Malaysian Primary Care Setting Research Articles

Diabetes empowerment scores among type 2 diabetes mellitus patients and its correlated factors: A cross-sectional study in a primary care setting in Malaysia.

BACKGROUNDThere are limited studies on diabetes empowerment among type 2 diabetes patients, particularly in the primary care setting.AIMTo assess the diabetes empowerment scores and its correlated factors among type 2 diabetes patients in a primary care clinic in Malaysia.METHODSThis is a cross sectional study involving 322 patients with type 2 diabetes mellitus (DM) followed up in a primary care clinic. Systematic sampling method was used for patient recruitment. The Diabetes Empowerment Scale (DES) questionnaire was used to measure patient empowerment. It consists of three domains: (1) Managing the psychosocial aspect of diabetes (9 items); (2) Assessing dissatisfaction and readiness to change (9 items); and (3) Setting and achieving diabetes goal (10 items). A score was considered high if it ranged from 100 to 140. Data analysis was performed using SPSS version 25 and multiple linear regressions was used to identify the predictors of total diabetes empowerment scores.RESULTSThe median age of the study population was 55 years old. 56% were male and the mean duration of diabetes was 4 years. The total median score of the DES was 110 [interquartile range (IQR) = 10]. The median scores of the three subscales were 40 with (IQR = 4) for “Managing the psychosocial aspect of diabetes”; 36 with (IQR = 3) for “Assessing dissatisfaction and readiness to change”; and 34 with (IQR = 5) for “Setting and achieving diabetes goal”. According to multiple linear regressions, factors that had significant correlation with higher empowerment scores among type 2 diabetes patients included an above secondary education level (P < 0.001), diabetes education exposure (P = 0.003), lack of ischemic heart disease (P = 0.017), and lower glycated hemoglobin (HbA1c) levels (P < 0.001).CONCLUSIONDiabetes empowerment scores were high among type 2 diabetes patients in this study population. Predictors for high empowerment scores included above secondary education level, diabetes education exposure, lack of ischemic heart disease status and lower HbA1c.

Barriers to smoking cessation: a qualitative study from the perspective of primary care in Malaysia

ObjectivesThis qualitative study aims to construct a model of the barriers to smoking cessation in the primary care setting.DesignIndividual in-depth, semistructured interviews were audio-taped, then verbatim transcribed and translated when...

Shared decision making: A dual-layer model to tackling multimorbidity in primary care.

It is common for primary care providers (PCPs) to manage complex multimorbidity. When caring for patients with multimorbidity, PCPs face challenges to tackle several issues within a short consultation in order to address patients' complex needs. Furthermore, some PCPs may lack access to a multidisciplinary team and need to manage multimorbidity within the confine of a PCP-patient partnership only. Instead of attempting to address multiple health issues within a single consultation, it would be more feasible and time effective for PCPs and patients to jointly prioritize the health issue to focus on. Using the Malaysian primary care setting as a case study, a dual-layer-shared decision-making approach is proposed whereby PCPs and patients make decisions on which disease(s) (layer 1) and treatment(s) (layer 2) to prioritize. This dual-layer model aims to address the challenges of short consultation time and limited healthcare resources by encouraging PCPs and patients to discuss, negotiate, and agree on the decision during the consultation to ensure patients' health needs are addressed.

Pitfalls in diagnosis and management of suspected urinary tract infection in an urban tropical primary care setting.

