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Fulltext The benefits of cognitive behavioral therapy (CBT) on diabetes distress and glycemic control in type 2 diabetes

Seyed-Reza, A., Norzarina, M.Z., Kimura, L.W.

Malaysian Journal of Psychiatry, 2015;24(2):18-28.
MyJurnal

Introduction: This study was designed to determine the effectiveness of combined group Cognitive-Behavioral Therapy (CBT) in improving diabetes distress and glycemic control among 60 adults with type 2 diabetes.
Methods: Half the participants were the experimental group (n = 30), and the other half was the control group (n = 30). Group therapy consisted of eight sessions for three months. Measures obtained at pre-test and post-test included the Diabetes Distress Scale (DDS-17) and blood examination to examine the level of HbA1c.
Result: The results indicated that group CBT had significant effects on the amelioration of diabetes distress and level of HbA1c among the participants of the experimental group.
Conclusion: The effectiveness of group CBT in the maintenance of good diabetic control in people who are suffering from type 2 diabetes was successfully demonstrated.
Study site: Pusat Sejahtera (Universiti Sains Malaysia Clinic), Pulau Pinang, Malaysia

Matched MeSH terms: Ambulatory Care Facilities
Fulltext The impact of a disease management program (COACH) on the attainment of better cardiovascular risk control in dyslipidaemic patients at primary care centres (The DISSEMINATE Study): a randomised controlled trial

Selvaraj FJ, Mohamed M, Omar K, Nanthan S, Kusiar Z, Subramaniam SY, et al.

BMC Fam Pract, 2012;13:97.
PMID: 23046818 DOI: 10.1186/1471-2296-13-97

BACKGROUND: To evaluate the efficacy of Counselling and Advisory Care for Health (COACH) programme in managing dyslipidaemia among primary care practices in Malaysia. This open-label, parallel, randomised controlled trial compared the COACH programme delivered by primary care physicians alone (PCP arm) and primary care physicians assisted by nurse educators (PCP-NE arm).
METHODS: This was a multi-centre, open label, randomised trial of a disease management programme (COACH) among dyslipidaemic patients in 21 Malaysia primary care practices. The participating centres enrolled 297 treatment naïve subjects who had the primary diagnosis of dyslipidaemia; 149 were randomised to the COACH programme delivered by primary care physicians assisted by nurse educators (PCP-NE) and 148 to care provided by primary care physicians (PCP) alone. The primary efficacy endpoint was the mean percentage change from baseline LDL-C at week 24 between the 2 study arms. Secondary endpoints included mean percentage change from baseline of lipid profile (TC, LDL-C, HDL-C, TG, TC: HDL ratio), Framingham Cardiovascular Health Risk Score and absolute risk change from baseline in blood pressure parameters at week 24. The study also assessed the sustainability of programme efficacy at week 36.
RESULTS: Both study arms demonstrated improvement in LDL-C from baseline. The least squares (LS) mean change from baseline LDL-C were -30.09% and -27.54% for PCP-NE and PCP respectively. The difference in mean change between groups was 2.55% (p=0.288), with a greater change seen in the PCP-NE arm. Similar observations were made between the study groups in relation to total cholesterol change at week 24. Significant difference in percentage change from baseline of HDL-C were observed between the PCP-NE and PCP groups, 3.01%, 95% CI 0.12-5.90, p=0.041, at week 24. There was no significant difference in lipid outcomes between 2 study groups at week 36 (12 weeks after the programme had ended).
CONCLUSION: Patients who received coaching and advice from primary care physicians (with or without the assistance by nurse educators) showed improvement in LDL-cholesterol. Disease management services delivered by PCP-NE demonstrated a trend towards add-on improvements in cholesterol control compared to care delivered by physicians alone; however, the improvements were not maintained when the services were withdrawn.
TRIAL REGISTRATION:
National Medical Research Registration (NMRR) Number: NMRR-08-287-1442Trial Registration Number (ClinicalTrials.gov Identifier): NCT00708370.

