FOLLOW-UPS AND REFERRALS 79 NMCS PRIMARY CARE 2012 FullReport

✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✎ ✚ LIST OF TABLES Table 2.1 Sample size for NMCS 2012 11 Table 2.2 Data entry error rate for NMCS 2012 14 Table 3.1 Total clinics sampled and responded for NMCS 2012 20 Table 3.2 Response rate for NMCS 2012 20 Table 3.3 Observed and weighted dataset for NMCS 2012 21 Table 4.1 Characteristics of doctors for NMCS 2012 24 Table 5.1 Characteristics of patient encounters in primary care clinics in 2012 29 Table 5.2 Duration of sick leave issued in primary care clinics in 2012 31 Table 6.1 Reasons for encounter by ICPC-2 components in primary care clinics in 2012 35 Table 6.2 Reasons for encounter by ICPC-2 components and sector 35 Table 6.3 Reasons for encounter by ICPC-2 chapters and common individual reasons for encounter within chapter in primary care clinics in 2012 36 Table 7.1 Diagnoses by ICPC-2 components in primary care clinics in 2012 43 Table 7.2 Diagnoses by ICPC-2 chapters and common individual diagnoses within chapter managed in primary care clinics in 2012 44 Table 7.3 Thirty most common diagnoses managed in public clinics in 2012 47 Table 7.4 Thirty most common diagnoses managed in private clinics in 2012 48 Table 8.1 Number of encounters for which medication was prescribed 50 Table 8.2 Prescribed medications by ATC level 1, 3 and 5 in primary care clinics in 2012 52 Table 8.3 Prescribed medications by ATC level 1 and sector in primary care clinics in 2012 57 Table 8.4 Thirty most frequently prescribed medications in public clinics in 2012 59 Table 8.5 Thirty most frequently prescribed medications in private clinics in 2012 60 Table 9.1 Types of investigations by ICPC-2 chapters and common individual test within chapter in primary care clinics in 2012 63 Table 9.2 Top 10 diagnoses for which investigation was most frequently ordered in primary care clinics in 2012 69 Table 10.1 Advicecounselling and procedures in primary care clinics in 2012 72 Table 10.2 Types of advicecounseling provided in primary care clinics in 2012 73 ✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✚ Table 10.3 Types of procedures performed in primary care clinics in 2012 74 Table 10.4 Ten most common diagnoses with advicecounseling in primary care clinics in 2012 77 Table 10.5 Ten most common diagnoses with procedures in primary care clinics in 2012 78 Table 11.1 Follow-up and referrals in primary care clinics in 2012 80 Table 11.2 Types of referrals in public clinics in 2012 81 Table 11.3 Types of referrals in private clinics in 2012 82 Table 11.4 Diagnoses most frequently referred to hospital in 2012 83 Table 11.5 Diagnoses most frequently referred to specialist in 2012 84 ✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✚ ✎ Figure 5.1 Age-gender distribution of patients in primary care clinics in 2012 28 Figure 5.2 Mode of payment in primary care clinics in 2012 30 Figure 5.3 3HUFHQWDJHRISULPDU\FDUHHQFRXQWHUVLVVXHGPHGLFDOFHUWLÀFDWHLQ Figure 6.1 Number of patient reasons for encounter in primary care