Introduction: Proper gestational diabetes mellitus (GDM) care is essential for optimal control and thus prevents adverse perinatal outcomes. This audit aimed to determine the quality of GDM care provided by a public polyclinic.
Methods: The audit was performed on the clinic-based medical record of GDM patients who had undergone at least
three prenatal follow-ups and one postnatal follow-up between January and November 2012. Patients with pre-existing diabetes mellitus were excluded. Results: A total of 74 medical records were audited and it showed that 94.6%
of patients were of age 25 and above, 91.9% were Malays, 71.6% were multigravida and 98.6% had risk factors of
GDM. 54.1% of diagnoses were made during the second trimester, while 25.7% and 20.2% of cases were detected
during the first and third trimester respectively. All of the GDM patients had their weight and blood pressure monitored, 85.1% had their fundal height checked as scheduled and 85.1% were referred for diet counselling. 81.9% and
100% of GDM patients who were not on treatment and on treatment correspondingly had their blood sugar profile
monitoring done as recommended. Only 13.5% of GDM patients were given prenatal family planning counselling
and 35.1% were given a six weeks’ postnatal oral glucose tolerance test appointment. Monthly ultrasound screening
and HbA1c monitoring was done in merely 51.4% and 58.1% of the GDM patients respectively. Conclusion: The
GDM care process in this public polyclinic could be improved further to achieve the standard recommendations.
BACKGROUND AND OBJECTIVE: Early diagnosis of chronic obstructive pulmonary disease (COPD) in primary care settings is difficult to achieve chiefly due to lack of availability of spirometry. This study estimated the prevalence of airflow limitation among chronic smokers using a handheld spirometer in this setting.
METHODS: This is a cross-sectional study performed on consecutive patients who were ≥40 years old with ≥10 pack-years smoking history. Face-to-face interviews were carried out to obtain demographic data and relevant information. Handheld spirometry was performed according to a standard protocol using the COPd-6 device (Model 4000, Vitalograph, Ennis, Ireland) in addition to standard spirometry. Airflow limitation was defined as ratio of forced expiratory volume in 1 s (FEV1 )/forced expiratory volume in 6 s <0.75 (COPd-6) or FEV1 /forced vital capacity <0.7. Multiple logistic regression analyses were used to determine predictors of airflow limitation.
RESULTS: A total of 416 patients were recruited with mean age of 53 years old. The prevalence of airflow limitation was 10.6% (n = 44) with COPd-6 versus 6% as gauged using standard spirometry. Risk factors for airflow limitation were age >65 years (odds ratio (OR) 3.732 95% confidence interval (CI): 1.100-1.280), a history of 'bad health' (OR 2.524, 95% CI: 1.037-6.142) and low to normal body mass index (OR 2.914, 95% CI: 1.191-7.190).
CONCLUSIONS: In a primary care setting, handheld spirometry (COPd-6) found a prevalence of airflow limitation of ∼10% in smokers. Patients were older, not overweight and had an ill-defined history of health problems.
KEYWORDS: Malaysia; chronic obstructive pulmonary disease; prevalence; primary care; smoke
Study site: Public primary health‐care clinic (Klinik Kesihatan), Sepang District, Selangor, Malaysia