Primary Care Clinics In Malaysia Research Articles

Handgrip strength, and erectile dysfunction among men with metabolic syndrome attending an institutional primary care clinic in Malaysia: A cross-sectional study.

Erectile dysfunction (ED) is an independent predictor for cardiovascular diseases (CVD). The prevalence increases with age, but little is known about the relationship between handgrip strength (HGS) and ED, especially among men with a high risk of CVD. This study aimed to determine the prevalence of ED among men aged ≥40 years with metabolic syndrome (MetS) and its association with HGS. A cross-sectional study at an institutional primary care clinic in Malaysia was conducted between June 2021 and October 2021. HGS and erectile function were assessed using a hand dynamometer and International Index of Erectile Function (IIEF-5) questionnaire, respectively. Multiple logistic regression analyses were performed to determine the association between sociodemographics, clinical characteristics, and HGS with ED. A total of 334 participants were recruited. The prevalence of ED was 79% (95% confidence interval [CI]: 0.75-0.84). ED was associated with elderly aged ≥60 years (odds ratio [OR] 3.27, 95%CI: 1.60-6.69), low HGS (OR 15.34, 95%CI: 5.64-41.81) and high total cholesterol (OR 0.36, 95%CI: 0.16-0.78). In conclusion, age above 60 years and those with low HGS are at higher risk of ED. Thus, robust screening of ED among men with MetS and improving muscle strength and physical fitness may be warranted.

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.

Home Medication Management and Practices among Post-stroke Patients: A Cross-sectional Study in a University-based Primary Care Clinic in Malaysia

Effective medication management practice (MMP) improves compliance of chronic conditions management and reduces medication error for better clinical outcomes. This is important for stroke survivors with multiple comorbidities and post-stroke complications. This study aimed to determine appropriateness of home MMP and its associated factors among post stroke patients. This was a cross-sectional, single-centre study involving 120 stroke patients of a primary care medical centre in Kuala Lumpur between January and March 2021. The assessment of MMP appropriateness relied on scores obtained through a set of questions administered via face-to-face, online or telephone interview. The mean age of participants was 65.1 (SD 11.7) years. 55.8% of participants had inappropriate home MMP; where the majority did not update their medication list (86.3%), did not memorise the medication’s name (75%), and did not return the leftover medication to the pharmacy (63.3%). Female gender (AOR: 2.74, 95% CI: 1.18-6.35, p-value: 0.019), household income (&gt; RM4850) (AOR: 2.82, 95% CI: 1.03-7.69, p-value: 0.043), and number of clinic appointments (&gt;2) (AOR: 5.27, 95% CI: 1.44-19.24, p-value: 0.012) were significantly correlated with better home MMP. The MMP among post-stroke patients was poor. Better home MMP were associated with female gender, higher socioeconomic status, and more frequent clinic appointments. Concerted health education should be provided, particularly focusing on medication management to improve home MMP in post-stroke patients and ultimately improving their overall health outcomes.

Translation and validation of menopause quick 6 (MQ6) into the Malay language

BackgroundInquiring conservative Asian women about their menopausal symptoms is often challenging in crowded primary healthcare clinics. Furthermore, the subject matter is culturally sensitive to most Malaysian women. Hence, the translation of MQ6 into Malay is crucial to enable self-administration, eliminating the necessity for interviewers and mitigating potential respondent shyness.MethodsThe Menopause Quick 6 (MQ6) questionnaire was translated into the Malay language with an addition of an item, henceforth termed MQ6 (M). Forward and backward translation was performed. Face and content validity were conducted. MQ6 (M) was self-administered to 400 women aged between 40 and 60 attending six primary healthcare clinics in Malaysia. To ascertain the reliability for MQ6 (M), corrected Item-Total Correlation, Squared Multiple Correlation, Cronbach’s Alpha if the Item is Deleted, and Kuder-Richardson Reliability Coefficients (KR20). Exploratory factor analysis was done to determine its’ construct validity.ResultsThe outcome of the validation was satisfactory. By the Lawshe method, the content validity ratios ranged from 0.6 to 1.0 and the content validity index was 0.914. The Internal consistency for MQ6(M) Cronbach’s alpha was 0.711 while Kuder-Richardson Reliability Coefficients KR20 was 0.676. Factor loading of all four items is above 0.70, indicating a well-defined structure. Whereas factor loading for three items fell within the range of 0.50–0.69 indicating a practically significant threshold for a new questionnaire.ConclusionMQ6 (M) has acceptable reliability and construct validity to be considered as a self-administered screening tool in primary care clinics in Malaysia.