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Challenges faced by primary care physicians when prescribing for patients with chronic diseases in a teaching hospital in Malaysia: a qualitative study

Sellappans R, Lai PS, Ng CJ

BMJ Open, 2015 Aug 27;5(8):e007817.
PMID: 26316648 DOI: 10.1136/bmjopen-2015-007817

OBJECTIVE: The aim of this study was to identify the challenges faced by primary care physicians (PCPs) when prescribing medications for patients with chronic diseases in a teaching hospital in Malaysia.
DESIGN/SETTING: 3 focus group discussions were conducted between July and August 2012 in a teaching primary care clinic in Malaysia. A topic guide was used to facilitate the discussions which were audio-recorded, transcribed verbatim and analysed using a thematic approach.
PARTICIPANTS: PCPs affiliated to the primary care clinic were purposively sampled to include a range of clinical experience. Sample size was determined by thematic saturation of the data.
RESULTS: 14 family medicine trainees and 5 service medical officers participated in this study. PCPs faced difficulties in prescribing for patients with chronic diseases due to a lack of communication among different healthcare providers. Medication changes made by hospital specialists, for example, were often not communicated to the PCPs leading to drug duplications and interactions. The use of paper-based medical records and electronic prescribing created a dual record system for patients' medications and became a problem when the 2 records did not tally. Patients sometimes visited different doctors and pharmacies for their medications and this resulted in the lack of continuity of care. PCPs also faced difficulties in addressing patients' concerns, and dealing with patients' medication requests and adherence issues. Some PCPs lacked time and knowledge to advise patients about their medications and faced difficulties in managing side effects caused by the patients' complex medication regimen.
CONCLUSIONS: PCPs faced prescribing challenges related to patients, their own practice and the local health system when prescribing for patients with chronic diseases. These challenges must be addressed in order to improve chronic disease management in primary care and, more importantly, patient safety.
Study site: Primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Factors affecting knowledge and skills retained among nurses after a neonate resuscitation training programme

Sek SC, Chan SG

The Malaysian Journal of Nursing, 2014;6(1):50-55.

Neonate Resuscitation Program, NRP training is given to nurses in batches. Such programs are vital because neonate resuscitation procedure or aid given to new born during delivery, help them begin breathing on their own, which can save many lives. Although such training is given to the nurses, no assessment has been done on the effectiveness of such training with regard to knowledge retention and transfer of training among the trainees. This study is retrospective in nature; it evaluates the level of knowledge and the conﬁdence in carrying out the neonate resuscitation procedure among 91 nurses involved such training. Besides that, the study ascertains their preparedness before undergoing the training and the opportunities provided to them to practice the skills learnt from the training at their work place. Factors that inﬂuence both their knowledge and skills after the training are also indentiﬁed. Study sample consist of 51 nurses from hospitals and 40 nurses from health clinics. Results show that skills acquired from training as measured by their conﬁdence at carrying out the learnt skill deteriorate faster than knowledge. Level of knowledge retained, conﬁdence at carrying out the neonate resuscitation procedure and opportunities for practicing the skill are all signiﬁcantly higher for the nurses at the hospitals compared to their counterparts in the health clinics at the 95 percent level. The recent trainees (2009) scored higher compared to the old trainees (2007 and 2008) with regard to their preparedness or motivation before the training although memory factor could play a part here. Conﬁdence at carrying out the neonate resuscitation procedure at the work place is a measure of the effectiveness of the NRP training because it constitutes transfer of training. Level of knowledge retained and opportunities for practicing skill at work place after the training, together with trainees' preparedness and motivation before the NRP training, all three contribute 35.7% towards trainees' conﬁdence in carrying out the NRP procedure at their work place. Contribution of these three variables is signiﬁcant at the 95% level or p< 0.05. Findings are consistent with the Model of factors that affect Learning Outcomes and Transfer of Training by Goldstein and Ford (2002).
Keywords: NEONATE RESUSCITATION

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Development and acceptance of a nutrition and lifestyle education booklet to improve mild cognitive impairment among elderly

