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1. Issues and Challenges in Implementing Care Coordinator in Primary Healthcare in Malaysia: A Qualitative Study

Author

Zalilah Abdullah, Siti Hajar Abdul Aziz, Nur Aliyah Sodri, Ainul Nadziha Mohd Hanafiah, Nor Idawaty Ibrahim, and Mohammad Zabri Johari

Subjects
Computer applications to medicine. Medical informatics, R858-859.7, Public aspects of medicine, RA1-1270
Abstract

Background: Primary healthcare is the earliest gateway for patient care, and improvisations are often needed to accommodate the ever-increasing demand in public health. The Enhanced Primary Healthcare (EnPHC) initiative is aimed at improving such needs, and one core intervention is the introduction of a care coordinator (CC). The purpose of this study was to identify barriers and facilitators in implementing a new intervention in primary healthcare clinics. Methods: This qualitative exploration study. All healthcare providers who were involved in EnPHC at the intervention clinics were selected as participants. In-depth interviews and focus group discussions were carried out among healthcare providers working in the intervention clinic. Thematic analysis was used to categorize data, based on the consolidated framework for implementation research (CFIR) theoretical framework domains. Results: A total of 61 healthcare providers participated. All 5 domains with 19 CFIR constructs emerged from the analysis. Inner setting played a significant role in facilitating CC intervention, in which culture, networking, and collaboration and leadership engagement played an essential role in supporting CC activities. Although CC tasks are complex, concerns of losing clinical skill and resource constraints were identified as potential barriers in CC implementations. Criteria for appointing new CCs emerged from the characteristics of individual constructs, in which the individual must be familiar and interested in community health, have good communication skills, and at least 3 years’ experience in the primary healthcare setting. Conclusion: The implementation of the CC intervention faces varying challenges in different settings. This is partially resolved through teamwork, guidance from mentors, and support from superiors. The complexity of the responsibility of the CC intervention is perceived as both a validation and a burden. Above all, it is seen as paramount in EnPHC intervention.

Published
2020
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2. The Effectiveness of Enhanced Primary Healthcare (EnPHC) Interventions on Type 2 Diabetes Management in Malaysia: Difference-in-differences (DID) Analysis

Author

Sheamini Sivasampu, Rifat Atun, Swee Hung Ang, Nazrila Hairizan Nasir, Chee Lee Chan, Dian Kusuma, Ming Tsuey Lim, Yvonne Mei Fong Lim, Nor Idawaty Ibrahim, Noraziani Khamis, Masliyana Husin, Faeiz Syezri Adzmin Jaafar, Sunita Shanmugam, Xin Rou Teh, Su Miin Ong, Dennis Ross-Degnan, and Anita K. Wagner

Subjects
medicine.medical_specialty, Nutrition and Dietetics, business.industry, Endocrinology, Diabetes and Metabolism, Psychological intervention, Primary health care, Type 2 diabetes, medicine.disease, Difference in differences, Text mining, Family medicine, Internal Medicine, Medicine, Family Practice, business
Abstract

Background To evaluate the effectiveness of the Enhanced Primary Healthcare (EnPHC) interventions on process of care and intermediate clinical outcomes among type 2 diabetes patients. Research Design and Methods This was a quasi-experimental controlled study of multi-pronged interventions conducted in 20 intervention and 20 control public primary care clinics in Malaysia from November 2016 to June 2019. Malaysian patients aged 30 years and above with a diagnosis of type 2 diabetes were selected via systematic random sampling. We conducted difference-in-differences analyses of data on process of care and intermediate clinical outcomes extracted from medical records. Results We reviewed 12,017 medical records of patients with type 2 diabetes. Process of care measures improved: HbA1c tests performed within the past three months (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 within the past year; BMI measured within the past six months (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. Conclusions EnPHC interventions were effective in improving process of care but not intermediate clinical outcomes for type 2 diabetes patients. The intervention package was successful in enhancing the quality of care in diabetes from the health provider perspective. Patient engagement and self-management support may be needed to bring forth changes in patient outcomes.

Published
2021
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3. Who are the breast cancer survivors in Malaysia?

Author

Nor Idawaty Ibrahim, E N Aina, Nabilla Al-Sadat, and Maznah Dahlui

Subjects
Adult, Cancer Research, medicine.medical_specialty, Epidemiology, Breast Neoplasms, Logistic regression, Breast cancer, Risk Factors, medicine, Humans, Survivors, Survival rate, Neoplasm Staging, Retrospective Studies, Gynecology, Proportional hazards model, business.industry, Obstetrics, Medical record, Carcinoma, Ductal, Breast, Public Health, Environmental and Occupational Health, Malaysia, Retrospective cohort study, Middle Aged, medicine.disease, Prognosis, Adenocarcinoma, Mucinous, Log-rank test, Survival Rate, Carcinoma, Lobular, Oncology, Adenocarcinoma, Female, Lymph Nodes, Neoplasm Grading, business, Follow-Up Studies
Abstract

Worldwide, breast cancer is the commonest cause of cancer death in women. However, the survival rate varies across regions at averages of 73%and 57% in the developed and developing countries, respectively.This study aimed to determine the survival rate of breast cancer among the women of Malaysia and characteristics of the survivors.A retrospective cohort study was conducted on secondary data obtained from the Breast Cancer Registry and medical records of breast cancer patients admitted to Hospital Kuala Lumpur from 2005 to 2009. Survival data were validated with National Birth and Death Registry. Statistical analysis applied logistic regression, the Cox proportional hazard model, the Kaplan-Meier method and log rank test.A total of 868 women were diagnosed with breast cancer between January 2005 and December 2009, comprising 58%, 25% and 17% Malays, Chinese and Indians, respectively. The overall survival rate was 43.5% (CI 0.573-0.597), with Chinese, Indians and Malays having 5 year survival rates of 48.2% (CI 0.444-0.520), 47.2% (CI 0.432-0.512) and 39.7% (CI 0.373-0.421), respectively (p0.05). The survival rate was lower as the stages increased, with the late stages were mostly seen among the Malays (46%), followed by Chinese (36%) and Indians (34%). Size of tumor3.0cm; lymph node involvement, ERPR, and HER 2 status, delayed presentation and involvement of both breasts were among other factors that were associated with poor survival.The overall survival rate of Malaysian women with breast cancer was lower than the western figures with Malays having the lowest because they presented at late stage, after a long duration of symptoms, had larger tumor size, and had more lymph nodes affected. There is an urgent need to conduct studies on why there is delay in diagnosis and treatment of breast cancer women in Malaysia.

Published
2012

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