Malaysian Primary Care Research Articles

Development and validation of a video-based intervention on self-care practices for patients with hypertension in Malaysian primary care settings.

Self-care practices among patients with hypertension have been shown to improve blood pressure control. Video-based interventions (VBIs) are helpful in enhancing patients' selfcare practices. However, validated VBIs in the Malay language for patients in primary care settings are scarce. This study aimed to develop and validate a VBI series in the Malay language to educate patients with hypertension on self-care practices in primary care settings. This study was conducted in three phases: (1) pre-production, (2) production and (3) post-production. The pre-production phase involved designing the storyboard and scripts, which underwent content validation by content experts and subsequently by patients with hypertension. Once the storyboards and scripts achieved acceptable consensus, the videos were recorded (production phase). The post-production phase included video editing and face validation among patients with hypertension. Statistical analysis included the calculation of the item-level content validation index (I-CVI) and item-level face validation index (I-FVI) during content and face validation, respectively. The storyboards and scripts for five videos were developed. The I-CVI of all videos was 1.0 after two rounds of content validation among six content experts. The I-CVI of all videos was 1.0 among five patients with hypertension. Five videos were recorded and edited, achieving an I-FVI of 1.0 during face validation among 10 patients. A VBI series consisting of five videos was developed and validated for use among patients with hypertension in primary care settings to improve their knowledge of self-care practices.

Impact evaluation of guidelines on antibiotic utilisation & appropriateness in Malaysian public primary care: an interrupted time series analysis

Impact evaluation of guidelines on antibiotic utilisation & appropriateness in Malaysian public primary care: an interrupted time series analysis

Prevalence and distributions of severely elevated low-density lipoprotein cholesterol (LDL-c) according to age, gender and clinic location among patients in the Malaysian primary care

BackgroundAdults with severely elevated low-density lipoprotein cholesterol (LDL-c) may have familial hypercholesterolaemia (FH) and are at high risk of atherosclerotic cardiovascular disease (ASCVD). The prevalence of elevated LDL-c in primary care clinics in Malaysia is not known. Therefore, this study aimed to determine the prevalence and distributions of severely elevated LDL-c among adult patients attending public primary care clinics in Malaysia. MethodsA cross-sectional study was conducted at 11 public primary care clinics in the central states of Malaysia, among adults ≥18 years old with LDL-c recorded in the electronic medical record. Sociodemographic and LDL-c data from 2018 to 2020 were extracted. Severely elevated LDL-c was defined as ≥4 mmol/L, which were further classified into: 4.0–4.9, 5.0–5.9, 6.0–6.9 and ≥ 7 mmol/L. ResultsOut of 139,702 patients, 44,374 (31.8 %) had severely elevated LDL-c of ≥4 mmol/L of which the majority were females (56.7 %). The mean (±SD) age of patients with severely elevated LDL-c was younger at 56.3 (±13.2) years compared to those with LDL-c of <4.0 mmol/L at 59.3 (±14.5) years. In terms of LDL-c levels, 30,751 (69.3 %), 10,412 (23.5 %), 2,499 (5.6 %) and 712 (1.6 %) were in the 4.0–4.9, 5.0–5.9, 6.0–6.9 and ≥ 7 mmol/L categories, respectively. ConclusionThe prevalence of severely elevated LDL-c of ≥4.0 mmol/L among adult patients in public primary care clinics was high. These patients need to be further investigated for secondary and inherited causes such as FH. Therapeutic lifestyle modification and pharmacological management are pivotal to prevent ASCVD in these patients.

Implementing HLA-B*58:01 testing prior to allopurinol initiation in Malaysian primary care setting: A qualitative study from doctors' and patients' perspective.

