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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.
Why do patients with chronic illnesses fail to keep their appointments? A telephone interview

Zailinawati AH, Ng CJ, Nik-Sherina H

Asia Pac J Public Health, 2006;18(1):10-5.
PMID: 16629433 DOI: 10.1177/10105395060180010301

Missed appointments affect patients' health in addition to reducing practice efficiency. This study explored the rate and reasons of non-attendance among patients with chronic illnesses. It was a cross-sectional descriptive study carried out in a family practice clinic over a one-month period in 2004. Those who failed turn up for scheduled appointments were interviewed by telephone based on a structured questionnaire. Out of 671 patients, the non-attendance rate was 16.7%. Sixty-seven percent of non-attenders were successfully interviewed. Males (p = 0.01), Indians (p = 0.015), patients with coronary artery disease (p = 0.017), multiple diseases (> 4) (p = 0.036) and shorter appointment intervals (p = 0.001) were more likely to default. The main reasons for non-attendance were: forgot the appointment dates (32.9%), not feeling well (12.3%), administrative errors (19.1%) and work or family commitments (8.2%). The majority would prefer a reminder through telephone (71.4%), followed by letters (41.3%). In conclusion, appropriate intervention could be taken based on the reasons identified in this study.

Study site: Family Practice Clinic of the
Department of Primary Care
Medicine, University of Malaya
Medical Centre, Malaysia
Fulltext Prevalence of insomnia and its impact on daily function amongst Malaysian primary care patients

Zailinawati AH, Mazza D, Teng CL

Asia Pac Fam Med, 2012 Nov 27;11(1):9.
PMID: 23186221 DOI: 10.1186/1447-056X-11-9

BACKGROUND: Insomnia is a common public health problem and the prevalence and impact of insomnia in primary care attendees is not well documented in the Asian population.
OBJECTIVES: To determine the prevalence of self-reported insomnia symptoms amongst adult primary care attendees and the association with socio-demographic factors; to ascertain the impact of insomnia on daily functioning and to describe the psychological profile of patients with insomnia.
METHODS: In this cross-sectional survey, 2049 adult patients (≥18 year old) attending seven primary care clinics in Peninsular Malaysia, completed the questionnaire asking about symptoms of insomnia (defined according to the International Classification of Sleep Disorders and DSM IV criteria) daytime impairment and psychological symptoms (assessed by Hospital Anxiety and Depression Scale).
RESULTS: The response rate was 86.2%. A total of 60% reported insomnia symptoms, 38.9% had frequent insomnia symptoms (>3 times per week), 30.7% had chronic insomnia without daytime consequences and 28.6% had chronic insomnia with daytime dysfunction. Indian ethnicity (OR 1.79; 95%CI, 1.28-2.49), age ≥ 50 or older (OR 1.82; 95%CI, 1.10-3.01), anxiety symptoms (OR 1.65; 95%CI, 1.21-2.22) and depression symptoms (OR 1.65; 95%CI, 1.21-2.26) were risk factors for chronic insomnia with daytime dysfunction. Amongst those with chronic insomnia with daytime dysfunction, 47.8% had anxiety symptoms (OR, 2.01; 95%CI, 1.57-2.59) and 36.5% had depression symptoms (OR, 2.74; 95%CI, 2.04-3.68) based on HADs score. They also had tendency to doze off while driving and to be involved in road traffic accidents.
CONCLUSIONS: A third of primary care attendees have insomnia symptoms and chronic insomnia, associated with significant daytime dysfunction and psychological morbidity. By identifying those at risk of having chronic insomnia, appropriate interventions can be commenced.
Epidemiology of insomnia in Malaysian adults: a community-based survey in 4 urban areas

Zailinawati AH, Ariff KM, Nurjahan MI, Teng CL

Asia Pac J Public Health, 2008;20(3):224-33.
PMID: 19124316 DOI: 10.1177/1010539508316975

This study aimed to determine the prevalence and pattern of insomnia in a Malaysian population aged 30 to 70 years. The sample consisted of 1611 subjects, recruited by stratified random sampling and interviewed using a semistructured questionnaire conducted in 2004. This was a community-based survey in 4 Malaysian states. The prevalence of insomnia symptom was 33.8%, and 12.2% of the subjects had chronic insomnia. Insomnia was more common among elderly; those who were separated, divorced, or widowed; and those who smoked at bedtime. Subjects with insomnia had a higher prevalence of feeling depressed (12.7), loss of concentration (19.1%), exhaustion (17.2%), poor memory (9.2%), decreased work productivity (6.4%), and perceived poor health status (40.9%; all, P < .05). A total of 22.2% of those with insomnia had excessive daytime sleepiness based on their Epworth Sleepiness Score (P =
Fulltext Daytime sleepiness and sleep quality among Malaysian medical students