clinics in 2012 34 Figure 6.2 Top 10 reasons for encounter in public clinics in 2012 38 Figure 6.3 Top 10 reasons for encounter in private clinics in 2012 39 Figure 7.1 Number of diagnoses managed per encounter in primary care clinics in 2012 42 Figure 7.2 JHJHQGHUVSHFLÀFUDWHVRIGLDJQRVHVPDQDJHGSHUHQFRXQWHUV by sector in 2012 43 Figure 8.1 Number of medications prescribed per encounter in primary care clinics in 2012 50 Figure 8.2 JHJHQGHUVSHFLÀFSUHVFULSWLRQUDWHVSHUHQFRXQWHUVE\VHFWRULQ Figure 9.1 Number of investigations ordered per encounter in primary care clinics in 2012 62 Figure 9.2 Top 10 investigations ordered in public clinics in 2012 68 Figure 9.3 Top 10 investigations ordered in private clinics in 2012 68 Figure 10.1 Ten most common advicecounseling provided in public clinics in 2012 74 Figure 10.2 Ten most common advicecounseling provided in private clinics in 2012 74 Figure 10.3 Ten most common procedures performed in public clinics in 2012 76 Figure 10.4 Ten most common procedures performed in private clinics in 2012 76 LIST OF FIGURES ✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✚ ✎ ✎ Acknowledgements The National Healthcare Statistics Initiative team would like to thank the Director-General of Health, Malaysia for his continuous support for this survey and permission to publish this report. Also, our sincere appreciation goes to the following for their participation, assistance, support and contribution: ‡ HSXW\LUHFWRUHQHUDORI+HDOWK5HVHDUFKDQG7HFKQLFDO6XSSRUW0LQLVWU\RI+HDOWK02+ ‡ HSXW\LUHFWRUHQHUDORI+HDOWK0HGLFDO02+ ‡ HSXW\LUHFWRUHQHUDORI+HDOWK3XEOLF+HDOWK02+ ‡ LUHFWRURIWKHOLQLFDO5HVHDUFKHQWUH1DWLRQDO,QVWLWXWHVRI+HDOWK02+ ‡ LUHFWRURIWKHDPLO\+HDOWKHYHORSPHQWLYLVLRQ02+ ‡ LUHFWRURIWKH3ODQQLQJDQGHYHORSPHQWLYLVLRQ02+ ‡ LUHFWRURIWKH3ULYDWH0HGLFDO3UDFWLFHLYLVLRQ02+DZDQJDQ.DZDODQPDODQ3HUXEDWDQ Swasta, CKAPS ‡ 6WDWHOHYHO3ULYDWH0HGLFDO3UDFWLFHRQWURO8QLWV8QLW.DZDODQPDODQ3HUXEDWDQ6ZDVWD UKAPS. ‡ 0DOD\VLDQ 0HGLFDO RXQFLO 0DOD\VLDQ 0HGLFDO VVRFLDWLRQ FDGHP\ RI DPLO\ 3K\VLFLDQV Malaysia. We thank the 392 medical doctors from both the public and private primary healthcare clinics who participated in the National Medical Care Survey NMCS between August and November 2012. This report would not have been possible without their support and contribution from these dedicated professionals. Last but not least, our greatest appreciation to all those who have supported or contributed to the success of the National Medical Care Survey 2012 and the publication of this report. Thank you. National Healthcare Statistics Initiative NHSI Primary Care Team Healthcare Statistics Unit National Clinical Research Centre Ministry of Health, Malaysia ✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✚ ✎ ✎ ✎ NATIONAL MEDICAL CARE SURVEY 2012 PROJECT TEAM Principal Investigator Datuk Dr. Noor Hisham Abdullah Principal Co-Investigator Dr. Sheamini Sivasampu Dr. Goh Pik Pin Research Evaluation Committee REC Dr. Kamaliah Mohd. Noh Professor Dr. Khoo Ee Ming Associate Professor Dr. Ng Chirk Jenn 3URIHVVRUU7DXÀN7HQJKHRQJLHQJ Dr. Kaviyarasan