched MeSH terms: Primary Health Care/methods; Primary Health Care/statistics & numerical data
Fulltext Chronic disease management in Singapore polyclinics

Lee VKM, Tan NC, Chong MH

Malays Fam Physician, 2006;1(2):94-96.
PMID: 27570599 MyJurnal

Singapore health care has taken a major leap and invested a large amount of money and work force in chronic disease management. These changes attempt to integrate population perspectives and personcentred perspectives. Primary health care team can play a lead role in chronic illness care, but health care organisation system support and policy are critical to its success. (Copied from article).

Matched MeSH terms: Primary Health Care
Fulltext The role of general practitioners in the management of erectile dysfunction-a qualitative study

Ng CJ, Low WY, Tan NC, Choo WY

Int J Impot Res, 2004 Feb;16(1):60-3.
PMID: 14963472 DOI: 10.1038/sj.ijir.3901141

The objective of this study was to explore the roles and perceptions of general practitioners (GPs) in the management of erectile dysfunction (ED). This qualitative study used focus group discussions and in-depth interviews. This study was conducted based on 28 GPs from an urban area in Malaysia who had managed patients with ED and prescribed anti-ED drugs. Main outcome measures included the roles of GPs in managing patients with ED (active or passive), perceptions regarding ED and the treatment, and factors influencing their decision to prescribe. Majority of the GPs assumed a passive role when managing patients with ED. This was partly due to their perception of the disease being nonserious. Some also perceived ED as mainly psychological in nature. The anti-ED drugs were often viewed as a lifestyle drug with potentially serious side effects. The fear of being perceived by patients as 'pushing' for the drug and being blamed if the patients were to develop serious side effects also hampered the management of this disease. GPs who participated in this study remained passive in identifying and treating patients with ED and this was attributed to their perception of the disease, drug treatment and patient's background.

Matched MeSH terms: Primary Health Care*
Development of a Sexually Transmitted Disease Client-friendly Unit at a Primary Care Clinic in Malaysia: Lessons Learnt

Pannir Selvam SB, Khoo EM, Chow SY, Wong PF, Mohsin SS, Abdullah A, et al.

Sex Transm Dis, 2019 02;46(2):143-145.
PMID: 30278029 DOI: 10.1097/OLQ.0000000000000918

Management of sexually transmitted diseases and human immunodeficiency virus is challenging due to the social stigma attached. We describe the development of a client-friendly sexually transmitted disease service in a primary care clinic in Malaysia with a special focus on key populations. Challenges and key lessons learnt from its development and implementation are discussed.

Matched MeSH terms: Primary Health Care/methods*
Practice Advisory on the Appropriate Use of NSAIDs in Primary Care

Ho KY, Cardosa MS, Chaiamnuay S, Hidayat R, Ho HQT, Kamil O, et al.

J Pain Res, 2020;13:1925-1939.
PMID: 32821151 DOI: 10.2147/JPR.S247781

Cyclo-oxygenase (COX)-2 selective and nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) are important in managing acute and chronic pain secondary to inflammation. As a greater understanding of the risks of gastrointestinal (GI), cardiovascular (CV) and renal events with NSAIDs use has emerged, guidelines have evolved to reflect differences in risks among NSAIDs. Updated guidelines have yet to reflect new evidence from recent trials which showed similar CV event rates with celecoxib compared to naproxen and ibuprofen, and significantly better GI tolerability for celecoxib. This practice advisory paper aims to present consensus statements and associated guidance regarding appropriate NSAID use based on a review of current evidence by a multidisciplinary group of expert clinicians. This paper is especially intended to guide primary care practitioners within Asia in the appropriate use of NSAIDs in primary care. Following a literature review, group members used a modified Delphi consensus process to determine agreement with selected recommendations. Agreement with a statement by 75% of total voting members was defined a priori as consensus. For low GI risk patients, any nonselective NSAID plus proton pump inhibitor (PPI) or celecoxib alone is acceptable treatment when CV risk is low; for high CV risk patients, low-dose celecoxib or naproxen plus PPI is appropriate. For high GI risk patients, celecoxib plus PPI is acceptable for low CV risk patients; low-dose celecoxib plus PPI is appropriate for high CV risk patients, with the alternative to avoid NSAIDs and consider opioids instead. Appropriate NSAID prescription assumes that the patient has normal renal function at commencement, with ongoing monitoring recommended. In conclusion, appropriate NSAID use requires consideration of all risks.

Matched MeSH terms: Primary Health Care
Fulltext A Rome III survey of functional dyspepsia among the ethnic Malays in a primary care setting

Lee YY, Wahab N, Mustaffa N, Daud N, Mohd Noor N, Shaaban J, et al.