Diagnosis and management of urinary tract infection (UTI) are complex, and do not always follow guidelines. The aim of this study was to determine adherence to the 2014 Malaysian Ministry of Health guidelines for managing suspected UTI in a Malaysian primary care setting. We retrospectively reviewed computerized medical records of adults with suspected UTI between July-December 2016. Excluded were consultations misclassified by the search engine, duplicated records of the same patient, consultations for follow-up of suspected UTI, patients who were pregnant, catheterised, or who had a renal transplant. Records were reviewed by two primary care physicians and a clinical microbiologist. From 852 records, 366 consultations were a fresh episode of possible UTI. Most subjects were female (78.2%) with median age of 61.5 years. The major co-morbidities were hypertension (37.1%), prostatic enlargement in males (35.5%) and impaired renal function (31.1%). Symptoms were reported in 349 (95.4%) consultations. Antibiotics were prescribed in 307 (83.9%) consultations, which was appropriate in 227/307 (73.9%), where the subject had at least one symptom, and leucocytes were raised in urine full examination and microscopic examination (UFEME). In 73 (23.8%) consultations antibiotics were prescribed inappropriately, as the subjects were asymptomatic (14,4.6%), urine was clear (17,5.5%), or UFEME did not show raised leucocytes (42,13.7%). In 7 (2.3%) consultations appropriateness of antibiotics could not be determined as UFEME was not available. Several pitfalls contributed to suboptimal adherence to guidelines for diagnosis and management of suspected UTI. This illustrates the complexity of managing suspected UTI in older subjects with multiple co-morbidities.

Effectiveness and prescription pattern of lipid-lowering therapy and its associated factors among patients with type 2 diabetes mellitus in Malaysian primary care settings.

BackgroundCardiovascular diseases (CVDs) are the main complication leading to morbidity and mortality among patients with type 2 diabetes mellitus (T2DM). There is a large amount of evidence to support the use of lipid-lowering therapy (LLT) for the prevention of CVD. This study aimed to assess the effectiveness and prescription quality of LLT among T2DM patients and to identify its associated factors.MethodsA multicenter cross-sectional study included 816 T2DM patients from four different primary care centers in Pahang, Malaysia. We involved LLT-eligible T2DM patients as per the national clinical practice guidelines (CPG). The assessment of therapy effectiveness focused on the attainment of target lipid measures stated in the CPG. Evaluation of the prescription quality was classified into appropriate, potentially inappropriate, and inappropriate, based on the compliance with guidelines and existence of potential safety concerns. Binomial logistic regression was employed to identify the predictors of LLT effectiveness and prescription quality.ResultsThe overall percentage of T2DM patients receiving statin therapy was 87.6% (715/816). Statin therapy was appropriately prescribed in 71.5% of the cases. About 17.5% of the LLT prescriptions have at least one significant drug interaction with co-prescribed medications. The achievement of the primary target of low-density lipoprotein cholesterol (LDL-C) levels was observed in only 37% of T2DM patients. The LLT indication and appropriateness of prescription were significantly associated with the attainment of LDL-C treatment goals. Primary prevention, Malay race, and hypertension were identified as predictors for appropriate prescribing of LLT among T2DM subjects.ConclusionThere is a need to enhance the quality of LLT prescribing in the primary care setting to cover all eligible high-risk patients and ensure patient safety. Strategies to improve the achievement of LDL-C goals among patients with T2DM, such as investigating the potential role of the combination therapy and high-intensity statin therapy, are required.

A9728 Comparison of awake home blood pressure using evening measurements to measurement done before bedtime in Malaysian hypertensive patients

Objectives: Studies have reported that home blood pressure (HBP) is a better predictor of cardiovascular mortality and morbidity than office blood pressure (BP). Guidelines recommend averaging the morning and evening HBP measurements to derive the mean awake BP. However recommendation in guidelines regarding the timing of evening HBP measurements is not consistent. Furthermore it is not convenient for most patients to measure the evening HBP before dinner. Hence this study aimed to compare the mean awake HBP when done in the morning and evening to HBP done in the morning and before going to bed. Methods: This is a cross-sectional study of 306 hypertensive patients in a primary care setting in Malaysia. A convenience sampling method was used to recruit patients. Patients were educated according to the standard guidelines on how to measure HBP using a validated oscillometric BP device. Two consecutive BP measurements were taken three times a day (morning, evening before dinner and at bedtime) for seven days. After excluding the measurements of the first day, the remaining measurements were used to derive the mean awake BP. Paired t-test was used for analysis. Results: The mean age of the population was 67 ± 10 years, 46.6% were males. The mean morning HBP was 129.5 mm ± 15 mmHg; mean evening BP taken before dinner was 126.9 ± 14.3 mmHg and bedtime 125.7 ± 15.9mmHg. The mean awake BP using morning and evening was 128.0 mmHg compared with 127.5 mmHg based on morning and bedtime readings, a difference of 0.5 mmHg (p = 0.13). Conclusion: There is no difference in awake HBP whether it is measured in the evening or before bedtime. For convenience of the patients, it would appear to be acceptable the HBP to be done before bed instead of the recommended time of evening before dinner.