Prevalence, risk factors and treatment outcomes of syphilis among people living with human immunodeficiency virus at primary care clinics in Malaysia: A retrospective study.

Syphilis and human immunodeficiency virus (HIV) coinfection is a common clinical problem with a significant rising trend worldwide. In Malaysia, the burden of care is shared between hospitals and primary care clinics. This study aimed to determine the prevalence of syphilis among people living with HIV (PLHIV) at primary care clinics in Malaysia and assess its association with sociodemographic characteristics, risk factors and treatment outcomes. This retrospective study included 750 PLHIV aged ≥18 years who attended primary care clinics in three different locations in Malaysia from 1 January 2017 to 31 December 2019. Data were obtained from the patients' clinical notes using a structured questionnaire evaluating the sociodemographic characteristics, history of sexual and lifestyle behaviours, diagnosis and management. The patients' age ranged from 18 to 78 years (mean=34.7, standard deviation=10.2). The prevalence of syphilis among the PLHIV at the three primary care clinics was 33.8% (n=254). Syphilis was significantly associated with gender (P=0.038) as well as sexual activity (P<0.001), substance use (P=0.038), history of chemsex (P=0.001) and history of sexually transmitted infections (STIs) (P<0.001) within the past 12 months. The majority of the PLHIV with syphilis received treatment at the primary care clinics (n=248, 97.3%), and up to 96.1% (n=245) had completed such treatment. Syphilis is prevalent among PLHIV at primary care clinics, and most patients receive standard treatment. Therefore, primary care doctors must enhance their knowledge to effectively manage STIs, especially syphilis.

Online health information behaviour and its association with statin adherence in patients with high cardiovascular risk: A prospective cohort study.

Statins are effective for preventing cardiovascular disease. However, many patients decide not to take statins because of negative influences, such as online misinformation. Online health information may affect decisions on medication adherence, but measuring it is challenging. This study aimed to examine the associations between online health information behaviour and statin adherence in patients with high cardiovascular risk. A prospective cohort study involving 233 patients with high cardiovascular risk was conducted at a primary care clinic in Malaysia. Participants used a digital information diary tool to record online health information they encountered for 2 months and completed a questionnaire about statin necessity, concerns and adherence at the end of the observation period. Data were analysed using structural equation modelling. The results showed that 55.8% (130 of 233 patients) encountered online health information. Patients who actively sought online health information (91 of 233 patients) had higher concerns about statin use (β = 0.323, p = 0.023). Participants with higher concern about statin use were also more likely to be non-adherent (β = -0.337, p < 0.001). Patients who actively sought online health information were more likely to have lower statin adherence, mediated by higher concerns about statin use (indirect effect, β = -0.109, p = 0.048). Our results suggest that patients with higher levels of concern about statins may be actively seeking online information about statins, and their concerns might influence how they search, what they find, and the potential to encounter misinformation. Our study highlights the importance of addressing patients' concerns about medications to improve adherence.