Allopurinol, the first-line treatment for chronic gout, is a common causative drug for severe cutaneous adverse reactions (SCAR). HLA-B*58:01 allele was strongly associated with allopurinol-induced SCAR in Asian countries such as Taiwan, Japan, Thailand and Malaysia. HLA-B*58:01 screening before allopurinol initiation is conditionally recommended in the Southeast-Asian population, but the uptake of this screening is slow in primary care settings, including Malaysia. This study aimed to explore the views and experiences of primary care doctors and patients with gout on implementing HLA-B*58:01 testing in Malaysia as part of a more extensive study exploring the feasibility of implementing it routinely. This qualitative study used in-depth interviews and focus group discussions to obtain information from patients with gout under follow-up in primary care and doctors who cared for them. Patients and doctors shared their gout management experiences and views on implementing HLA-B*58:01 screening in primary care. Data were coded and analysed using thematic analysis. 18 patients and 18 doctors from three different healthcare settings (university hospital, public health clinics, private general practitioner clinics) participated. The acceptability to HLA-B*58:01 screening was good among the doctors and patients. We discovered inadequate disclosure of severe side effects of allopurinol by doctors due to concerns about medication refusal by patients, which could potentially be improved by introducing HLA-B*58:01 testing. Barriers to implementation included out-of-pocket costs for patients, the cost-effectiveness of this implementation, lack of established alternative treatment pathway besides allopurinol, counselling burden and concern about genetic data security. Our participants preferred targeted screening for high-risk populations instead of universal screening. Implementing HLA-B*58:01 testing in primary care is potentially feasible if a cost-effective, targeted screening policy on high-risk groups can be developed. A clear treatment pathway for patients who test positive should be made available.

A comparison between antibiotic utilisation in public and private community healthcare in Malaysia

BackgroundThere are two parallel systems in Malaysian primary healthcare services: government funded public primary care and privately-owned practices. While there have been several studies evaluating antibiotic utilisation in Malaysian public healthcare, there is a lack of literature on the use of antibiotics in the private sector. There is a dire need to evaluate the more recent performance of public vs. private community healthcare in Malaysia. As such, this study aimed at measuring and comparing the utilisation of antibiotics in the public and private community healthcare sectors of Malaysia in 2018–2021.MethodsThis study was a retrospective analysis of antibiotic utilisation in Malaysian primary care for the period of 1 January 2018 until 31 December 2021 using the nationwide pharmaceutical procurement and sales data from public and private health sectors. Rates of antibiotic utilisation were reported as Defined Daily Doses per 1000 inhabitants per day (DID) and stratified by antibiotic classes. The secondary analysis included proportions of AWaRe antibiotic category use for each sector and proportion of antibiotic utilisation for both sectors.ResultsThe overall national antibiotic utilisation for 2018 was 6.14 DID, increasing slightly to 6.56 DID in 2019, before decreasing to 4.54 DID in 2020 and 4.17 DID in 2021. Private primary care antibiotic utilisation was almost ten times higher than in public primary care in 2021. The public sector had fewer (four) antibiotic molecules constituting 90% of the total antibiotic utilisation as compared to the private sector (eight). Use of Access antibiotics in the public sector was consistently above 90%, while use of Access category antibiotics by the private sector ranged from 64.2 to 68.3%. Although use of Watch antibiotics in the private sector decreased over the years, the use of Reserve and ‘Not Recommended’ antibiotics increased slightly over the years.ConclusionAntibiotic consumption in the private community healthcare sector in Malaysia is much higher than in the public sector. These findings highlight the need for more rigorous interventions targeting both private prescribers and the public with improvement strategies focusing on reducing inappropriate and unnecessary prescribing.

Prevalence and associated factors of lipohypertrophy in insulin-injected patients with diabetes in selected primary care clinics in Peninsular Malaysian: A cross-sectional study.

This study aimed to determine the prevalence and associated factors of lipohypertrophy in insulin-injecting patients with diabetes at selected primary care clinics in Malaysia. This cross-sectional study was conducted among adults aged ≥18 years with type 1 or 2 diabetes treated with insulin for at least 6 months at six selected public primary care clinics in Malaysia. The Injection Technique Questionnaire was used, and physical examination was conducted to detect the presence of lipohypertrophy. Univariate and multivariate logistic regression analyses were conducted using IBM SPSS version 26. A total of 506 patients with type 2 diabetes were included in this study; of them, 60.47% were women, and 48.42% were Malays. The prevalence of lipohypertrophy was 39.6% (95% Confidence Interval, CI =35%-44%). The univariate analysis revealed that a larger number of injections per day, longer needle length, repeated use of needles, incorrect rotation of the injection site, longer insulin use duration, higher total insulin dose and higher HbA1c level were significantly associated with lipohypertrophy. In the multivariate logistic regression analysis, incorrect rotation of the injection site was the only independent associated factor of lipohypertrophy. The prevalence of lipohypertrophy in this study is comparable with that in other studies. The identified associated factors of lipohypertrophy must be addressed in ongoing health education for insulin-injecting patients at Malaysian primary care clinics. Educating healthcare professionals and increasing awareness among patients with diabetes are important steps in preventing this complication.