Sailin Associate Professor Dr. Jamaluddin Abdul Rahman Ms. Siti Fauziah Abu Project Managers Mr. Lim Ka Keat September 2011 – September 2012 Ms. Yvonne Lim Mei Fong Dr. Hwong Wen Yea, Amy Survey Coordinators Ms. Aisyah Ali 5HVHDUFK2IÀFHUV Ms. Sharmini Chandran Mr. Shantha Kumar Chandrasekaran Ms. Kasturi Manoharan Ms. Siti Aminah Ismail Ms. Hanan Hamimi Wahid Ms. Maryam Nazeera Suhaimi Mr. Poovanesva Rao Yang Ketter Rahman Data Analysis Ms. Norazida Ab. Rahman Ms. Yvonne Lim Mei Fong Database DevelopersAdministrators Altus Solutions Sdn. Bhd. ✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✎ ✛ ACE Angiotensin converting enzyme ATC :+2QDWRPLFDO7KHUDSHXWLFKHPLFDOODVVLÀFDWLRQV\VWHP BEACH Bettering the Evaluation and Care of Health CI RQÀGHQFH,QWHUYDO CKAPS Cawangan Kawalan Amalan Perubatan Swasta DG Director General of Health, Ministry of Health, Malaysia FMS Family Medicine Specialist GP General Practice or Practitioner HbA1c Haemoglobin, type A1c ICPC ,QWHUQDWLRQDOODVVLÀFDWLRQRI3ULPDU\DUH IQR Interquartile range KK Klinik Kesihatan LCL RZHURQÀGHQFHLPLW MOH Ministry of Health, Malaysia MREC Medical Research and Ethics Committee, Ministry of Health Malaysia NCD Non-communicable disease NCRC National Clinical Research Centre NHEWS National Healthcare Establishment Workforce Survey Primary Care NHSI National Healthcare Statistics Initiative NIH National Institutes of Health NMCS National Medical Care Survey NMUS National Medicines Use Survey NOS 1RWRWKHUZLVHVSHFLÀHG REC Research Evaluation Committee RFEs Reasons for encounter SOCSO Social Security Organisation UCL 8SSHURQÀGHQFHLPLW UKAPS Unit Kawalan Amalan Perubatan Swasta WHO World Health Organisation WONCA World Organization of National Colleges, Academies and Academic Associations of General PractitionersFamily Physicians WP Wilayah Persekutuan ABBREVIATIONS ✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✛ - Not applicable More than • More than or equal to Less than Percentage SYMBOLS ✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✜ EXECUTIVE SUMMARY The National Medical Care Survey NMCS is a provider-based survey, which aims to study the characteristics and morbidity pattern of patients, as well as healthcare activities in terms of investigations, procedures, counselling and visit disposition provided at primary care level in Malaysia. 7KLVVWXG\FRYHUHGSXEOLFDQGSULYDWHFOLQLFVIURPÀYHVHOHFWHGUHJLRQVLQ0DOD\VLD:3.XDODXPSXU 6HODQJRU :33XWUDMD\D.HODQWDQ.XFKLQJDQG.RWD.LQDEDOX7KHFOLQLFVZHUHVWUDWLÀHGDFFRUGLQJ to region and sector, and selected through random sampling. Doctors from these clinics were asked to JLYHGHWDLOVRQSDWLHQWVWKH\VDZRQRQHVSHFLÀFGD\ZKLFKZDVUDQGRPO\DOORFDWHGEHWZHHQXJXVWWR November 2012. This report presents data collected from 69 public clinics and 120 private clinics. Doctors working at primary care clinics A total of 408 doctors participated in NMCS 2012; 259 63.5 from public clinics and 149 36.5 from private clinics. Of these, 350 doctors provided their socio-demographic details 229 public doctors and 121 private doctors. ‡ RIWKHUHVSRQGHQWVZHUHIHPDOHV+LJKHUSURSRUWLRQRIIHPDOHVZDVVHHQLQSXEOLF clinics 76.4; 175229 as compared to private clinics 39.7; 48121. ‡ OPRVWKDOIRIWKHGRFWRUVLQSXEOLFFOLQLFVDQGLQSULYDWHFOLQLFVDJHGEHWZHHQWR 39 years old. On the contrary, 62.8 of the doctors in private clinics and 6.9 in public clinics were over 50 years old. ‡ 2QO\GRFWRUVLQSXEOLFFOLQLFVDQGGRFWRUVLQSULYDWHFOLQLFVKDGSRVWJUDGXDWH TXDOLÀFDWLRQV0DMRULW\RIWKHPVSHFLDOLVHGLQIDPLO\PHGLFLQH Patients seen at primary care clinics There were 141,593 patient encounters recorded for NMCS 2012; 42,340 encounters 29.9 were from public clinics and 99,253 encounters 70.1 from private clinics. ‡ RIWKHSDWLHQWVVHHQZHUHIHPDOHVLQSXEOLFFOLQLFVDQGLQSULYDWHFOLQLFV ‡ 7KHPHGLDQDJHRISDWLHQWVZDV\HDUVDQGWKHDJHGLVWULEXWLRQZHUHDVIROORZV,QIDQWV\HDU \HDUV\HDUV\HDUV\HDUVDQG•\HDUV 11.5. ‡ 7KH DJH GLVWULEXWLRQV RI SDWLHQWV VHHQ LQ SXEOLF DQG SULYDWH FOLQLFV ZHUH VLPLODU EXW D ODUJHU percentage of older patients were seen in public clinics where 20.7 of patients in public clinics and RISDWLHQWVLQSULYDWHFOLQLFVZHUH•\HDUVROG ‡ 0DMRULW\ RI SDWLHQWV VHHQ ZHUH 0DOD\ IROORZHG E\ KLQHVH ,QGLDQ DQG others 5.6. ‡ RISDWLHQWVVHHQLQSULYDWHFOLQLFVSDLGRXWRISRFNHWDQGSDLGE\WKLUGSDUW\SD\HUV such as insurance. Visits to public clinics were all subsidised by government with a minimal charge of RM1 per encounter and is free for patients older than 60 years. ‡ 0HGLFDOFHUWLÀFDWHZHUHLVVXHGWRRISDWLHQWVLQSXEOLFFOLQLFVLQSULYDWHFOLQLFV The duration of sick leave ranged from half day to 21 days. Reasons for seeking treatment at primary care clinics Reason for seeking treatment is also otherwise known as reasons for encounter RFEs. From the 141,593 patient encounters, 233,326 RFEs were recorded; 73,616 31.5 in public clinics and 159,710 68.5 in private clinics. Overall, there were 165 RFEs for every 100 patient encounters. ✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✢ ‡ 7KHPRVWFRPPRQ5SUHVHQWHGLQSXEOLFFOLQLFVZDVIROORZXSRUWUHDWPHQWIRUK\SHUWHQVLRQWKDW made up 17.7 13,028 of all RFEs 31 per 100 encounters. This was followed by diabetes 20 per 100 encounters and lipid disorder 19 per 100 encounters. ‡ VIRUSULYDWHFOLQLFVIHYHUDQGFRXJKZHUHWKHPRVWFRPPRQ5VDQGERWKZHUHUHFRUGHGDWDUDWH of 25 per 100 encounters. Abdominal pain was the third highest and seen in 10 out of 100 encounters. Types of diagnosis Of the 141,593 patient encounters at primary care clinics, 188,944 diagnoses were made with average 133 diagnoses made per 100 patient encounters. In public clinics, there were 68,877 diagnoses 36.5 at a rate of 163 diagnoses per 100 encounters. Private clinics managed 120,067 diagnoses 63.5 at a rate of 121 diagnoses per 100 encounters. ‡ 3DWLHQWVVHHQLQSXEOLFFOLQLFVZHUHPRVWO\IRUWUHDWPHQWRIQRQFRPPXQLFDEOHGLVHDVHVRUHYHU\ 100 patient encounters, 33 had the diagnosis of hypertension and it was the commonest diagnosis. This was followed by lipid disorder 22 per 100 encounters and diabetes 24 per 100 encounters. In private clinics however, hypertension diagnosis was made in only 5 out of 100 encounters, diabetes in 3 per 100 encounters