Knowledge, awareness and practice regarding familial hypercholesterolaemia among primary care physicians in Malaysia: The importance of professional training

Background and aimsThis study aimed to determine knowledge, awareness and practice (KAP) regarding familial hypercholesterolaemia (FH) among Malaysian primary care physicians (PCP), and to compare KAP between PCP with postgraduate qualification (PCP-PG-Qual) and PCP without PG qualification (PCP-noPG-Qual). MethodsThis was a cross-sectional study involving PCP with ≥1-year working experience in Malaysian primary care settings. An adapted and validated 25-item FH-KAP questionnaire was disseminated during primary care courses. Total score for each domain was calculated by summing-up the correct responses, converted into percentage scores. Normality distribution was examined and comparisons of mean/median percentage scores were made between the two groups of PCP. ResultsA total of 372 PCP completed the questionnaire. Regarding knowledge, 77.7% correctly defined FH. However, only 8.3% correctly identified coronary artery disease risk in untreated FH. The mean percentage knowledge score was significantly higher in PCP-PG-Qual compared to PCP-noPG-Qual (48.9, SD ± 13.92 vs. 35.2, SD ± 14.13), t(370) = 8.66, p < 0.001. Regarding awareness, 39% were aware of the NICE FH guideline and only 27.2% were aware of FH diagnostic criteria. The median percentage awareness score was significantly higher in PCP-PG-Qual compared to PCP-noPG-Qual (15.4, IqR ± 23.08 vs. 7.7, IqR ± 11.54), p = 0.013. Regarding practice, only 19.1% stratified FH patients as high risk irrespective of other risk factors. The mean percentage practice score was significantly higher in PCP-PG-Qual compared to PCP-noPG-Qual (52.4, SD ± 12.92 vs. 42.7, SD ± 16.63), t(370) = 9.65, p < 0.001. ConclusionsSubstantial gaps in FH-KAP among Malaysian PCP were identified, with PCP-PG-Qual having better knowledge, awareness and practice than PCP-noPG-Qual, emphasising the importance of professional training and certification.

Validity and reliability of the patient assessment on chronic illness care (PACIC) questionnaire: the Malay version

BackgroundMajority of patients with chronic illnesses such as diabetes, receive care at primary care setting. Efforts have been made to restructure diabetes care in the Malaysian primary care setting in accordance with the Chronic Care Model (CCM). The Patient Assessment on Chronic Illness Care (PACIC) is a validated self-report tool to measure the extent to which patients with chronic illness receive care that aligns with the CCM. To date, no validated tool is available to evaluate healthcare delivery based on the CCM in the Malay language. Thus, the study aimed to translate the PACIC into the Malay language and validate the questionnaire among patients with diabetes in the Malaysian public primary care setting.MethodsThe English version of the PACIC questionnaire is a 20-item scale measuring five key components, which are patient activation, decision support, goal setting, problem solving and follow-up care. The PACIC underwent forward - backward translation and cross cultural adaptation process to produce the PACIC-Malay version (PACIC-M). Reliability was tested using internal consistencies and test-retest reliability analyses, while construct validity was tested using the exploratory factor analysis (EFA).ResultsThe content of PACIC-M and the original version were conceptually equivalent. Overall, the internal consistency by Cronbach’s α was .94 and the intra-class correlation coefficient was .93. One item was deleted (item 1) when the factor loading was < 0.4. The factor analyses using promax identified three components (‘Goal Setting/Tailoring and Problem solving/Contextual’, ‘follow-up/coordination’ and ‘patient activation and delivery system design/ decision support’); explaining 61.2% of the variation. The Kaiser-Meyer-Olkin (KMO) was 0.93 and Bartlett’s test of sphericity was p = .000. Therefore, the final version of the PACIC-M consisted of 19 items, framed within three components.ConclusionThe findings demonstrated that the PACIC-M measured different dimensions from the English version of PACIC. It is however; highly reliable and valid to be used in assessing three CCM model subscales. Further confirmatory factor analysis of PACIC-M should be conducted to confirm this new model.