Reducing Premature Coronary Artery Disease in Malaysia by Early Identification of Familial Hypercholesterolemia Using the Familial Hypercholesterolemia Case Ascertainment Tool (FAMCAT): Protocol for a Mixed Methods Evaluation Study.

Familial hypercholesterolemia (FH) is predominantly caused by mutations in the 4 FH candidate genes (FHCGs), namely, low-density lipoprotein receptor (LDLR), apolipoprotein B-100 (APOB-100), proprotein convertase subtilisin/kexin type 9 (PCSK9), and the LDL receptor adaptor protein 1 (LDLRAP1). It is characterized by elevated low-density lipoprotein cholesterol (LDL-c) levels leading to premature coronary artery disease. FH can be clinically diagnosed using established clinical criteria, namely, Simon Broome (SB) and Dutch Lipid Clinic Criteria (DLCC), and can be identified using the Familial Hypercholesterolemia Case Ascertainment Tool (FAMCAT), a primary care screening tool. This study aims to (1) compare the detection rate of genetically confirmed FH and diagnostic accuracy between the FAMCAT, SB, and DLCC in the Malaysian primary care setting; (2) identify the genetic mutation profiles, including novel variants, in individuals with suspected FH in primary care; (3) explore the experience, concern, and expectation of individuals with suspected FH who have undergone genetic testing in primary care; and (4) evaluate the clinical utility of a web-based FH Identification Tool that includes the FAMCAT, SB, and DLCC in the Malaysian primary care setting. This is a mixed methods evaluation study conducted in 11 Ministry of Health primary care clinics located at the central administrative region of Malaysia. In Work stream 1, the diagnostic accuracy study design is used to compare the detection rate and diagnostic accuracy of the FAMCAT, SB, and DLCC against molecular diagnosis as the gold standard. In Work stream 2, the targeted next-generation sequencing of the 4 FHCGs is used to identify the genetic mutation profiles among individuals with suspected FH. In Work stream 3a, a qualitative semistructured interview methodology is used to explore the experience, concern, and expectation of individuals with suspected FH who have undergone genetic testing. Lastly, in Work stream 3b, a qualitative real-time observation of primary care physicians using the "think-aloud" methodology is applied to evaluate the clinical utility of a web-based FH Identification Tool. The recruitment for Work stream 1, and blood sampling and genetic analysis for Work stream 2 were completed in February 2023. Data collection for Work stream 3 was completed in March 2023. Data analysis for Work streams 1, 2, 3a, and 3b is projected to be completed by June 2023, with the results of this study anticipated to be published by December 2023. This study will provide evidence on which clinical diagnostic criterion is the best to detect FH in the Malaysian primary care setting. The full spectrum of genetic mutations in the FHCGs including novel pathogenic variants will be identified. Patients' perspectives while undergoing genetic testing and the primary care physicians experience in utilizing the web-based tool will be established. These findings will have tremendous impact on the management of patients with FH in primary care and subsequently reduce their risk of premature coronary artery disease. DERR1-10.2196/47911.