Quality of Sleep and Associated Factors Among Healthcare Providers During Covid-19 in Malaysia: A Web-based Cross-sectional Study

Introduction: COVID-19 has placed enormous strain on healthcare providers (HCPs). This study aimed to determine the quality of sleep (QoS), and associated factors, of HCPs in primary care clinics during the COVID-19 pandemic. Methods: This was a web-based cross-sectional study of HCPs from 30 primary care clinics in Malaysia. QoS was assessed using a validated single-item scale, and the response ranged from 0 (poor) to 10 (excellent). SPSS version 26 was used for the analysis. Results: Our study included 1280 respondents. The mean QoS score was 6.725 = 1.961. One demographic factor that was positively associated with QoS was age. Having one workplace, nurse, medical assistant, medical laboratory technician (or healthcare assistant compared to being a driver, were also significantly positively associated with QoS. Personality factors that were significantly positively associated with QoS were HCPs’ abilities to cope with work stress and be altruistic. There were negative correlations between QoS and being a male HCP, concern about COVID-19 mortality and perceived risk of exposure to COVID-19. Conclusion: HCPs with clinical roles who were older, had a single workplace, were altruistic and could cope with work stress had better QoS. To maintain the QoS of HCPs, healthcare organisations should promote regular activities supporting the staffs’ mental health and encourage compassion for the organisation and an altruistic work culture, especially among younger employees.

Factors Associated With Frailty Among Older Adults Attending a Rural Public Primary Care Clinic in Malaysia

Introduction: Frailty is a condition occurring in older age with a reduction in homeostatic reserve and inability to react against external stressors. This resulted in falls, disability, loss of independence and mortality. At present, there are limited studies on frailty in the rural settings in Malaysia. We aimed to determine the proportion of frailty and the factors associated with frailty among older adults attending a rural clinic in Selangor. Methods: A cross-sectional study involving older adults aged &gt;60 years who attended a rural public healthcare clinic were recruited from February-April 2018 using a systematic random sampling method. Face-to-face interview using structured pretested questionnaires and physical assessment was conducted. Data collected included socio-demography, frailty status, functional status, cognitive function, self-reported chronic diseases and polypharmacy. All analyses were done using SPSS software version 22.0. Results: The response rate was 93% with 250 participants. A total of 29 (11.6%) participants were frail and 75 (30%) were pre-frail. The factors associated with pre-frail and frail among older adults were the presence of two chronic diseases or more (aOR=4.89; 95%CI=1.29, 18.51; p=0.019), presence of polypharmacy (aOR=1.97; 95%CI=1.05, 3.72; p=0.035), abnormal walking speed based on Time Up and Go test (aOR=12.80; 95%CI=4.57, 35.86; p&lt;0.001), and dependent IADLs based on Lawton’s IADLs (aOR= 3.06; 95%CI=1.28, 7.33; p=0.012). Conclusion: Older adults attending the rural primary clinic with risk factors such as multiple chronic diseases and polypharmacy should be screened for frailty as the condition is potentially reversible if interventions are started early.

Prevalence and burden of diabetes mellitus-related symptoms in patients with type 2 diabetes mellitus: A cross-sectional study.

Type 2 diabetes mellitus (T2DM) is a significant non-communicable disease in Malaysia, with a prevalence of 18.1%, per the National Health and Morbidity Survey. This study aimed to determine the prevalence and burden of diabetes mellitus-related symptoms and whether these symptoms were addressed by primary care doctors. This 1-month cross-sectional study was conducted at an urban hospital-based primary care clinic in Malaysia. Patients with T2DM were recruited using systematic random sampling. Participants answered a self-administered questionnaire adapted from the Diabetes Symptom Checklist-Revised, which evaluated the sociodemographic characteristics, burden of diabetes mellitus-related symptoms in the past month and post-consultation feedback about symptoms. Data were analysed using SPSS. Four hundred eighteen participants were included, yielding a response rate of 97.7%. Hyperglycaemia was the most prevalent symptom, with 48.1% of the participants reporting a frequent need to empty their bladder. Most participants experienced a low symptom burden, so 56.7% did not report their symptoms to their doctors. The participants who reported their symptoms had a higher symptom burden. Among them, 97.5% indicated that their doctors addressed their symptoms. Approximately 78% reported satisfaction and good coping skills when their symptoms were addressed. Hyperglycaemia was the most prevalent diabetes mellitus-related symptom among the patients with T2DM. The symptom burden was generally low, so most patients did not report their symptoms to their doctors. Those who reported their symptoms had a higher symptom burden. Further studies must explore why patients do not report their symptoms and how doctors address patients' symptoms.