Zailinawati AH, Teng CL, Chung YC, Teow TL, Lee PN, Jagmohni KS

Med J Malaysia, 2009 Jun;64(2):108-10.
PMID: 20058567 MyJurnal

Poor sleep quality and daytime somnolence is reported to be associated with cardiovascular events, road traffic accident, poor academic performance and psychological distress. Some studies documented that it is prevalent in most populations but its frequency among medical students has not been documented in Malaysia. This is a self-administered questionnaire survey of medical students from International Medical University, Malaysia. Daytime sleepiness of medical students was assessed using Epworth Sleepiness Scale (ESS). Student scoring ESS > 11 was regarded as having excessive daytime sleepiness. Psychological distress was measured using 12-item General Health Questionnaire (GHQ-12). A total of 799 medical students participated in this survey (response rate 69.5%). Daytime sleepiness occurred in 35.5%, psychological distress was present in 41.8% and 16.1% reported bad sleep quality. Daytime sleepiness was significantly more common among the clinical students, those with self-reported bad sleep quality and psychological distress; but unrelated to the number of hours sleep at night. We have documented high prevalence of daytime sleepiness, poor sleep quality and psychological distress. Higher frequency among clinical students and the significant relationship with psychological distress suggest possible link to the stressful clinical training.
Fulltext The accuracy of mother's touch to detect fever in children: a systematic review

Teng CL, Ng CJ, Hanafi NS, Zailinawati AH, Tong SF

J Trop Pediatr, 2008 Feb;54(1):70-3.
PMID: 18039678 DOI: 10.1093/tropej/fmm077

Universally, mothers often use touching to detect fever in their children. We perform a systematic review of published diagnostic studies evaluating the ability of mothers to detect fever in their children by touching. We found 10 studies satisfying our inclusion criteria. The meta-analysis revealed a summary sensitivity of 89.2% and summary specificity of 50%-maternal touch is perhaps more useful to exclude fever rather than to 'rule in' fever. However, due to significant heterogeneity in the included studies, interpretation of the summary data is difficult.
Fulltext Pain morbidity in primary care - preliminary observations from two different primary care settings

Zailinawati AH, Teng CL, Kamil MA, Achike FI, Koh CN

Med J Malaysia, 2006 Jun;61(2):162-7.
PMID: 16898306 MyJurnal

The prevalence of pain complaints as a reason for patient-doctor encounters in the local primary care setting is unknown. We performed a cross-sectional survey of such encounters in one public primary care clinic (KK) and 17 general practice clinics (GP), from the city of Seremban, Negeri Sembilan, Malaysia. Reasons for visits were recorded by doctors in KK and medical students in GP using a structured questionnaire. Morbidity data was coded using the International Classification of Primary Care (ICPC-2). A total of 2234 encounters were recorded (80.9% from KK, 19.1% from GP). The overall prevalence of pain complaints was 31.9% with a significant difference between the two cohorts (KK 28.7% and GP 45.2%, p<0.001). Musculoskeletal pain complaints were more common in KK than GP (40.9% versus 29.7%, p<0.05). Of the 3 main ethnic groups in Malaysia (Malay, Chinese and Indian) the Indian patients at KK had the highest prevalence of pain complaints and the Chinese at the GP had the lowest. Thus pain was a common complaint in the two different primary care settings studied. Some of the differences observed are probably due to the differences in the healthcare seeking behaviour of patients consulting at these two settings as well as differences in the payment systems.
Fulltext Antibiotics for URTI and UTI -- prescribing in Malaysian primary care settings

Teng CL, Tong SF, Khoo EM, Lee V, Zailinawati AH, Mimi O, et al.

Aust Fam Physician, 2011 May;40(5):325-9.
PMID: 21597554

Background: Overprescription of antibiotics is a continuing problem in primary care. This study aims to assess the antibiotic prescribing rates and antibiotic choices for upper respiratory tract infections (URTI) and urinary tract infections (UTI) in Malaysian primary care.
Method: Antibiotic prescribing data for URTI and UTI was extracted from a morbidity survey of randomly selected primary care clinics in Malaysia.
Results: Analysis was performed of 1163 URTI and 105 UTI encounters. Antibiotic prescribing rates for URTI and UTI were 33.8% and 57.1% respectively. Antibiotic prescribing rates were higher in private clinics compared to public clinics for URTI, but not for UTI. In URTI encounters, the majority of antibiotics prescribed were penicillins and macrolides, but penicillin V was notably underused. In UTI encounters, the antibiotics prescribed were predominantly penicillins or cotrimoxazole.
Discussion: Greater effort is needed to bring about evidence based antibiotic prescribing in Malaysian primary care, especially for URTIs in private clinics.
Keywords: general practice, prescriptions, drug; upper respiratory tract infection; urinary tract infection; antibiotics, guideline; evidence based medicine
Study site: Klinik Kesihatan, Malaysia
Process of care and prescribing practices for hypertension in public and private primary care clinics in Malaysia

Tong SF, Khoo EM, Nordin S, Teng CL, Lee VK, Zailinawati AH, et al.