Frequency and predictors of inappropriate medication dosages for cardiovascular disease prevention in chronic kidney disease patients: A retrospective cross-sectional study in a Malaysian primary care clinic

Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular events. This study aimed to assess the frequency of inappropriate medication dosages (IMD) for cardiovascular disease prevention among patients with CKD and its predictors in an urban academic primary care clinic in Selangor, Malaysia. All patients who attended the clinic from April to June 2019 and fulfilled the inclusion criteria were included in this cross-sectional study, except for those with an estimated glomerular filtration rate (eGFR) of more than 90 ml/min, diagnosed with urinary tract infection, pregnant or were on dialysis for end stage renal disease. Their prescriptions on the electronic medical record (EMR) system were evaluated for appropriateness using the dose adjustment recommendations based on the 2018 Malaysian Clinical Practice Guidelines on management of CKD. A total of 362 medical records were included in this study. 16.6% (95% Confidence Interval [CI]: 12.9–20.8) or 60 out of 362 of the patient records analysed contained medications prescribed with inappropriate dosages. Patients with higher stages of CKD were associated with higher odds of IMD, namely CKD stage G3b (adjusted Odds Ratio [aOR] 10.41; 95% CI: 2.31–46.88) and CKD stage 4–5 (aOR 15.76; 95% CI: 3.22–77.28). Other predictors of IMD were diagnosis of diabetes mellitus (aOR 6.40; 95% CI: 2.15–19.01), number of prescribed medications of 5 or more (aOR 4.69; 95% CI: 1.55–14.20), and eGFR reduction of more than 25% over one year (aOR 2.82; 95% CI: 1.41–5.65). Within the limitations of this study, we conclude that the occurrence of IMD for CVD prevention was low in CKD patients in this primary care clinic. Medications with inappropriate dosages identified in this study include simvastatin, fenofibrate, hydrochlorothiazide, spironolactone, metformin, gliclazide, sitagliptin, dapagliflozin and empagliflozin. Clinicians should consider the predictors of inappropriate medication dosages listed above when prescribing to patients with CKD to reduce the risk of medications-related toxicities and adverse effects. Limitations of this study should be considered when interpreting the findings presented.

Impact of COVID-19 Pandemic on Antibiotic Utilisation in Malaysian Primary Care Clinics: An Interrupted Time Series Analysis.

The COVID-19 pandemic has resulted in a dramatic change in the delivery of primary healthcare across the world, presumably changing trends in consultations for infectious diseases and antibiotic use. This study aimed at describing and evaluating the impact of COVID-19 on antibiotic use in public primary care clinics in Malaysia between 2018 and 2021. Data from the nationwide procurement database of systemic antibiotics from public primary care clinics in Malaysia between January 2018 and December 2021 were analysed using interrupted time series analysis. The monthly number of defined daily doses per 1000 inhabitants per day (DID) was calculated and grouped by antibiotic class. The trend of antibiotic utilisation rates had been decreasing by 0.007 DID monthly before March 2020 (p = 0.659). With the introduction of national lockdown due to COVID-19 beginning March 2020, there was a significant reduction in the level of antibiotic utilisation rates of 0.707 (p = 0.022). Subsequently, the monthly trend showed a slight upward change until the end of the study period (p = 0.583). Our findings indicate that there was a significant decrease in antibiotic utilisation for systemic use in primary care following the COVID-19 pandemic compared with the preceding years (January 2018-March 2020).

Healthcare resources, organisational support and practice in asthma in six public health clinics in Malaysia

Asthma, a common chronic respiratory illness is mostly managed in primary care. We aimed to determine healthcare resources, organisational support, and doctors’ practice in managing asthma in a Malaysian primary care setting. A total of six public health clinics participated. We found four clinics had dedicated asthma services. There was only one clinic which had a tracing defaulter system. Long-term controller medications were available in all clinics, but not adequately provided. Resources, educational materials, and equipment for asthma management were present, though restricted in number and not placed in main locations of the clinic. To diagnose asthma, most doctors used clinical judgement and peak flow metre measurements with reversibility test. Although spirometry is recommended to diagnose asthma, it was less practiced, being inaccessible and unskilled in using as the main reasons. Most doctors reported providing asthma self-management; asthma action plan, but for only half of the patients that they encountered. In conclusion, there is still room for improvement in the provision of clinic resources and support for asthma care. Utilising peak flow metre measurement and reversibility test suggest practical alternative in low resource for spirometry. Reinforcing education on asthma action plan is vital to ensure optimal asthma care.

Medication adherence, its associated factors and implication on glycaemic control in patients with type 2 diabetes mellitus: A cross-sectional study in a Malaysian primary care clinic.

