Search

Asthma exacerbations are among the commonest reasons for hospitalizations in Malaysian pilgrims during the Hajj. We interviewed 21 stakeholders involved in the pre-Hajj health examination at 14 primary care clinics, to explore their perceptions on barriers to and facilitators of asthma care for Hajj pilgrims. The disadvantages of the short time frame and centralized organization of the pre-Hajj health examinations were viewed as compromising clinicians’ level of competencies in asthma care, which could potentially be enhanced through more training, audit, and supervision by specialists. Longer time frame to permit sufficient disease control, provision of care by a dedicated asthma team, asthma registry to support continuous care, more resources of long-acting β-agonist/inhaled corticosteroid, and provision of influenza and pneumococcal vaccines at no cost were the perceived facilitators. Delivery of asthma education, especially the asthma action plan, should be tailored to the level of the pilgrim’s health literacy and facilitated by educational resources, family engagement, and regular health briefing.

Background: Frailty is an important health issue in an aging population; it is a state of vulnerability that renders the elderly susceptible to adverse health outcomes, including disability, hospitalization, long-term care admission and death. Early frailty stages are recognizable through screening and are reversible with targeted interventions. To date, however, there is no screening tool for use in Malaysia. The English Pictorial Fit-Frail Scale (PFFS) is a visual tool that assesses a person’s fitness-frailty level in 14 health domains, with higher scores indicating higher frailty. Objective: The aim was to translate and adapt the English PFFS for use in Malaysian clinical settings. Methods: The original English PFFS underwent forward and backward-translation by two bilingual translators to and from the Malay language. A finalized version, the PFFS-Malay (PFFS-M), was formed after expert reviewers’ consensus and was pilot tested with 20 patients, 20 caregivers, 16 healthcare assistants, 17 nurses and 22 doctors. Score agreement between patients and their caregivers and among healthcare professionals were assessed. All participants rated their understanding of the scale using the feasibility survey forms. Results: A total of 95 participants were included. There were high percentages of scoring agreements among all participants on the scale (66.7% to 98.9%). Overall feedback from all respondents were positive and supported the face validity of the PFFS-M. Conclusion: The PFFS-M reflects an accurate translation for the Malaysian population. The scale is usable and feasible and has face validity. Reliability and predictive validity assessments of the PFFS-M are currently underway.

Background: Asthma was one of the top causes of hospitalization and unscheduled medical attendances due to acute exacerbations and its complications. In Malaysia, all pilgrims must undergo a mandatory health examination and certified fit to perform pilgrimage. We studied the current organisational and clinical routines of Hajj health examination in Malaysia with a focus on the delivery of care for pilgrims with asthma.Methods: We conducted non-participant observation to obtain ethnographic understanding of Hajj health examination activities for 2019. Observations were guided by a checklist and recorded as notes that were analysed thematically. The study was conducted at 11 public (from each region in Malaysia, namely, North, South, East, West of Peninsular Malaysia, and Sabah and Sarawak of East Malaysia) and two private primary care clinics.Results: We observed considerable variation in the implementation and practice of Hajj health examinations among the 11 public clinics but no marked variation among the private clinics. The short time span of between three to four months was inadequate for disease control measures and had put pressure on health care providers. They mostly viewed the Hajj health examination as merely a certification of fitness to perform the pilgrimage, though respiratory health assessment was often inadequate. The opportunity to optimise the health of pilgrims with asthma by providing the appropriate medications, asthma action plan and asthma education including the preventive measures was disregarded. The preliminary health screening, which aimed to optimise pilgrims' health before the actual Hajj health examination was not appreciated by either pilgrims or health care providers.Conclusions: There is great potential to reform the current system of Hajj health certification in order to optimise its potential benefits for pilgrims with asthma. A systematic approach to restructuring the delivery of Hajj health examination could address the time constraints, clinical competency of primary health care providers and resources limitations.