A comparison of evidence-based medicine practices between primary care physicians in rural and urban primary care settings in Malaysia: a qualitative study

ObjectiveThis study aimed to compare the evidence-based practices of primary care physicians between those working in rural and in urban primary care settings.Research designData from two previous qualitative studies, the...

Relationship between self-efficacy, self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus in the Malaysian primary care setting

BackgroundSelf-efficacy has been shown to be positively correlated with self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus. However, such evidence is lacking in the Malaysian primary care setting. The objectives of this study were to i) determine the levels of self-efficacy, self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus in the Malaysian primary care setting ii) determine the relationship between self-efficacy, self-care behaviour and glycaemic control iii) determine the factors associated with glycaemic control.MethodsThis was a cross-sectional study involving patients with type 2 diabetes mellitus from two public primary care clinics in Malaysia. Self-efficacy and self-care behaviour levels were measured using previously translated and validated DMSES and SDSCA questionnaires in Malay versions, respectively. Glycaemic control was measured using HbA1c.ResultsA total of 340 patients with type 2 diabetes mellitus were recruited. The total mean (±SD) of self-efficacy and self-care behaviour scores were 7.33 (±2.25) and 3.76 (±1.87), respectively. A positive relationship was found between self-efficacy and self-care behaviour (r 0.538, P < 0.001). Higher self-efficacy score was shown to be correlated with lower HbA1c (r − 0.41, P < 0.001). Multiple linear regression analysis demonstrated that higher self-efficacy scores (b − 0.398; 95% CI: -0.024, − 0.014; P < 0.001), shorter duration of diabetes (b 0.177; 95% CI: 0.002, 0.007; P < 0.001) and smaller waist circumference (b 0.135; 95% CI: 0.006, 0.035; P = 0.006), were significantly associated with good glycaemic control.ConclusionThis study demonstrated that higher self-efficacy was correlated with improved self-care behaviour and better glycaemic control. Findings of this study suggest the importance of including routine use of self-efficacy measures in the management of type 2 diabetes mellitus in primary care.

Assessment of Lipid-Lowering Therapy Prescribing Among Patients with Type 2 Diabetes Mellitus in Malaysian Primary Care Settings

Dyslipidemia is a major contributor to the evolution of cardiovascular disease (CVD) among patients with type 2 diabetes mellitus (T2DM). There is a guideline recommendation to offer statin therapy to all T2DM patients between 40 to 75 years old for either primary or secondary CVD prophylaxis. Nevertheless, the suboptimal management of diabetic dyslipidemia in the Malaysian primary care settings has been reported. This study aimed to describe the statin therapy prescribing pattern among patients with T2DM, evaluate the appropriateness of statin therapy prescribing, and assess the level of achievement of the primary target (LDL-C) for diabetic dyslipidemia treatment.

Antibiotic prescribing in public and private practice: a cross-sectional study in primary care clinics in Malaysia.

BackgroundAntibiotic overuse is driving the emergence of antibiotic resistance worldwide. Good data on prescribing behaviours of healthcare providers are needed to support antimicrobial stewardship initiatives. This study examined the differences in antibiotic prescribing rates of public and private primary care clinics in Malaysia.MethodsWe used data from the National Medical Care Survey (NMCS), a nationwide cluster sample of Malaysian public and private primary care clinics in 2014. NMCS contained demographic, diagnoses and prescribing from 129 public clinics and 416 private clinics. We identified all encounters who were prescribed antibiotic and analyse the prescribing rate, types of antibiotics, and diagnoses that resulted in antibiotic.ResultsFive thousand eight hundred ten encounters were prescribed antibiotics; antibiotic prescribing rate was 21.1 % (public clinics 6.8 %, private clinics 30.8 %). Antibiotic prescribing was higher in private clinics where they contributed almost 87 % of antibiotics prescribed in primary care. Upper respiratory tract infection (URTI) was the most frequent diagnosis in patients receiving antibiotic therapy and accounted for 49.2 % of prescriptions. Of the patients diagnosed with URTI, 46.2 % received antibiotic treatment (public 16.8 %, private 57.7 %). Penicillins, cephalosporins and macrolides were the most commonly prescribed antibiotics and accounted for 30.7, 23.6 and 16.0 % of all antibiotics, respectively. More recently available broad-spectrum antibiotics such as azithromycin and quinolones were more frequently prescribed in private clinics.ConclusionsAntibiotic prescribing rates are high in both public and private primary care settings in Malaysia, especially in the latter. This study provides evidence of excessive and inappropriate antibiotic prescribing for self-limiting conditions. These data highlights the needs for more concerted interventions targeting both prescribers and public. Improvement strategies should focus on reducing inappropriate prescribing.