Medication adherence and metabolic control remain suboptimal among patients with diabetes mellitus in Malaysia despite the clear benefits of reduced vascular complications and mortality risk. This study examined the factors associated with medication adherence and glycaemic control in patients with type 2 diabetes mellitus in a primary care clinic. This cross-sectional study was conducted in a public health clinic in Pagoh, Johor, among 386 patients recruited via systematic random sampling. Data were obtained using a validated 7-item structured questionnaire, glycated haemoglobin (HbA1c) test and medical record review. Logistic regression analysis was performed to determine the factors associated with medication adherence. The mean patient age was 60.04± 10.75 years, and the mean HbA1c level was 8.3±2.0%. Approximately 60.3% of the participants were adherent to their medication, and an increasing age was significantly associated with medication nonadherence (adjusted odds ratio [OR]: 0.959; confidence interval [CI]: 0.934-0.985). Medication adherence (adjusted OR: 2.688; CI: 1.534- 4.708) and use of combined oral medications (adjusted OR: 5.604; CI: 3.078-10.203), combined oral medications with insulin (adjusted OR: 23.466; CI: 8.208-67.085) and insulin only (adjusted OR: 6.528; CI: 1.876-22.717) were associated with good glycaemic control. Older age (adjusted OR: 0.954; CI: 0.923-0.986) and Malay ethnicity (adjusted OR: 0.284; CI: 0.101-0.794) were associated with poor glycaemic control. Suboptimal medication adherence and glycaemic control are prevalent in primary care settings, especially among elderly patients. Counselling should be targeted to patients and their caretakers to improve medication adherence and optimise metabolic control.

Prevalence of undiagnosed depression among patients with hypertension: A cross-sectional study of Malaysian primary care perspective

Introduction: This study aimed to determine the prevalence of suspected depression and its associated factors among patients with hypertension in a Malaysian primary care clinic. Methods: This cross-sectional study was conducted in a primary care clinic from 1 June to 31 August 2019 using the Patient Health Questionnaire-9. Results: The prevalence of suspected depression was 9.0%. The significant predictors of depression were Indian ethnicity (adjusted odd ratio [AOR]: 2.373; confidence interval [CI]: 1.147–4.907), divorce (AOR: 3.5; CI: 1.243–9.860), singleness (AOR: 2.241; CI: 1.182–4.251), heavy episodic drinking (AOR: 7.343; CI: 2.494–21.624), low physical activity level (AOR: 1.921; CI: 1.093–2.274), low fibre intake (AOR: 1.836; CI: 1.061–3.178), uncontrolled blood pressure (AOR: 1.800; CI: 1.134–2.858) and presence of hypertension complications (AOR: 3.263; CI: 2.053–5.185). Conclusion: Primary health care providers must screen for depression among patients with hypertension, particularly those within high-risk groups, and implement interventions that address modifiable risk factors.

Prevalence of undiagnosed depression among patients with hypertension: A cross-sectional study of Malaysian primary care perspective.

This study aimed to determine the prevalence of suspected depression and its associated factors among patients with hypertension in a Malaysian primary care clinic. This cross-sectional study was conducted in a primary care clinic from 1 June to 31 August 2019 using the Patient Health Questionnaire-9. The prevalence of suspected depression was 9.0%. The significant predictors of depression were Indian ethnicity (adjusted odd ratio [AOR]: 2.373; confidence interval [CI]: 1.147-4.907), divorce (AOR: 3.5; CI: 1.243-9.860), singleness (AOR: 2.241; CI: 1.182-4.251), heavy episodic drinking (AOR: 7.343; CI: 2.494-21.624), low physical activity level (AOR: 1.921; CI: 1.0932.274), low fibre intake (AOR: 1.836; CI: 1.061-3.178), uncontrolled blood pressure (AOR: 1.800; CI: 1.134-2.858) and presence of hypertension complications (AOR: 3.263; CI: 2.053-5.185). Primary health care providers must screen for depression among patients with hypertension, particularly those within high-risk groups, and implement interventions that address modifiable risk factors.

Primary Care Physicians' Perspectives on Identifying Familial Hypercholesterolaemia in Primary Care: A Qualitative Study.

