A cross sectional study was conducted to determine the perception of Hospital Directors in performing clinical duties. This was done through a postal survey which was conducted covering all public hospitals in Malaysia. The majority of Hospital Directors had read the circular at the time of the study and agreed to do clinical work besides managerial duties. Before the issuance of the directive, the majority of those directors were already doing some clinical work. However they disagreed that by doing clinical work they could help overcome the problem of shortage of doctors. They agreed that the duration of 10 hours per week is suitable to do clinical duties. In term of confidence in giving curative treatment, the Hospital Directors especially those from district hospitals without specialists were confident in giving curative care to individuals. As for the clinicians, the majority felt that the implementation of the directive for Hospital Directors to do clinical work will not disrupt the clinicians' routine duties.
Study site: University Malaya, Universiti Kebangsaan Malaysia; Hospital Kuala Lumpur, Malaysia
Diabetes mellitus is a chronic disorder with many vascular complications, leading to significant morbidity and mortality. The prevalence of Type 2 diabetes mellitus in Malaysia has risen dramatically from 6.3% (NHMS 1 in 1986); to 8.3% (NHMS 2 in 1996); and to 14.9% (NHMS 3 in 2006). An audit was conducted on patient's medical records from selected MOH health facilities to assess the control of diabetes using HbA1c. The response rate was 69.6% and the control of diabetes was poor. Only 18.4% of patients with valid HbA1c had value less than 6.5%. This is notably worst amongst patients from younger age groups. Many recommended investigations such as fundoscopy and urine microalbumin had not been done regularly. Efforts to look for various vascular complications were under-reported. About 45% of patients had been treated with 2 oral antidiabetic agents; mainly the sulphonylureas and the biguanides. Only 13.3% of patients were on insulin despite having poorly controlled disease. There is an urgent need to improve the management of diabetes mellitus in these areas:- (i) improving the glycemic control status (particularly among younger diabetic patients) with early and optimal use of oral diabetic drugs and insulin; (ii) stringent monitoring of glycemic control with adequate funds for regular performance of HbA1c (at least every 6 monthly for all diabetic patients) (iii) organizing regular updates or interactive programme for diabetes healthcare providers from primary, secondary and tertiary care; (iv) ensuring regular and prompt review of diabetic complications so that the complications can be dealt with early; (v) producing more diabetes educators to strengthen and standardize the diabetes education programme; and promote patients adherence to non-pharmacological and pharmacological interventions.