Why is there variation in the practice of evidence-based medicine in primary care? A qualitative study

ObjectiveTo explore the factors, including barriers and facilitators, influencing the practice of evidence-based medicine (EBM) across various primary care settings in Malaysia based on the doctors’ views and experiences.Research designThe...

Perceptions of Doctors and Pharmacists towards Medication Error Reporting and Prevention in Kedah, Malaysia: A Rasch Model Analysis

Objective: Reporting of medication errors in Malaysia is currently low. Consequently, the objective of the study is to explore the perceptions of doctors and pharmacists towards reporting of medication errors and to explore perceived factors that could cause or prevent medication errors. Method: The study was a cross-sectional mail survey. All eight primary outpatient care clinics under Kuala Muda District Health Office, Kedah, Malaysia were included. The study targeted all doctors and pharmacists working in these clinics. The survey questionnaire consisted of two domains — perceptions of medication errors reporting and exploration of perceived preventive factors of medication errors. The Rasch model was used in data analysis. Results: A total of sixty-seven questionnaires were received from the eight clinics, giving a response rate of 100%. Doctors believed that patients’ knowledge about their medications and counselling by pharmacists are the most important preventing factors of medication errors. Pharmacists believed that compliance with the standard operating procedures, decreasing the heavy workload and patients’ knowledge about their medications are the most important preventing factors. Regarding reporting of medication errors, both doctors and pharmacists had relatively the same perceptions. While they did not agree that their workload interferes with their ability to report medication errors, both pharmacists and doctors moderately agreed that individuals could be blamed when an error is reported in the department. Conclusion: The study findings showed that the workload was not a barrier to medication error reporting. Moreover, both doctors and pharmacists stated that prevention of medication errors is a high priority in their work place. However, the fear of blame could prevent some doctors and pharmacists from reporting medication errors.Consequently, reporting medication errors needs be encouraged in the Malaysian primary care setting building on the current initiatives and activities in Malaysia. This could further promote the culture of medication safety and error reporting.

Study protocol of EMPOWER participatory action research (EMPOWER-PAR): a pragmatic cluster randomised controlled trial of multifaceted chronic disease management strategies to improve diabetes and hypertension outcomes in primary care.

BackgroundChronic disease management presents enormous challenges to the primary care workforce because of the rising epidemic of cardiovascular risk factors. The chronic care model was proven effective in improving chronic disease outcomes in developed countries, but there is little evidence of its effectiveness in developing countries. The aim of this study was to evaluate the effectiveness of the EMPOWER-PAR intervention (multifaceted chronic disease management strategies based on the chronic care model) in improving outcomes for type 2 diabetes mellitus and hypertension using readily available resources in the Malaysian public primary care setting. This paper presents the study protocol.Methods/DesignA pragmatic cluster randomised controlled trial using participatory action research is underway in 10 public primary care clinics in Selangor and Kuala Lumpur, Malaysia. Five clinics were randomly selected to provide the EMPOWER-PAR intervention for 1 year and another five clinics continued with usual care. Each clinic consecutively recruits type 2 diabetes mellitus and hypertension patients fulfilling the inclusion and exclusion criteria over a 2-week period. The EMPOWER-PAR intervention consists of creating/strengthening a multidisciplinary chronic disease management team, training the team to use the Global Cardiovascular Risks Self-Management Booklet to support patient care and reinforcing the use of relevant clinical practice guidelines for management and prescribing. For type 2 diabetes mellitus, the primary outcome is the change in the proportion of patients achieving HbA1c < 6.5%. For hypertension without type 2 diabetes mellitus, the primary outcome is the change in the proportion of patients achieving blood pressure < 140/90 mmHg. Secondary outcomes include the proportion of patients achieving targets for serum lipid profile, body mass index and waist circumference. Other outcome measures include medication adherence levels, process of care and prescribing patterns. Patients’ assessment of their chronic disease care and providers’ perceptions, attitudes and perceived barriers in care delivery and cost-effectiveness of the intervention are also evaluated.DiscussionResults from this study will provide objective evidence of the effectiveness and cost-effectiveness of a multifaceted intervention based on the chronic care model in resource-constrained public primary care settings. The evidence should instigate crucial primary care system change in Malaysia.Trial RegistrationClinicalTrials.gov NCT01545401