Sa’ida Munira Johari, Suzana Shahar, Roslee Rajikan, Safiyyah A. Aziz

Jurnal Sains Kesihatan Malaysia, 2011;9(2):45-50.
MyJurnal

Mild cognitive impairment (MCI) is a common disorder among elderly and may worsen to dementia. The aim of this study is to develop a nutrition and lifestyle booklet to implement better lifestyle modification, as an effort to delay cognitive decline. A series of discussions with a research group comprising of dieticians, nutritionists, a geriatrician and a public health physician were conducted to ascertain the content of the booklet. There were seven guidelines in the booklet including; eat more fish, eat more foods rich in folic acid, eat more fruits and vegetables, exercise regularly, do activities to stimulate memory, stop smoking and alcohol drinking and stay cheerful and positive. Evaluation of acceptance for the booklet was carried out which comprised of assessment on content, graphic and design among elderly and health staff at health clinic in Cheras. The assessment involved 15 Malay elderly subjects aged 60 to 81 years (mean age 66.1 ±6.6 years), with 60.0% men and 40.0% women and 10 health staff aged 36.6 ± 12.0 years, with range of 27 to 58 years, consists of 20.0% men and 80.0% women also participated. Most of elderly subjects (80.0%, n = 12) indicated they understood information in the booklet. Meanwhile, 20.0% (n = 3) of elderly expressed they did not fully understand the content of the booklet in particular on sentence and terminology. All health staff (100.0%) understood the information in the booklet. This booklet was well accepted by elderly subjects and health staff, however adding more graphics, simplifying sentence structures and minimizing scientific terminologies to improve understanding were suggested. The booklet has the potential to increase the nutritional and health knowledge of elderly specifically with MCI. This would motivate them to adopt healthy eating and lifestyle, thus reducing cognitive decline and prevent dementia.
Keywords: Cognitive, education, booklet, elderly, lifestyle

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Prevalence of Falls among Older People attending a Primary Care Clinic in Kuala Lumpur, Malaysia

Sazlina, S.G., Krishnan, R., Shamsul, A.S., Zaiton, A., Visvanathan, R.

Malaysian Journal of Community Health, 2008;14(1):11-0.
MyJurnal

Introduction : The aim of this study was to determine the prevalence and the pattern of falls in community dwelling older people attending a primary care clinic in Kuala Lumpur, Malaysia.
Methods : A cross sectional study was conducted in an urban primary care clinic. Participants aged 60 years and older were included in the study. A structured questionnaire, assessing socio-demographic variables, medical and falls history was administered by one investigator over a 3-month period in 2004.
Results : A total of 151 respondents participated in this study with a response rate of 72%. The prevalence of falls was 47.0% over the previous 12-months period. Fifty-seven percent reported experiencing recurrent falls. Majority (61%) of falls occurred in the home and the two most common places were the bathroom (27%) and stairs (27%). Sixty-one percent of older people who fell, sustained an injury and most sought medical attention.
Conclusion : In conclusion, falls are common amongst older people attending this primary care clinic. It occurred commonly in the home in the bathroom and near stairs. However, a larger local community study is warranted to determine the prevalence and risk factors for falls in Malaysia.

Study site: primary care clinic in Kuala Lumpur, Malaysia

Matched MeSH terms: Ambulatory Care Facilities
Control of glycemia and other cardiovascular disease risk factors in older adults with type 2 diabetes mellitus: data from the Adult Diabetes Control and Management

Sazlina SG, Mastura I, Ahmad Z, Cheong AT, Adam BM, Jamaiyah H, et al.

Geriatr Gerontol Int, 2014 Jan;14(1):130-7.
PMID: 23581598 DOI: 10.1111/ggi.12070

The aims of the present study were to assess the control of glycemia and other cardiovascular disease risk factors, and the association between age and these controls among older adults with type 2 diabetes in Malaysia.