Context Familial hypercholesterolaemia (FH) is a common autosomal dominant disorder, causing elevated cholesterol from birth, premature heart disease, and early death. Objective This study explored primary care physicians' experiences and perspectives on identifying FH in Malaysian primary care. Study Design and Analysis A qualitative study involving semi-structured interviews and focus group discussions with 22 primary care physicians (PCPs) in two primary care clinic settings. The interviews and focus group discussions were audio recorded, and the recordings were transcribed verbatim. The data in the transcripts were analysed using thematic approach. Setting Primary Care Clinics Population Studied Primary Care Physicians in two primary care clinics. Intervention A qualitative study involving semi-structured interviews and focus group discussions Outcome Measures Primary Care Physicians' perceptions and experiences of identifying individuals at high risk of FH in their clinical practice, and the acceptability and perceived challenges of trying to do this were explored during the interviews and focus group discussions. Findings PCPs felt there was potential for FH to be identified earlier in primary care. They had some existing knowledge and awareness of diagnostic criteria for FH but highlighted several challenges. In their practice, this included limited time in routine clinical care, availability of medication and clinical expertise; and critical lack of family history and physical examination findings in health records. The barriers on a systemic level were shortage of lipid specialist services and the absence of local care pathways for FH. The PCPs recommended a user-friendly case-finding tool for FH, and establishing FH registry and clinical practice guideline in Malaysia, alongside a national FH screening strategy and awareness campaigns for both clinicians and general public. Conclusions PCPs are positive about improving the identification of FH in primary care. However greater support in their practice and wider system developments and change are needed.

Respiratory microorganisms in acute pharyngitis patients: Identification, antibiotic prescription patterns and appropriateness, and antibiotic resistance in private primary care, central Malaysia.

Acute pharyngitis (AP) is a common reason for private primary care consultations, thus providing an avenue for widespread antibiotic intake among the community. However, there is limited data on the antibiotic prescription appropriateness and resistance information in the Malaysian private primary care setting, therefore, this study aimed to investigate the prevalence of isolated viruses and bacteria, antibiotic resistance patterns, antibiotic prescription patterns and appropriateness by general practitioners (GPs) and factors affecting antibiotic resistance and antibiotic prescription patterns. To investigate, a cross-sectional study was conducted among 205 patients presenting with AP symptoms at private primary care clinics in central Malaysia from 3rd January 2016 to 30th November 2016. Throat swabs were collected from 205 AP patients for two purposes: (i) the detection of four common respiratory viruses associated with AP via reverse-transcription real-time PCR (qRT-PCR); and (ii) bacterial identification using matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS). Bacterial isolates were then subjected to antibiotic susceptibility screening and McIsaac scoring was calculated post-prescription based on GP selection of criteria. Generalized estimating equations analysis with multiple logistic regression was conducted to identify factors associated with presence of virus and antibiotic prescription. The results showed that 95.1% (195/205) of patients had at least one of the four viruses, with rhinovirus (88.5%) being the most prevalent, followed by adenovirus (74.9%), influenza A virus (4.6%) and enterovirus (2.1%). A total of 862 non-repetitive colonies were isolated from the culture of throat swabs from 205 patients who were positive for bacteria. From a total of 22 genera, Streptococcus constitutes the most prevalent bacteria genus (40.9%), followed by Neisseria (20%), Rothia (13.0%), Staphylococcus (11%) and Klebsiella (4.9%). Only 5 patients carried group A beta-hemolytic streptococci (GABHS). We also report the presence of vancomycin-resistant S. aureus or VRSA (n = 9, 10.1%) among which one isolate is a multidrug-resistant methicillin-resistant S. aureus (MDR-MRSA), while 54.1% (n = 111) were found to carry at least one antibiotic-resistant bacteria species. Application of the McIsaac scoring system indicated that 87.8% (n = 180) of patients should not be prescribed antibiotics as the majority of AP patients in this study had viral pharyngitis. The antibiotic prescription appropriateness by applying post-prescription McIsaac scoring was able to rule out GABHS pharyngitis in this sample with a GABHS culture-positive sensitivity of 40% (n = 2/5) and specificity of 90% (180/200). In conclusion, antibiotic-resistant throat isolates and over-prescription of antibiotics were observed and McIsaac scoring system is effective in guiding GPs to determine occurrences of viral pharyngitis to reduce unnecessary antibiotic prescription.