Determinants of doctors' decisions to inquire about sexual dysfunction in Malaysian primary care settings.

BackgroundPerceptions of how receptive men are to sexual health inquiry may affect Malaysian primary care doctors’ decisions to initiate such a discussion with their male patients. This paper quantifies the impact of doctors’ perceptions of men’s receptivity on male sexual health inquiry. Sexual health inquiry is one of the five areas in a study on determinants of offering preventive health checks to Malaysian men.MethodsThis was a cross sectional survey among primary care doctors in Malaysia. The questionnaire was based on an empirical model defining the determinants of primary care doctors’ intention to offer health checks. The questionnaire measured: (I) perceived receptivity of male patients to sexual health inquiry; (II) doctors’ attitudes towards the importance of sexual health inquiries; (III) perceived competence and, (IV) perceived external barriers. The outcome variable was doctors’ intention in asking about sexual dysfunction in three different contexts (minor complaints visits, follow-up visits and health checks visits). All items were measured on the Likert scale of 1 to 5 (strongly disagree/unlikely to strongly agree/likely) and internally validated.Results198 doctors participated (response rate 70.4%). Female primary care doctors constituted 54.5%. 78% of respondents were unlikely to ask about sexual dysfunction in visits for minor complaints to their male patients, 43.6% in follow up visits and 28.2% in health checks visits. In ordinal regression analysis, positive perception of men’s receptivity to sexual health inquiry significantly predicted the doctors’ intention in asking sexual dysfunction in all three contexts; i.e., minor complaints visits (P=0.013), follow-up visits (P<0.0001) and health checks visits (P=0.002). Perceived competence in sexual health inquiry predicted their intention in the follow-up visits (P=0.006) and health checks visits (P<0.001). Lower cost to health checks only predicted their intention in the follow-up visits (P=0.010).ConclusionsWhilst sexual health inquiry should be initiated in an appropriate context, ‘perceived receptivity’ to sexual health inquiry significantly affected doctors’ intention in initiating sexual health inquiry to their male patients. Malaysian men’s health may be substantially improved by strategies that assist doctors to identify patient ‘receptivity’.

Hypertension and the development of new onset chronic kidney disease over a 10 year period: a retrospective cohort study in a primary care setting in Malaysia.

BackgroundLittle is known about the rate of progression to chronic kidney disease (CKD) among hypertensive patients, particularly at the primary care level. This study aims to examine risk factors associated with new onset CKD among hypertensive patients attending a primary care clinic.MethodsThis is a 10-year retrospective cohort study of 460 patients with hypertension who were on treatment. Patient information was collected from patient records. CKD was defined as a glomerular filtration rate <60 ml/min per 1.73 m2 (Cockcroft-Gault equation). Multiple logistic regression statistics was used to test the association in newly diagnosed CKD.ResultsThe incidence of new CKD was 30.9% (n = 142) with an annual rate of 3%. In multivariate logistic regression analysis, factors associated with development of new onset of CKD among hypertensive patients were older age (odds ratio [OR] 1.123, 95% confidence interval [CI] 1.078-1.169), presence of diabetes (OR 2.621, 95% CI 1.490-4.608), lower baseline eGFR (OR 1.041, 95% CI 0.943-0.979) and baseline hyperuricaemia (OR 1.004, 95% CI 1.001-1.007).ConclusionsThe progression to new onset CKD is high among urban multiethnic hypertensive patients in a primary care population. Hence every effort is needed to detect the presence of new onset CKD earlier. Hypertensive patients who are older, with underlying diabetes, hyperuricaemia and lower baseline eGFR are associated with the development of CKD in this population.