Matched MeSH terms: Ambulatory Care Facilities
Fulltext A clinical audit on diabetes care in two urban public primary care clinics in Malaysia

Sazlina SG, Zailinawati AH, Zaiton A, Ong I

Malaysian Journal of Medicine and Health Sciences, 2010;6(1):101-109.
MyJurnal

Introduction: The incidence of diabetes mellitus (DM) is increasing globally and it is associated with significant morbidity and mortality. The importance of a better quality of diabetes care is increasingly acknowledged. Objective: This clinical audit was conducted to assess the quality of care given to type 2 DM patients in public primary care clinics. Methods: A clinical audit was conducted in two selected urban public primary care clinics, between April and June of 2005. The indicators and criteria of quality care were based on the current Malaysian clinical practice guidelines for type 2 DM. A structured pro forma was used to collect data. Results: A total of 396 medical records of patients with type 2 DM were included in this audit. Most of the patients had measurements of fasting blood glucose and blood pressure recorded in more than 90% of the visits over the previous one year. Twenty-seven percent of the patients had glycosylated haemoglobin (HbA1c) done every 6 months with a mean of 8.3%. Only 15.6% had HbA1c values less than 6.5 %. Fifty percent had blood pressure controlled at 130/80 mmHg and below; and 13.0% had low density lipoprotein cholesterol values of 2.6 mmol/L or less. The majority of the patients were overweight or obese. Conclusions: The quality of diabetes care in this study was
found to be suboptimal. There is a gap between guidelines and clinical practice. Certain measures to improve the quality of diabetes care need to be implemented with more rigour.

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Predictors of poor glycaemic control in older patients with type 2 diabetes mellitus

Sazlina SG, Mastura I, Cheong AT, Bujang Mohamad A, Jamaiyah H, Lee PY, et al.

Singapore Med J, 2015 May;56(5):284-90.
PMID: 25814074 DOI: 10.11622/smedj.2015055

Introduction: We assessed the predictors of poor glycaemic control among older patients with type 2 diabetes mellitus (T2DM) in Malaysia.
Methods: This cross-sectional study used the data of 21,336 patients aged ≥ 60 years with T2DM from the Adult Diabetes Control and Management Registry 2008-2009.
Results: Predictors of poor glycaemic control were: age groups 60-69 years (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.66-2.33) and 70-79 years (OR 1.43, 95% CI 1.20-1.71); Malay (OR 1.53, 95% CI 1.41-1.66) and Indian (OR 1.32, 95% CI 1.19-1.46) ethnicities; T2DM durations of 5-10 years (OR 1.46, 95% CI 1.35-1.58) and > 10 years (OR 1.75, 95% CI 1.59-1.91); the use of oral antidiabetic agents only (OR 5.86, 95% CI 3.32-10.34), insulin only (OR 17.93, 95% CI 9.91-32.43), and oral antidiabetic agents and insulin (OR 29.42, 95% CI 16.47-52.53); and elevated blood pressure (OR 1.10, 95% CI 1.01-1.20), low-density lipoprotein cholesterol (OR 1.48, 95% CI 1.38-1.59) and triglycerides (OR 1.61, 95% CI 1.51-1.73). Hypertension (OR 0.71, 95% CI 0.64-0.80), hypertension and dyslipidaemia (OR 0.68, 95% CI 0.61-0.75), pre-obesity (OR 0.89, 95% CI 0.82-0.98) and obesity (OR 0.76, 95% CI 0.70-0.84) were less likely to be associated with poor glycaemic control.
Conclusion: Young-old and middle-old age groups (i.e. < 80 years), Malay and Indian ethnicities, longer T2DM duration, the use of pharmacological agents, and elevated blood pressure and lipid levels were associated with poor glycaemic control. The presence of comorbidities, pre-obesity and obesity were less likely to be associated with poor glycaemic control.
Keywords: Malaysia; diabetes mellitus; glycaemic control; older patients; registry.

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Angiotensinogen M235T gene variants and its association with essential hypertension and plasma renin activity in Malaysian subjects: a case control study

Say YH, Ling KH, Duraisamy G, Isaac S, Rosli R

BMC Cardiovasc Disord, 2005;5(1):7.
PMID: 15811183

Essential hypertension is a major public health concern worldwide where its prevalence accounts for various cerebrovascular diseases. A common molecular variant of angiotensinogen (AGT), the precursor of potent vasoactive hormone angiotensin II, has been incriminated as a marker for genetic predisposition to essential hypertension in some ethnics. This case-control study was designed not only to determine the association of the AGT M235T gene variants with essential hypertension, but also its relationship to Plasma Renin Activity (PRA) in subjects attending the Health Clinic, Kuala Lumpur, Malaysia.