Family history has long been recognised as a non-invasive and inexpensive tool to identify individuals at risk of genetic conditions. Even in the era of evolving genetic and genomic technology, the role of family history in predicting individual risk for genetic testing and guiding in preventive interventions is still relevant, especially in low-resource countries. The aim of this study was to explore primary care doctors' views and experiences in family history taking and how they utilised family history in day-to-day clinical consultations in Malaysia. Four focus group discussions and six in-depth interviews involving 25 primary care doctors were conducted. Three themes emerged from the analysis: (1) primary care doctors considered family history as an important part of clinical assessment, (2) proactive versus reactive approach in collecting family history and (3) family history collection was variable and challenging. Family history was documented in either free text or pedigree depending on the perception of its appropriateness during the consultation. This study highlighted the need to improve the approach, documentation and the implementation of family history in the Malaysian primary care settings. Integrating family filing concept with built-in clinical decision support into electronic medical records is a potential solution in ensuring effective family history taking in primary care.

Victims of intimate partner violence (IPV) are frequent attendees at health care facilities. Although most literature on this subject focuses on developed or Western countries, there is a dearth of information from Asian countries. This study aims to estimate the prevalence of IPV among women attending urban primary care services in Malaysia and to identify the risk factors associated with IPV. Six out of 15 available public primary care clinics in the federal territory of Kuala Lumpur, Malaysia, were randomly selected. The sampling size for each clinic was conducted proportionate to the clinic’s average daily patient attendance. A total of 882 women participated in this study via a self-administered questionnaire. We administered the women’s experience with battering scale (WEB-scale) to estimate the prevalence of psychological violence and included a screening question for physical and sexual assault. The results showed that 22.0% of the women surveyed reported experiencing IPV. Ethnicity appears to be a significant predictor, with Chinese and Indian women reporting IPV at a higher rate than Malay women. Women with IPV are more likely to come from lower income households, have witnessed parental IPV, receive less social support, and have poorer psychological well-being. Our findings indicate that the prevalence of IPV among women attending urban public primary care clinics is high. Health care providers should pay close attention during clinical encounters for any sign of IPV, particularly among those presenting with risk factors.

Background Women of childbearing age are predisposed to becoming overweight or obese. This study determines the mean, prevalence and factors associated with 6 months postpartum weight retention among urban Malaysian mothers. Methods A prospective cohort study was conducted at baseline (after delivery), 2, 4 and 6 months postpartum. From 638 eligible mothers initially recruited, 420 completed until 6 months. Dependent variable was weight retention, defined as difference between weight at 6 months postpartum and pre-pregnancy weight, and weight retention ≥5 kg was considered excessive. Independent variables included socio-demographic, history of pregnancy and delivery, lifestyle, practices and traditional postpartum practices. Results Average age was 29.61 ± 4.71 years, majority (83.3%) were Malays, 58.8% (low education), 70.0% (employed), 65.2% (middle income family), 33.8% (primiparous) and 66.7% (normal/instrumental delivery). Average gestational weight gain was 12.90 ± 5.18 kg. Mean postpartum weight retention was 3.12 ± 4.76 kg, 33.8% retaining ≥5 kg. Bivariable analysis showed low income, primiparity, gestational weight gain ≥12 kg, less active physically, higher energy, protein, carbohydrate and fat intake in diet, never using hot stone compression and not continuing breastfeeding were significantly associated with higher 6 months postpartum weight retention. From multivariable linear regression analysis, less active physically, higher energy intake in diet, gestational weight gain ≥12 kg, not continuing breastfeeding 6 months postpartum and never using hot stone compression could explain 55.1% variation in 6 months postpartum weight retention. Conclusion Women need to control gestational weight gain, remain physically active, reduce energy intake, breastfeed for at least 6 months and use hot stone compression to prevent high postpartum weight retention.