Effectiveness of an integrated-Weight Management Programme (i-WMP) in Reducing Body Weight among Noncommunicable Disease Patients in Malaysian Government Primary Care Clinics: A Randomised Controlled Tria

Introduction: Obesity is a global issue called as “globesity”. Overweight and obesity may lead to many noncommunicable diseases (NCDs). Primary care is the first centre to monitor and follow-up the progress of NCD patients. Therefore, the objective of this study was to determine the effectiveness of an integrated-Weight Management Programme (i-WMP) to reduce body weight among NCD patients from two Government primary care clinics from Hulu Langat District. Methods: This study was single-blinded randomised controlled trial by design. There were 244 eligible patients were randomised into intervention (n = 122) or wait-list control group (n = 122). The i-WMP was developed based on the behaviour change wheel through the operationalization of behaviour change techniques. The duration of this intervention programme was four weeks. Data collected at week 0, week 4, and week 12. The software IBM SPSS was used to analyse the data. Generalized linear mixed model analysis with intention-to-treat principle was applied. Results: The retention rate was 74.2%. Findings showed that the i-WMP was significantly effective in reducing not only body weight as primary outcome but also secondary outcomes such as waist-to-height ratio, waist circumference, body mass index, and total sitting time. It also improved effectively other secondary outcomes such as participants’ knowledge, attitude, and practice towards dietary and towards physical activity. However, no significant changes were reported for body fat percentage and total physical activity metabolic equivalent of task-minutes/week. Conclusion: Implications surrounding the implementation of i-WMP in the primary care clinics are recommended.

The Pictorial Fit-Frail Scale-Malay version (PFFS-M): reliability and validity testing in Malaysian primary care.

This study investigated the reliability and convergent validity of the PFFS-Malay version (PFFS-M) among patients (with varying educational levels), caregivers, and health care professionals (HCPs). PFFS-M cutoffs for frailty severity were developed. This is a cross-sectional study from 4 primary care clinics where 240 patients aged >60 years and their caregivers were enrolled. Patients were assigned to a nurse or a health care assistant (HCA) for 2 separate PFFS-M assessments administered by HCPs of the same profession, as well as by a doctor during the first visit (inter-rater reliability). Patients were also administered the Self-Assessed Report of Personal Capacity & Healthy Ageing (SEARCH) tool, a 40-item frailty index, by a research officer. The correlation between patients' PFFS-M scores and SEARCH tool scores determined convergent validity. Patients returned 1 week later for PFFS-M reassessment by the same HCPs (test-retest reliability). Caregivers completed the PFFS-M for the patient at both clinic visits. Classification cut-points for the PFFS-M were derived against frailty categories defined through the SEARCH tool. The inter-rater (intraclass correlation coefficient [ICC] = 0.92 [95% CI, 0.90-0.93)] and test-retest (ICC = 0.94 [95% CI, 0.92-0.95]) reliability between all raters was excellent, including by patients' education levels. The convergent validity was moderate (r = 0.637, p < 0.001), including for varying educational background. PFFS-M categories were identified as: 0-3, no frailty; 4-5, at risk of frailty; 6-8, mild frailty; 9-12, moderate frailty; and >13, severe frailty. PFFS-M is a reliable and valid tool with frailty severity scores now established for use of this tool in primary care clinics.

Factors Associated with Screening Mammogram Uptake among Women Attending an Urban University Primary Care Clinic in Malaysia.