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Health care consumers' perspectives on pharmacist integration into private general practitioner clinics in Malaysia: a qualitative study

Saw PS, Nissen LM, Freeman C, Wong PS, Mak V

Patient Prefer Adherence, 2015;9:467-77.
PMID: 25834411 DOI: 10.2147/PPA.S73953

BACKGROUND: Pharmacists are considered medication experts but are underutilized and exist mainly at the periphery of the Malaysian primary health care team. Private general practitioners (GPs) in Malaysia are granted rights under the Poison Act 1952 to prescribe and dispense medications at their primary care clinics. As most consumers obtain their medications from their GPs, community pharmacists' involvement in ensuring safe use of medicines is limited. The integration of a pharmacist into private GP clinics has the potential to contribute to quality use of medicines. This study aims to explore health care consumers' views on the integration of pharmacists within private GP clinics in Malaysia.
METHODS: A purposive sample of health care consumers in Selangor and Kuala Lumpur, Malaysia, were invited to participate in focus groups and semi-structured interviews. Sessions were audio recorded and transcribed verbatim and thematically analyzed using NVivo 10.
RESULTS: A total of 24 health care consumers participated in two focus groups and six semi-structured interviews. Four major themes were identified: 1) pharmacists' role viewed mainly as supplying medications, 2) readiness to accept pharmacists in private GP clinics, 3) willingness to pay for pharmacy services, and 4) concerns about GPs' resistance to pharmacist integration. Consumers felt that a pharmacist integrated into a private GP clinic could offer potential benefits such as to provide trustworthy information on the use and potential side effects of medications and screening for medication misadventure. The potential increase in costs passed on to consumers and GPs' reluctance were perceived as barriers to integration.
CONCLUSION: This study provides insights into consumers' perspectives on the roles of pharmacists within private GP clinics in Malaysia. Consumers generally supported pharmacist integration into private primary health care clinics. However, for pharmacists to expand their capacity in providing integrated and collaborative primary care services to consumers, barriers to pharmacist integration need to be addressed.
KEYWORDS: Malaysia; general practitioners; health care consumer; pharmacist integration; private clinic

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Use of prescription medicines in Malaysia 2005

Sarojini S, Faridah A, Lim CM, Sameerah SA, Lim TO, Lai LS, et al.

Med J Malaysia, 2008 Aug;63(3):203-6.
PMID: 19248690 MyJurnal

The National Medicines Use Survey (NMUS) which started in 2004 and is still ongoing was conducted with the intent to continuously and systematically collect data on the use of medicines, to provide an overview on the use of medicines in Malaysia. The objective of the NMUS is therefore to quantify the present state and time trends of medicines utilization at various levels of our health care system whether national, regional, local or institutional. From the data available, for the Year 2005, the most commonly used medicine in Malaysia were anti-diabetic medications, of which glibenclamide is the most common followed by metformin, were the top 2 of the list of drugs utilized in DDD/1000 population/day. Collectively, however, taking into account the various antihypertensives by therapeutic groups, anti-hypertensive medicines were more commonly used than anti-diabetics. Hypertension and diabetes mellitus are the two most prevalent chronic disorders in the country and thus, such high medicines utilization rates for these conditions are to be expected. From the general practice prescription data, it was estimated that a patient with hypertension was prescribed a median of only one (1) anti-hypertensive medication. This means, the vast majority of patients (81%) were on monotherapy, which is hardly sufficient to achieve treatment target. Clearly then, given the prevalence of hypertension, many patients were not on drug treatment at all, and of those treated, their drug treatment are likely to be inadequate.

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Carpal tunnel syndrome in pregnancy - you need to ask!

Sapuan J, Yam KF, Noorman MF, De Cruz PK, Abdul Razab WN, Rozali ZI, et al.

Singapore Med J, 2012 Oct;53(10):671-5.
PMID: 23112019

Carpal tunnel syndrome (CTS) is a common pregnancy complication. However, it is often overlooked by medical practitioners and patients alike. This study aimed to describe CTS in relation to pregnancy and assess how significant the disease was among pregnant women.

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Influenza A (H1N1) pandemic: Pahang experience

Sapian, M., Sahhir, K., Rosnah, I., Ardi, A., Rohida, T., Azura, M, et al.