Asia Pac J Public Health, 2012 Sep;24(5):764-75.
PMID: 21659332 DOI: 10.1177/1010539511402190

This study aimed to compare the process of care and the choice of antihypertensive medications used in both public and private primary care clinics in Malaysia. A cross-sectional survey was completed in 2008 on randomly selected 100 public health clinics and 114 private primary care clinics in Malaysia. A total of 4076 patient records, 3753 (92.1%) from public clinics and 323 (7.9%) from private clinics were analyzed. Less than 80% of the records documented the recommended clinical and laboratory assessments. The rates of documentation for smoking status, family history of premature death, retinal assessment, and urine albumin tests were lower in public clinics. Overall, 21% of the prescription practices were less than optimal. The process of care and the use of antihypertensive medications were not satisfactory in both settings.
Fulltext Are Indians and females less tolerant to pain? An observational study using a laboratory pain model

Das Gupta E, Zailinawati AH, Lim AW, Chan JB, Yap SH, Hla YY, et al.

Med J Malaysia, 2009 Jun;64(2):111-3.
PMID: 20058568 MyJurnal

In Malaysia, it is a common belief among health care workers that females and Indians have lower pain threshold. This experience, although based on anecdotal experience in the healthcare setting, does not allow differentiation between pain tolerance, and pain expression. To determine whether there is a difference in the tolerance to pain between the three main ethnic groups, namely the Malays, Chinese and Indians as well as between males and females. This was a prospective study, using a laboratory pain model (ischaemic pain tolerance) to determine the pain tolerance of 152 IMU medical students. The mean age of the students was 21.8 years (range 18-29 years). All of them were unmarried. The median of ischaemic pain tolerance for Malays, Chinese and Indians were 639s, 695s and 613s respectively (p = 0.779). However, statistically significant difference in ischaemic pain tolerance for males and females Indian students were observed. Possible ethnic difference in pain tolerance in casual observation is not verified by this laboratory pain model. Difference in pain tolerance between genders is shown only for Indians.
Fulltext A comparison of morbidity patterns in public and private primary care clinics in malaysia

Mimi O, Tong SF, Nordin S, Teng CL, Khoo EM, Abdul-Rahman A, et al.

Malays Fam Physician, 2011;6(1):19-25.
PMID: 25606215 MyJurnal

OBJECTIVES: To compare the morbidity patterns in public and private primary care clinics; determine patients' reasons for encounter (RFE) and diagnoses using the ICPC-2, and compare ten commonest diagnoses and RFEs.
METHODS: A cross-sectional study on randomly selected clinics was conducted nationwide. Doctors completed the Patient Encounter Record (PER) for systematically selected encounters for a week.
RESULTS: Response rate was 82.0% (public clinic) and 33% (private clinic) with 4262 encounters and 7280 RFE. Overall, the three commonest disease categories encountered were respiratory (37.2%), general and unspecified (29.5%), and cardiovascular diseases (22.2%). Public and private clinics handled 27% versus 50% acute cases and 20.0% versus 3.1% chronic cases i.e. 33.7 and 5.6 chronic diseases per 100 RFE respectively.
CONCLUSION: Doctors in public clinics saw more chronic and complex diseases as well as pregnancy related complaints and follow-up cases while in private clinics more acute and minor illnesses were seen. Health services should be integrated and support given to co-manage chronic diseases in both sectors.
KEYWORDS: Malaysia; Primary practice; delivery of health care; morbidity pattern; reasons for encounter
Fulltext The use of text messaging to improve attendance in primary care: a randomized controlled trial

Leong KC, Chen WS, Leong KW, Mastura I, Mimi O, Sheikh MA, et al.

Fam Pract, 2006 Dec;23(6):699-705.
PMID: 16916871

BACKGROUND: Non-attendance is common in primary care and previous studies have reported that reminders were useful in reducing broken appointments.
OBJECTIVE: To determine the effectiveness of a text messaging reminder in improving attendance in primary care.
DESIGN:
Multicentre three-arm randomized controlled trial.
SETTING: Seven primary care clinics in Malaysia. Participants. Patients (or their caregivers) who required follow-up at the clinics between 48 hours and 3 months from the recruitment date. Interventions. Two intervention arms consisted of text messaging and mobile phone reminders 24-48 hours prior to scheduled appointments. Control group did not receive any intervention. Outcome measures. Attendance rates and costs of interventions.
RESULTS: A total of 993 participants were eligible for analysis. Attendance rates of control, text messaging and mobile phone reminder groups were 48.1, 59.0 and 59.6%, respectively. The attendance rate of the text messaging reminder group was significantly higher compared with that of the control group (odds ratio 1.59, 95% confidence interval 1.17 to 2.17, P = 0.005). There was no statistically significant difference in attendance rates between text messaging and mobile phone reminder groups. The cost of text messaging reminder (RM 0.45 per attendance) was lower than mobile phone reminder (RM 0.82 per attendance).
CONCLUSIONS: Text messaging reminder system was effective in improving attendance rate in primary care. It was more cost-effective compared with the mobile phone reminder.

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