Fear of Covid-19 and Burnout Among Healthcare Providers in Malaysia: Is Resilience a Missing Link?

Introduction: During the COVID-19 pandemic, healthcare providers have been in great fear due to the high risk of contracting COVID-19 infection at any time. This study aimed to determine the mediating role of resilience on the relationship between fear of COVID-19 and burnout in primary care healthcare providers in Malaysia. Methods: This was an online cross-sectional study involving 1280 healthcare providers aged 18 years and older from 30 government primary care clinics in Malaysia. We used the COVID-19 Fear Scale, the Copenhagen Burnout Inventory Scale, and the Short Brief Resilience Scale to collect data from the respondents. Smart-PLS was used to perform mediation analysis. Results: The mean age of the respondents was 36 years old and mean duration of working experience was 11 years. The majority of the respondents were female (82.4%) and Malays (82.3%). The study population consisted of nurses (47.4%), doctors (26%), medical assistants (11.9), healthcare assistant (7.1%), medical laboratory technicians (6.4%) and drivers(1.3).The results show that fear of COVID-19 positively predicts burnout. According to the results, resilience mediates the relationship between fear of COVID-19 and all the three burnout domains, namely personal burnout (β=0.175,p&lt;0.001), work-related burnout (β=0.175,p&lt;0.001) and client-related burnout (β=0.172,p&lt;0.001). Additionally, resilience reduces the impact of COVID-19 fear on the three domains of burnout. Conclusion: Our study has reported a mediating effect of resilience on the relationship between fear of COVID-19 and burnout.

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.

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).

The Effectiveness of Enhanced Primary Healthcare (EnPHC) interventions on Type 2 diabetes management in Malaysia: Difference-in-differences (DID) analysis

AimsTo evaluate the effectiveness of the Enhanced Primary Healthcare (EnPHC) interventions on process of care and intermediate clinical outcomes among type 2 diabetes patients. MethodsThis was a quasi-experimental controlled study conducted in 20 intervention and 20 control public primary care clinics in Malaysia from November 2016 to June 2019. Type 2 diabetes patients aged 30 years and above were selected via systematic random sampling. Outcomes include process of care and intermediate clinical outcomes. Difference-in-differences analyses was conducted. ResultsWe reviewed 12,017 medical records of patients with type 2 diabetes. Seven process of care measures improved: HbA1c tests (odds ratio (OR) 3.31, 95% CI 2.13, 5.13); lipid test (OR 4.59, 95% CI 2.64, 7.97), LDL (OR 4.33, 95% CI 2.16, 8.70), and urine albumin (OR 1.99, 95% CI 1.12, 3.55) tests; BMI measured (OR 15.80, 95% CI 4.78, 52.24); cardiovascular risk assessment (OR 174.65, 95% CI 16.84, 1810.80); and exercise counselling (OR 1.18, 95% CI 1.04, 1.33). We found no statistically significant changes in intermediate clinical outcomes (i.e. HbA1c, LDL, HDL and BP control). ConclusionsEnPHC interventions was successful in enhancing the quality of care, in terms of process of care, by changing healthcare providers behaviour.

PS-C34-3: EXPERIENCES AND INFLUENCES OF ONLINE HEALTH INFORMATION-SEEKING ABOUT STATIN USE IN PATIENTS WITH HIGH CARDIOVASCULAR RISK: A QUALITATIVE STUDY.