Malaysian Journal of Public Health Medicine, 2010;10(1):62-69.
MyJurnal

On 24th April 2009 the World Health Organisation (WHO) announced Pandemic Influenza A (H1N1) alert phase 4 which was later raised to phase 6 on 11th June 2009. By 11th October 2009, 199 countries were affected with 399,232 laboratory confirmed cases resulting in 4735 death. In Pahang, the state and district operation rooms were activated on the 28th April and 5th May 2009 respectively to monitor surveillance, control and preventives measures carried out. This study was done to describe the situation of Pandemic Influenza A (H1N1) in Pahang from 28th April 2009 till 10th October 2009 in terms of laboratory confirmed cases and clusters reported, Influenza-Like Illness (ILI) surveillance, Severe Acute Respiratory Infection (sARI) surveillance and health education activities. During the period, 490 laboratory confirmed Influenza A (H1N1) cases were registered with 5 deaths. The age ranges from less than 1 year to 76 years with median of 16 years old. 207 ILI clusters were recorded, 139 (67.5%) were Influenza A (H1N1) clusters. For surveillance activity, 11,570 (2.2%) of outpatient attendances were ILI cases while 966 (2.0 %) of total admissions were sARI cases. There were 14,927 health education activities carried out during the period. The number of people affected by Pandemic Influenza A (H1N1) in Pahang reached its peak in mid August 2009 and later showed a downward trend. ILI surveillance was a useful tool to detect Influenza A (H1N1) activity in Pahang.
Study site: Klinik kesihatan, outpatient clinics, hospitals, Pahang, Malaysia

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Assess, adapt and act: a paediatric surgery division's initial approach in a rapidly evolving pandemic

Sanmugam A, Vythilingam G, Singaravel S, Nah SA

Pediatr Surg Int, 2020 Aug;36(8):925-931.
PMID: 32594243 DOI: 10.1007/s00383-020-04704-1

PURPOSE: The COVID-19 pandemic has placed an unprecedented test on the delivery and management of healthcare services globally. This study describes the adaptive measures taken and evolving roles of the members of the paediatric surgery division in a developing country during this period.
METHODS: We adopted multiple adaptive strategies including changes to stratification of surgeries, out-patient services by urgency and hospital alert status, policy writing involving multidisciplinary teams, and redeployment of manpower. Modifications were made to teaching activities and skills training to observe social distancing and mitigate reduced operative learning opportunities. Roles of academic staff were expanded to include non-surgical duties.
RESULTS: The planned strategies and changes to pre COVID-19 practices were successful in ensuring minimal disruption to the delivery of essential paediatric surgical services and training. Despite the lack of established guidelines and literature outlining strategies to address the impact of this pandemic on surgical services, most of the initial measures employed were consistent with that of other surgical centres.
CONCLUSION: Changes to delivery of surgical services and surgical training warrant a holistic approach and a constant re-evaluation of practices with emergence of new experiences and guidelines.

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Safety culture perceptions of pharmacists in Malaysian hospitals and health clinics: a multicentre assessment using the Safety Attitudes Questionnaire

Samsuri SE, Lua PL, Fahrni ML

BMJ Open, 2015 Nov 26;5(11):e008889.
PMID: 26610761 DOI: 10.1136/bmjopen-2015-008889