Background: Respiratory disease are the commonest health problem seen during the annual Hajj pilgrimage. All Malaysian pilgrims attend a medical screening three months before the Hajj. Aim: To observe current organisational and clinical routines of pre-Hajj medical screening with a focus on the care of those with asthma. Methods: We conducted non-participant observation of the medical screening in 14 selected centres. Observations were guided by a topic guide and recorded as notes, which were analysed thematically. Results: The aim of the screening was to certify patients as fit to go (or not) rather than optimising health before the pilgrimage. The process of screening was standardised by a medical booklet issued by Malaysian Pilgrims Board. However, clinics were free to adapt the flow and content of the screening process. Issues identified with regards to asthma assessment were poor communication of preventive measures, inadequate training of the medical officers and inadequate resources such as space, equipment and personnel which hindered effective flow of care. This led to gaps in the assessment of pilgrims with asthma and feelings of uncertainties and pressure in those doing the screening. Conclusions: There are numerous logistical, resource and skills gaps in the screening. More fundamentally, the screening is conceptualised as ‘providing certification of fitness’ for Hajj pilgrims. Reframing these consultations as an opportunity for optimisation of care could enable the pre-Hajj medical to have a meaningful impact on the health of pilgrims. This study was funded by the NIHR RESPIRE Global Health Research Unit and is written on behalf of the RESPIRE collaborators.

Background The effectiveness of lifestyle intervention for weight loss on cardiometabolic risk factors among overweight and obese individuals in the community setting remains inconclusive. This study aimed to evaluate the effect of a 6-month weight loss lifestyle intervention on cardiometabolic risk factors among overweight and obese women and the sustainability of the changes in those markers at 12-month follow-up, comparing an intervention group with a control group. Methods A total of 243 participants from MyBFF@home were included in this study. Fasting blood samples at baseline, 6- and 12-month were assessed for fasting plasma glucose (FPG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides. The effect of the intervention on cardiometabolic risk markers were investigated within and between study groups using t-test and general linear model (GLM) repeated measure ANOVA. Results Results from repeated measures ANOVA showed intervention effect only in TC where significant reduction was found in the intervention group (− 0.26 mmol/L [95% CI: – 0.47 to − 0.06], p

INTRODUCTION: Unplanned pregnancy is a major public health concern globally. Numerous studies found various factors that can predict or determine unplanned pregnancy. However, there were no studies that reported this problem in Malaysia. The objective of this study is to determine the prevalence of unplanned pregnancy in Malaysia and the associated factors.METHODS: This nationwide cross-sectional study targeted to women at postpartum period at government primary health care clinics throughout Malaysia. Structured questionnaire with face-to-face interview was used for data collection. The factors studied included mothers’ age, husband’s age, ethnicity, religion, marital status, education, occupation, household income, polygamous marriage, family support, contraception used, and disagreement of husband on contraception, smoking and alcohol consumption. History of emotional, physical and sexual intimate partner violence (IPV) were also studied.RESULTS: A total of 5727 Malaysian postpartum mothers were involved in this survey. The prevalence of unplanned pregnancy was 42.9% (95% CI: 38.6, 47.4). The multivariate logistic regression revealed that older mothers aged 45-49 years old (aOR: 8.010; 95%CI: 1.909, 33.013) and Muslim mothers (aOR: 2.465; 95%CI: 1.432-4.241) were significantly associated with unplanned pregnancy. In terms of household income, mothers with less than RM1000 per month were 1.712 (95% CI: 1.080, 2.713) times more likely to have unplanned pregnancy. The other significant associated factor was history of emotional intimate partner violence; aOR [1.720 (95% CI: 1.011, 2.925)].CONCLUSIONS: Unplanned pregnancies were observed to be higher among older Muslim women from low income family. A possibility of unmet need for family planning should be considered and appropriate intervention strategies planned for these at-risk population.

This study aimed to develop an intervention to reduce medical errors and to determine if the intervention can reduce medical errors in public funded primary care clinics. A controlled interventional trial was conducted in 12 conveniently selected primary care clinics. Random samples of outpatient medical records were selected and reviewed by family physicians for documentation, diagnostic, and management errors at baseline and 3 months post intervention. The intervention package comprised educational training, structured process change, review methods, and patient education. A significant reduction was found in overall documentation error rates between intervention (Pre 98.3% [CI 97.1-99.6]; Post 76.1% [CI 68.1-84.1]) and control groups (Pre 97.4% [CI 95.1-99.8]; Post 89.5% [85.3-93.6]). Within the intervention group, overall management errors reduced from 54.0% (CI 49.9-58.0) to 36.6% (CI 30.2-43.1) and medication error from 43.2% (CI 39.2-47.1) to 25.2% (CI 19.9-30.5). This low-cost intervention was useful to reduce medical errors in resource-constrained settings.