Objectives: Online health information (OHI) about statin use has created debates among healthcare professionals and the public. As a result, online misinformation about statins has led to an increase in the discontinuation of statins. OHI has been shown to influence patients’ health decisions and behaviours. This study explores the views and experiences of OHI-seeking about statins in patients with high cardiovascular risk and how OHI influences patient decision-making and statin adherence. Designs and method: This is a qualitative study with semi-structured in-depth interviews of 20 patients with high cardiovascular risk from a primary care clinic in Malaysia. We included participants who were at least 18 years old and had high cardiovascular risk where statin use is indicated as per guideline (i.e. with pre-existing cardiovascular disease (CVD), diabetes mellitus, chronic kidney disease, a 10-year risk for CVD &gt; 20% based on the Framingham General CVD risk score) and have sought OHI about statins. We used an interpretive description approach with thematic analysis. Results: The age of the participants ranged from 39–74 years, with 16 (80%) participants having hypertension. 12 (60%) participants took a statin for primary CVD prevention. The duration of statin use ranged from 2 weeks to 30 years. Six themes emerged from the interviews (Figure 1): (1) Participants sought different types of OHI throughout the disease trajectory depending on their information needs, (2) There is a changing paradigm of OHI-seeking behaviour, where passive exposure to OHI appears to have increased relative to active searching, (3) Participants sought a wide range of OHI from hypercholesterolemia, lifestyle modification and complementary alternative medicine, (4) Statin-related OHI was mainly negative and stressed the side effects of statins, (5) OHI triggered emotional reactions that may affect patients’ decision on statin adherence, (6) Doctors’ responses to participants’ OHI-seeking behaviour affected patient-doctor communication and patients’ decision in taking statins. Conclusions: This study highlights the changing information needs throughout patient journeys, suggesting the opportunity to provide needs-oriented OHI to patients with high cardiovascular risk. Passive OHI exposure appears to have an influence on patients’ adherence to statins. The quality of patient-doctor communication about OHI-seeking behaviour remains a critical factor in patient decision making. Doctors should discuss patients’ information needs and OHI-seeking behaviour throughout the disease trajectory and provide evidence-based health information to patients. Strategies are needed to address patients’ concerns about statins, acknowledge their emotional reactions toward OHI and support their need for evidence-based OHI.

Feasibility of supported self-management with a pictorial action plan to improve asthma control

Supported self-management reduces asthma-related morbidity and mortality. This paper is on a feasibility study, and observing the change in clinical and cost outcomes of pictorial action plan use is part of assessing feasibility as it will help us decide on outcome measures for a fully powered RCT. We conducted a pre–post feasibility study among adults with physician-diagnosed asthma on inhaled corticosteroids at a public primary-care clinic in Malaysia. We adapted an existing pictorial asthma action plan. The primary outcome was asthma control, assessed at 1, 3 and 6 months. Secondary outcomes included reliever use, controller medication adherence, asthma exacerbations, emergency visits, hospitalisations, days lost from work/daily activities and action plan use. We estimated potential cost savings on asthma-related care following plan use. About 84% (n = 59/70) completed the 6-months follow-up. The proportion achieving good asthma control increased from 18 (30.4%) at baseline to 38 (64.4%) at 6-month follow-up. The proportion of at least one acute exacerbation (3 months: % difference −19.7; 95% CI −34.7 to −3.1; 6 months: % difference −20.3; 95% CI −5.8 to −3.2), one or more emergency visit (1 month: % difference −28.6; 95% CI −41.2 to −15.5; 3 months: % difference −18.0; 95% CI −32.2 to −3.0; 6 months: % difference −20.3; 95% CI −34.9 to −4.6), and one or more asthma admission (1 month: % difference −14.3; 95% CI −25.2 to −5.3; 6 months: % difference −11.9; 95% CI −23.2 to −1.8) improved over time. Estimated savings for the 59 patients at 6-months follow-up and for each patient over the 6 months were RM 15,866.22 (USD3755.36) and RM268.92 (USD63.65), respectively. Supported self-management with a pictorial asthma action plan was associated with an improvement in asthma control and potential cost savings in Malaysian primary-care patients.Trial registration number: ISRCTN87128530; prospectively registered: September 5, 2019, http://www.isrctn.com/ISRCTN87128530.

Diagnostic Accuracy of Centor Score for Diagnosis of Group A Streptococcal Pharyngitis among Adults in Primary Care Clinics in Malaysia.