Validation of the GAD-7 (Malay version) among women attending a primary care clinic in Malaysia

Anxiety is a common mental health disorder in primary care, with a higher prevalence among women compared to men. This is the first study to validate the Generalised Anxiety Disorder-7 questionnaire (GAD-7) as a case-finding instrument for anxiety in a primary care setting in Malaysia. The objective was to determine the diagnostic accuracy of the Malay version of the GAD-7 in detecting anxiety among women. This cross-sectional study was conducted in a government-funded primary care clinic in Malaysia. Consecutive women participants attending the clinic during data collection were given self-administered questionnaires including the GAD-7 (Malay version). Participants then were selected using systematic weighted random sampling for Composite International Diagnostic Interviews (CIDI). The GAD-7 was validated against the CIDI reference standard. The response rate was 87.5% for the questionnaire completion (895/1023), and 96.8% for diagnostic interviews (151/156). The prevalence of anxiety was 7.8%. The GAD-7 had a sensitivity of 76% (95% CI 61%-87%), a specificity of 94% (88%-97%), positive LR 13.7 (6.2-30.5) and negative LR 0.25 (0.14-0.45). The Malay version of the GAD-7 was found to be valid and reliable in case-finding for anxiety in this study. Due to its brevity, it is a suitable case-finding instrument for detecting anxiety in primary care settings in Malaysia.

Psychiatric morbidity among adult patients in a semi-urban primary care setting in Malaysia.

BackgroundScreening for psychiatric disorders in primary care can improve the detection rate and helps in preventing grave consequences of unrecognised and untreated psychiatric morbidity. This is relevant to the Malaysian setting where mental health care is now also being provided at primary care level. The aim of this paper is to report the prevalence of psychiatric illness in a semi-urban primary care setting in Malaysia using the screening tool Patient Health Questionnaire (PHQ).MethodsThis is a cross-sectional study carried out in a semi-urban primary healthcare centre located south of Kuala Lumpur. Systematic random sampling was carried out and a total of 267 subjects completed the PHQ during the study period.ResultsThe proportion of respondents who had at least one PHQ positive diagnosis was 24.7% and some respondents had more than one diagnosis. Diagnoses included depressive illness (n = 38, 14.4%), somatoform disorder (n = 32, 12.2%), panic and anxiety disorders (n = 17, 6.5%), binge eating disorder (n = 9, 3.4%) and alcohol abuse (n = 6, 2.3%). Younger age (18 to 29 years) and having a history of stressors in the previous four weeks were found to be significantly associated (p = 0.036 and p = 0.044 respectively) with PHQ positive scores.ConclusionThese findings are broadly similar to the findings of studies done in other countries and are a useful guide to the probable prevalence of psychiatric morbidity in primary care in other similar settings in Malaysia.

Orgasmic Dysfunction Among Women at a Primary Care Setting in Malaysia

The aim of this study was to investigate the prevalence of orgasmic dysfunction and the potential risk factors that may be associated with orgasmic dysfunction among women at a primary care setting in Malaysia. A validated questionnaire for sexual function was used to assess orgasmic function. A total of 230 married women aged 18 to 70 years participated in this study. Their sociodemographic and marital profiles were compared between those who had orgasmic dysfunction and those who did not, and the risk factors were examined. The prevalence of orgasmic dysfunction in the primary care population was 51.9%. Women with orgasmic dysfunction were found to be significantly higher in the following groups: age >45 years, being non-Malay, having lower academic status, married longer, having more children, married to an older husband, and being at menopausal state. Women with infrequent sexual intercourse are less likely to be orgasmic (odds ratio = 0.29, 95% confidence interval = 0.11-0.74).