Background Patient safety is vital in patient care. There is a lack of studies on medical errors in primary care settings. The aim of the study is to determine the extent of diagnostic inaccuracies and management errors in public funded primary care clinics. Methods This was a cross-sectional study conducted in twelve public funded primary care clinics in Malaysia. A total of 1753 medical records were randomly selected in 12 primary care clinics in 2007 and were reviewed by trained family physicians for diagnostic, management and documentation errors, potential errors causing serious harm and likelihood of preventability of such errors. Results The majority of patient encounters (81%) were with medical assistants. Diagnostic errors were present in 3.6% (95% CI: 2.2, 5.0) of medical records and management errors in 53.2% (95% CI: 46.3, 60.2). For management errors, medication errors were present in 41.1% (95% CI: 35.8, 46.4) of records, investigation errors in 21.7% (95% CI: 16.5, 26.8) and decision making errors in 14.5% (95% CI: 10.8, 18.2). A total of 39.9% (95% CI: 33.1, 46.7) of these errors had the potential to cause serious harm. Problems of documentation including illegible handwriting were found in 98.0% (95% CI: 97.0, 99.1) of records. Nearly all errors (93.5%) detected were considered preventable. Conclusions The occurrence of medical errors was high in primary care clinics particularly with documentation and medication errors. Nearly all were preventable. Remedial intervention addressing completeness of documentation and prescriptions are likely to yield reduction of errors.

Yew Kong Lee,1 Chirk Jenn Ng,1 Ping Yein Lee,2 Ee Ming Khoo,1 Khatijah Lim Abdullah,3 Wah Yun Low,4 Azah Abdul Samad,5 Wei Seng Chen61Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 2Department of Family Medicine, Universiti Putra Malaysia, Serdang, Selangor, Malaysia; 3Department of Nursing Sciences, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 4Faculty of Medicine Dean's Office, University of Malaya, Kuala Lumpur, Malaysia; 5Klinik Kesihatan Pantai, Kuala Lumpur, Malaysia; 6Klinik Alam Medic, Puchong, Selangor, MalaysiaBackground: Patients with type 2 diabetes often require insulin as the disease progresses. However, health care professionals frequently encounter challenges when managing patients who require insulin therapy. Understanding how health care professionals perceive the barriers faced by patients on insulin will facilitate care and treatment strategies.Objective: This study explores the views of Malaysian health care professionals on the barriers faced by patients using insulin.Methods: Semi-structured qualitative interviews and focus group discussions were conducted with health care professionals involved in diabetes care using insulin. Forty-one health care professionals participated in the study, consisting of primary care doctors (n = 20), family medicine specialists (n = 10), government policymakers (n = 5), diabetes educators (n = 3), endocrinologists (n = 2), and one pharmacist. We used a topic guide to facilitate the interviews, which were audio-recorded, transcribed verbatim, and analyzed using a thematic approach.Results: Five themes were identified as barriers: side effects, patient education, negative perceptions, blood glucose monitoring, and patient adherence to treatment and follow-up. Patients perceive that insulin therapy causes numerous negative side effects. There is a lack of patient education on proper glucose monitoring and how to optimize insulin therapy. Cost of treatment and patient ignorance are highlighted when discussing patient self-monitoring of blood glucose. Finally, health care professionals identified a lack of a follow-up system, especially for patients who do not keep to regular appointments.Conclusion: This study identifies five substantial barriers to optimizing insulin therapy. Health care professionals who successfully identify and address these issues will empower patients to achieve effective self-management. System barriers require government agency in establishing insulin follow-up programs, multidisciplinary diabetes care teams, and subsidies for glucometers and test strips.Keywords: primary care, focus groups, noncommunicable disease, diabetes, insulin, qualitative study