BMC Gastroenterol, 2013;13:84.
PMID: 23672671 DOI: 10.1186/1471-230X-13-84

Backgrounds: The study aimed to survey for FD in a primary care setting in a population known to have an extremely low prevalence of Helicobacter pylori (H. pylori) infection, with the hypothesis that in such a population, dyspepsia should have been relatively less common.
Methods: The Rome III FD Diagnostic Questionnaire was translated into the Malay language and later tested for reliability. A prospective cross-sectional survey was then performed involving 160 Malay patients attending primary care clinic after informed consent. Patients positive for symptoms of FD were subjected to upper endoscopy and exclusion of H. pylori infection. Univariable and multivariable analyses were used to test for associated risk factors.
Results: The back-translated questionnaire was similar to the original English version and was reliable (Cronbach Alpha-coefficient 0.85). Of the 160 surveyed subjects, 19 of them (11.9%) had symptoms of FD. With exclusion of erosive diseases (3/160 or 1.9%) from endoscopy, 16 subjects or 10% had FD. None of the 19 subjects were positive for H. pylori infection. Epigastric pain syndrome was present in 11/16 (68.8%) and the rest, overlap with postprandial distress syndrome. With multivariable analysis, a married status (OR = 8.1; 95% CI 1.0-36.5) and positive psychosocial alarm symptoms (OR = 3.8; 95% CI 1.0-14.0) were associated with FD. Of those married subjects, females were more likely to have FD and psychosocial symptoms than men (6.3% vs. 1.9%), P = 0.04.
Conclusions: FD was more common than one had expected among Malays attending primary care clinic in an area with low prevalence of H. pylori.
Keywords: Functional dyspepsia, Malays, Rome III, Females, Marriage, Psychosocial alarm
Questionnaire: Rome III Functional Dyspepsia Diagnostic questionnaire; Red Flag Questionnaire; Psychosocial Alarm Questionnaire; Hospital Anxiety Depression Scale; HADS

Study site: primary care clinic within the university hospital of Universiti Sains Malaysia (USM)

Matched MeSH terms: Primary Health Care*
Fulltext Satisfaction level and asthma control among Malaysian asthma patients on Symbicort Maintenance and Reliever Therapy (SMART) in the primary care setting (SMARTEST study)

Liam CK, Pang YK, Chua KT

Asian Pac J Allergy Immunol, 2014 Jun;32(2):145-52.
PMID: 25003728 DOI: 10.12932/AP0359.32.2.2013

OBJECTIVE: To evaluate Malaysian patients' satisfaction levels and asthma control with Symbicort SMART® in the primary care setting.
METHOD: This is a cross-sectional, multicentre study involving adult patients with persistent asthma who were prescribed only Symbicort SMART in the preceding one month prior to recruitment. Patients' satisfaction with Symbicort SMART and asthma control were evaluated using the self-administered Satisfaction with Asthma Treatment Questionnaire (SATQ) and the Asthma Control Test (ACT).
RESULTS: Asthma was controlled (ACT score >20) in 189 (83%) of 228 patients. The mean overall SATQ score for patients with controlled asthma was 5.65 indicating a high satisfaction level, which was positively correlated with high ACT scores. There were differences in asthma control based on ethnicity, number of unscheduled visits and treatment compliance.
CONCLUSIONS: Symbicort SMART resulted in a high satisfaction level and asthma control among Malaysian patients treated in the primary care setting and it is an effective and appealing treatment for asthmatic patients.
Study site: General practice clinics, Malaysia

Matched MeSH terms: Primary Health Care/methods*
Reliability and Validity of the M-MALMAS Instrument to Assess Medication Adherence in Malay-Speaking Patients with Type 2 Diabetes

Lai PSM, Sellappans R, Chua SS

Pharmaceut Med, 2020 06;34(3):201-207.
PMID: 32436200 DOI: 10.1007/s40290-020-00335-y

BACKGROUND: The English Malaysian Medication Adherence Scale (MALMAS) has been validated for assessing medication adherence of people with type 2 diabetes. However, Malay is the national language of Malaysia.
OBJECTIVES: The aim of this study was to cross-culturally adapt and validate the Malay MALMAS (M-MALMAS) in Malaysia.
METHODS: Adults with type 2 diabetes, who could understand Malay, were recruited between May 2016 and February 2017 from a primary care clinic in Kuala Lumpur, Malaysia. The M-MALMAS and the Malay version of the Morisky Medication Adherence Scale (MMAS-8) were administered at baseline to test for convergent validity. Four weeks later, the M-MALMAS was re-administered. Predictive validity of the M-MALMAS was assessed by correlating the medication adherence scores with levels of glycated haemoglobin (HbA1c).
RESULTS: In total, 100 of 104 people agreed to participate (response rate = 96.2%). The overall Cronbach's α and McDonald's Ω for the M-MALMAS was 0.654 and 0.676, respectively (mean = 0.665). At test-retest, no significant difference was found for all items. The median total score interquartile range (IQR) of the M-MALMAS was 7.0 (6.0-8.0) and this was significantly correlated to the median total score of the Malay MMAS-8 [median (IQR) = 7.0 (5.8-8.0), p

Matched MeSH terms: Primary Health Care

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