OBJECTIVE: To assess the safety attitudes of pharmacists, provide a profile of their domains of safety attitude and correlate their attitudes with self-reported rates of medication errors.
DESIGN: A cross-sectional study utilising the Safety Attitudes Questionnaire (SAQ).
SETTING: 3 public hospitals and 27 health clinics.
PARTICIPANTS: 117 pharmacists.
MAIN OUTCOME MEASURES: Safety culture mean scores, variation in scores across working units and between hospitals versus health clinics, predictors of safety culture, and medication errors and their correlation.
RESULTS: Response rate was 83.6% (117 valid questionnaires returned). Stress recognition (73.0±20.4) and working condition (54.8±17.4) received the highest and lowest mean scores, respectively. Pharmacists exhibited positive attitudes towards: stress recognition (58.1%), job satisfaction (46.2%), teamwork climate (38.5%), safety climate (33.3%), perception of management (29.9%) and working condition (15.4%). With the exception of stress recognition, those who worked in health clinics scored higher than those in hospitals (p<0.05) and higher scores (overall score as well as score for each domain except for stress recognition) correlated negatively with reported number of medication errors. Conversely, those working in hospital (versus health clinic) were 8.9 times more likely (p<0.01) to report a medication error (OR 8.9, CI 3.08 to 25.7). As stress recognition increased, the number of medication errors reported increased (p=0.023). Years of work experience (p=0.017) influenced the number of medication errors reported. For every additional year of work experience, pharmacists were 0.87 times less likely to report a medication error (OR 0.87, CI 0.78 to 0.98).
CONCLUSIONS: A minority (20.5%) of the pharmacists working in hospitals and health clinics was in agreement with the overall SAQ questions and scales. Pharmacists in outpatient and ambulatory units and those in health clinics had better perceptions of safety culture. As perceptions improved, the number of medication errors reported decreased. Group-specific interventions that target specific domains are necessary to improve the safety culture.
Study site: Klinik kesihatan, hospitals, Malaysia

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Knowledge of osteoporosis among men attending primary care clinic and the associated factors. [Abstract]

Samsudin S, Mohd Hashim S, Nawi A

International Medical Journal Malaysia, 2017;16(11):41.
MyJurnal

Introduction: Osteoporosis has frequently been regards as a disease of women only. However, men are also at risk of developing osteoporosis. We aimed to evaluate the knowledge of osteoporosis among men and its associated factors.
Materials and method: A cross-sectional study of 245 male patients aged 50 and above was conducted in the primary care clinic, University Kebangsaan Malaysia Medical Centre. The research instrument used in this study was a validated self-administered questionnaire which consists of socio-demographic data and 16 items of knowledge of osteoporosis among men.
Results: The mean score for knowledge was 7.78± 3.32 out of 16 points. Most of the subjects (83 percent) knew the definition of osteoporosis but were not aware that osteoporosis was a silent disease. Only a quarter of subjects (38 percent) recognized family history as a risk factors for osteoporosis. Despite 78 percent of subjects answer correctly regarding importance of calcium intake in their diet however only 7 percent
of them knew the recommended dosage of daily calcium intake. Knowledge of osteoporosis was found to be significantly associated with education and total monthly household income.
Conclusion: Findings indicate limited knowledge of osteoporosis among the subjects. Public education of osteoporosis among men is important to increase their knowledge. Meanwhile, primary care doctors should also emphasize and educate men regarding osteoporosis to enhance their knowledge of the disease.

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Perceptions and attitudes towards medication error reporting in primary care clinics: a qualitative study in Malaysia

Samsiah A, Othman N, Jamshed S, Hassali MA

PLoS One, 2016;11(12):e0166114.
PMID: 27906960 DOI: 10.1371/journal.pone.0166114

OBJECTIVE: To explore and understand participants' perceptions and attitudes towards the reporting of medication errors (MEs).

METHODS: A qualitative study using in-depth interviews of 31 healthcare practitioners from nine publicly funded, primary care clinics in three states in peninsular Malaysia was conducted for this study. The participants included family medicine specialists, doctors, pharmacists, pharmacist assistants, nurses and assistant medical officers. The interviews were audiotaped and transcribed verbatim. Analysis of the data was guided by the framework approach.

RESULTS: Six themes and 28 codes were identified. Despite the availability of a reporting system, most of the participants agreed that MEs were underreported. The nature of the error plays an important role in determining the reporting. The reporting system, organisational factors, provider factors, reporter's burden and benefit of reporting also were identified.

CONCLUSIONS: Healthcare practitioners in primary care clinics understood the importance of reporting MEs to improve patient safety. Their perceptions and attitudes towards reporting of MEs were influenced by many factors which affect the decision-making process of whether or not to report. Although the process is complex, it primarily is determined by the severity of the outcome of the errors. The participants voluntarily report the errors if they are familiar with the reporting system, what error to report, when to report and what form to use.