Screening mammograms have resulted in a reduction in breast cancer mortality, yet the uptake in Malaysia was low. This study aimed to determine the prevalence and factors associated with screening mammogram uptake among women attending a Malaysian primary care clinic. A cross-sectional study was conducted among 200 women aged 40 to 74 attending the clinic. The data was collected using questionnaires assessing sociodemographic, clinical characteristics, knowledge and health beliefs. Multiple logistic regression was used to identify factors associated with mammogram uptake. The prevalence of screening mammograms was 46.0%. About 45.5% of women with high breast cancer risk had never undergone a mammogram. Older participants, aged 50 to 74 (OR = 2.57, 95% CI: 1.05, 6.29, p-value = 0.039) and those who received a physician’s recommendation (OR = 7.61, 95% CI: 3.81, 15.20, p-value < 0.001) were more likely to undergo screening mammography. Significant health beliefs associated with mammogram uptake were perceived barriers (OR = 0.81, 95% CI: 0.67, 0.97, p-value = 0.019) and cues to action (OR = 1.30, 95% CI: 1.06, 1.59, p-value = 0.012). Approximately half of the participants and those in the high-risk group had never undergone a mammogram. Older age, physician recommendation, perceived barriers and cues to action were significantly associated with mammogram uptake. Physicians need to play an active role in promoting breast cancer screening and addressing the barriers.

The Relationships between Depression and Physical Activity with Medication Adherence among Patients with Type 2 Diabetes Mellitus in Klang Valley, Malaysia

Studies among the Type 2 Diabetes Mellitus (T2DM) patients have shown that optimal mental health status is associated with better medication adherence leading to a good blood glucose control. This research aims to determine the relationship between psychological well-being and physical activity levels with medication adherence among the T2DM patients. A cross-sectional study was conducted on 240 diabetic patients at an outpatient primary care clinic from a tertiary teaching hospital in Klang Valley, Malaysia. The questionnaires used in the study were Medication Compliance Questionnaire (MCQ), Hospital Anxiety and Depression Scale (HADS), and Godine-Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ). The research hypotheses were tested by the Pearson Chi-Square Test of Independence. Physical activity shows a non-significant relationship with medication adherence Concur with the previous study, depression is one of the crucial factors that correlate with poor medication adherence among diabetic patients in Malaysia. There is a statistically significant relationship between poor medication adherence with depression. Thus, appropriate psychological assessment must be offered to all T2DM patients as part of the treatment management in all Malaysian primary care services. This study proves that in managing a patient with T2DM, psychological well-being must be addressed at follow-ups by the attending doctor to ensure a favourable patient outcome and to reduce morbidity.

Assessing the Availability of Teleconsultation and the Extent of Its Use in Malaysian Public Primary Care Clinics: Cross-sectional Study.

BackgroundThe integration of teleconsultation into health care systems as a complement to existing approaches to care is growing rapidly. There is, however, limited information on the extent of its implementation across low- and middle-income countries.ObjectiveThe aim of this study was to determine the availability and the extent of teleconsultation in Malaysian primary care clinics.MethodsA cross-sectional study of public primary care clinics in Malaysia was conducted between November 2020 and December 2020. All clinics in Malaysia that see more than 300 daily patients were recruited. A web-based, self-administered questionnaire including questions on availability of the service, whether it uses video or telephone, and the types of services it provides was distributed to the medical officer in charge of each clinic.ResultsIn total, 97.6% (249/255) of the clinics responded. Out of these clinics, 45.8% (114/249) provided teleconsultation. A majority of the clinics providing consultation (69/114, 60.5%) provided only telephone consultation, while 24.6% (28/114) of the clinics offered video and telephone consultation, and 14.9% (17/114) offered only video consultation. Eighty percent (92/114) of the clinics were located in urban areas. A breakdown by state showed that 17.5% (20/114) and 16.7% (19/114) of the clinics were from two larger states; other states comprised less than 10% each (range 7-9/114). For the clinics providing video consultation, funding for the service came mostly (42/45, 93%) from the Ministry of Health. Conversely, nearly 1 out of 4 (23/97) clinics that provided telephone consultation funded the service either from donations or through self-funding. Most of the clinics provided teleconsultation for diabetes and hypertension. Less than 50% of the clinics with teleconsultation used it for follow up with allied health care providers or pharmacists (video consultation, 20/45; telephone consultation, 36/97).ConclusionsOur findings show that telephone consultation is more widely used than video consultation, despite a quarter of its funding being self-subsidized or obtained through donations. Also, teleconsultation was less utilized by allied health care providers and pharmacists. Plans for the expansion of teleconsultation in Malaysian primary health care should take into consideration these findings to ensure a better and more cost-effective implementation of the service.