BackgroundPharyngitis is a common presentation seen in general practice, but it is difficult to differentiate whether its etiology is viral or bacterial. The Centor score gives an approximation of the etiology of the pharyngitis, which informs physicians of the need to prescribe antibiotics. This study aimed to assess the validity of the Centor score in diagnosing Group A streptococcal (GAS) pharyngitis amongst adults in Malaysia.MethodsThis cross-sectional study was conducted to compare the clinical criteria of the Centor score to the gold standard throat swab culture results amongst 215 adults presenting with sore throat in primary care clinics. The participants were adult patients who complained of sore throat and visited the three public primary care clinics in Sepang, Malaysia. The convenience sampling method was used. The throat swabs were analysed for β-haemolytic streptococci. Demographic and clinical data, including the Centor score, were analysed in relation to the pathogen.ResultsPharyngitis was diagnosed in 130 (60.5%) of the participants. Six isolates (2.4%) were identified as GAS pharyngitis. Both Centor scores 3 and 4 had a sensitivity of 50%, and specificities of 97.6% and 100%, respectively.ConclusionA Centor score < 3 is favourable for excluding a diagnosis of GAS pharyngitis. Centor scores 3 and 4 require further examination to confirm a diagnosis of GAS pharyngitis.

Initiating Activation in Diabetes Self-Management From Patients’ Perspective

Patients’ active role is crucial in managing chronic illnesses like type 2 diabetes. Current evidence demonstrated patients who were activated had better clinical outcomes. Some factors influencing patient activation have been identified but there is little knowledge on how patients successfully start to take their role in managing diabetes. This study aimed to explore how patients begin to activate themselves in self-management. The narrative inquiry was taken as the qualitative methodological approach. Ten participants with type 2 diabetes were purposively sampled from a public primary care clinic in Malaysia. In-depth interviews were conducted and recorded. The data were analysed with thematic analysis. Three themes and four subthemes were generated. The first theme, “Learning what to do” describes the learning process from social networks and healthcare professionals that helped to define their role. The second theme highlighted that patients wished for a gradual approach in initiating activation, i.e. “Taking one step at a time”. They started with a more straightforward self-management task and needed more time to take up their role. The third theme pointed out that when patients could not perform certain self-management tasks, they would engage with someone else to help: “Engaging with someone for challenging tasks.” In conclusion, diabetes self-management education is substantial in developing ‘patient activation,’ i.e. patient’s ability to self-manage. The self-management plan should also be realistic and suit patients’ circumstances. Having a health partner or buddy among family members or peers is helpful when trying to adopt good dietary habits and perform regular exercise.

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.

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.

Incidence of angiotensin-converting enzyme inhibitor-induced cough in a Malaysian public primary care clinic: A retrospective cohort study

Introduction: The incidence of angiotensin-converting enzyme inhibitors (ACEi)-induced cough has been reported between 5% and 30% but is unknown in Malaysia. This study aimed to determine the incidence of ACEi-induced cough and its associated factors in a public primary care clinic in Malaysia. Methods: A retrospective review of electronic medical records of patients who were initiated ACEi between January 1, 2015, and December 31, 2015, and reviewed until July 31, 2016. A total of 1,091 patients were newly prescribed ACEi, and 394 patients were eligible for this study. We excluded patients who defaulted follow-ups with no further clinic visits before July 31, 2016, were transferred to the clinic without the recorded date of ACEi initiation, were transferred to other clinics during the study period, were followed up at other clinics and attended the study clinic for a short period, or were given only a stat dose of ACEi. Results: Among the 394 patients initiated on ACEi, 225 (57.1%) were male, 369 (93.7%) were Malay, 376 (95.4%) had hypertension, and 192 (48.7%) had diabetes. The incidence of ACEi-induced cough was 24.1%, and 42 (10.7%) patients developed cough on the day of therapy initiation. There was no association between age, gender, ethnicity, type of ACEi, and cough. Conclusion: Approximately one quarter of patients developed cough after ACEi initiation, and approximately half of them developed cough within 1 week of ACEi initiation. Doctors should consider early follow-up for patients initiated on ACEi therapy to ensure adherence, quality of life, and minimise unnecessary treatment.