Matched MeSH terms: Ambulatory Care Facilities
Fulltext Ecological Study of Sick Building Syndrome among Healthcare Workers at Johor Primary Care Facilities

Salvaraji L, Shamsudin SB, Avoi R, Saupin S, Kim Sai L, Asan SB, et al.

Int J Environ Res Public Health, 2022 Dec 19;19(24).
PMID: 36554980 DOI: 10.3390/ijerph192417099

INTRODUCTION: Persistent exposure to indoor hazards in a healthcare setting poses a risk of SBS. This study determines the prevalence of and risk factors for SBS among healthcare workers in health clinics.
METHODS: A cross-sectional study was conducted across four health clinics from February 2022 to May 2022. As part of the study, self-administered questionnaires were completed to determine symptoms related to SBS. An indoor air quality (IAQ) assessment was conducted four times daily for fifteen minutes at five areas in each clinic (laboratory, lobby, emergency room, pharmacy, and examination room).
RESULT: Most of the areas illustrated poor air movement (<0.15 m/s), except for the laboratory. The total bacterial count (TBC) was above the standard limit in both the lobby and emergency room (>500 CFU/m3). The prevalence of SBS was 24.84% (77) among the healthcare workers at the health clinics. A significant association with SBS was noted for those working in the examination room (COR = 2.86; 95% CI = 1.31; 6.27) and those experiencing high temperature sometimes (COR = 0.25; 95% CI = 0.11; 0.55), varying temperature sometimes (COR = 0.31; 95% CI = 0.003), stuffy air sometimes (COR = 0.17; 95% CI = 0.005; 0.64), dry air sometimes (COR = 0.20; 95% CI = 0.007; 0.64), and dust sometimes (COR = 0.25; 95% CI = 0.11; 0.60) and everyday (COR = 0.34; 95% CI = 0.14; 0.81). Only healthcare workers in the examination room (AOR = 3.17; 95% CI = 1.35; 7.41) were found to have a significant risk of SBS when controlling for other variables.
CONCLUSION: SBS is prevalent among healthcare workers at health clinics.

Matched MeSH terms: Ambulatory Care Facilities
Fulltext The self-care profiles and its determinants among adults with hypertension in primary health care clinics in Selangor, Malaysia

Salim H, Lee PY, Sazlina SG, Ching SM, Mawardi M, Shamsuddin NH, et al.

PLoS One, 2019;14(11):e0224649.
PMID: 31693677 DOI: 10.1371/journal.pone.0224649

INTRODUCTION: Self-care has been shown to improve clinical outcome of hypertension. Gauging the level of self-care among patients with hypertension enables the design of their personalized care plans. This study aimed to determine the self-care profiles and its determinants among patients with hypertension in the Malaysian primary care setting.
METHODS: This was a cross sectional study conducted between 1 October 2016-30 April 2017 in three primary care clinics in the state of Selangor, Malaysia. All adults aged 18 years and above with hypertension for at least 6 months were recruited with a systematic random sampling of 1:2 ratio. The participants were assisted in the administration of the structured questionnaire, which included socio-demographic information, medical information and the Hypertension Self-Care Profile (HTN SCP) tool. Statistical analysis was done using SPSS version 20.0. Multiple linear regression was performed to determine the determinants for self-care.
RESULTS: The mean age of the participants was 59.5 (SD10.2) years old. There were more women (52.5%) and most were Malays (44.0%) follow by Chinese (34%) and Indians (21%). Majority (84.2%) had secondary or primary school level of education. A third (30.7%) had a family history of hypertension. The mean total HTN-SCP score was 124.2 (SD 22.8) out of 180. The significant determinants that influenced the HTN-SCP scores included being men (B-4.5, P-value0.008), Chinese ethnicity (B-14.7, P-value<0.001), primary level education/no formal school education level (B-15.7, P-value<0.001), secondary level education (B-9.2, P-value<0.001) and family history of hypertension (B 4.4, P-value 0.014).
CONCLUSIONS: The overall hypertension self-care profile among patients in this multi-ethnic country was moderate. Being men, Chinese, lower education level and without family history of hypertension were associated with lower hypertension self-care profile score. Healthcare intervention programmes to address self-care should target this group of patients.

Matched MeSH terms: Ambulatory Care Facilities/statistics & numerical data*

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