and lipid disorder in 2 per 100 encounters. ‡ \ FRPSDULVRQ PDMRULW\ RI WKH FDVHV ZKLFK SULYDWH SULPDU\ FDUH SURYLGHUV VDZ ZHUH IRU DFXWH illnesses. The most common diagnosis in private clinics was upper respiratory infection that contributed to 21.5 of all diagnoses in private clinics and diagnosed in 26 out of 100 encounters. Gastrointestinal infection was the second most common diagnosis, though it only constituted 5.0 of diagnoses 6 per 100 encounters. Medications prescribed A total of 479,856 medications were recorded, at an average of 254 medications per 100 encounters and 190 medications per 100 diagnoses. Public clinics prescribed a total of 130,484 medications 244 per 100 encounters; 150 per 100 diagnoses and private clinics prescribed 255,788 medications 258 per 100 encounters; 213 per 100 diagnoses. ‡ 0HGLFDWLRQVZHUHSUHVFULEHGIRURIWRWDOHQFRXQWHUVLQSXEOLFFOLQLFV and 90.3 in private clinics. ‡ ,QSXEOLFFOLQLFVPHGLFDWLRQVPRVWFRPPRQO\SUHVFULEHGZHUHSDUDFHWDPROSHUHQFRXQWHUV metformin 17 per 100 encounters, amlodipine 16 per 100 encounters, lovastatin 15 per 100 encounters, and perindopril 13 per 100 encounters. ‡ 7KHWRSÀYHPHGLFDWLRQVSUHVFULEHGLQSULYDWHFOLQLFVZHUHSDUDFHWDPROSHUHQFRXQWHUV diphenhydramine 10 per 100 encounters, diclofenac 9 per 100 encounters, chlorphenamine 8 per 100 encounters, and butylscopolamine 8 per 100 encounters. Investigations ordered There were 53,028 investigations recorded, of which 64.4 was ordered by doctors at public clinics. The average rate of investigation ordered was 38 per 100 encounters; public clinics had 81 investigations per 100 encounters and private clinics had 19 investigations per 100 encounters. ‡ 0DMRULW\RIWKHLQYHVWLJDWLRQVUHFRUGHGZHUHODERUDWRU\WHVWVLDJQRVWLFUDGLRORJ\LPDJLQJ test constituted 21.4 of all investigations. ‡ ,QSXEOLFFOLQLFVJOXFRVHWHVWZDVWKHPRVWIUHTXHQWO\RUGHUHGLQYHVWLJDWLRQSHUHQFRXQWHUV In private clinics, urine test was most common 4 per 100 encounters. ‡ LDEHWHVK\SHUWHQVLRQDQGOLSLGGLVRUGHUZHUHWKHPRVWFRPPRQGLDJQRVHVIRUZKLFKLQYHVWLJDWLRQV were ordered. ✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✣ Advicecounselling and procedures There were 36,782 advicecounselling 26 per 100 encounters and 3,607 procedures 3 per 100 encounters recorded in 2012. ‡ DGYLFHFRXQVHOOLQJZHUHSURYLGHGLQSXEOLFFOLQLFVDQGZHUHSURYLGHG in private clinics. ‡ PRQJWKHW\SHVRIDGYLFHFRXQVHOOLQJSURYLGHGLQSULPDU\FDUHFOLQLFVZHUHJHQHUDODGYLFH HGXFDWLRQRQGLHWPHGLFDWLRQVÁXLGVLQWDNHDQGK\JLHQH ‡ RIWRWDOSURFHGXUHVZHUHSHUIRUPHGLQSXEOLFFOLQLFVZKLOHWKHUHVWZHUHGRQHLQ private clinics. ‡ UHVVLQJZDVWKHPRVWFRPPRQSURFHGXUHUHFRUGHGDQGDFFRXQWHGIRURIDOOSURFHGXUHV performed in primary care clinics. Follow-up and referrals There were 46,043 patient encounters 32.5 arranged for follow-up after visit to primary care clinics. Arrangements for follow-up were made more frequent in public clinics 63 out of 100 encounters compared to private clinics 19 out of 100 encounters. Referral was provided for 5,873 patient encounters 4.1 during visit to primary care clinics. Similar to follow-up, the referral rate was higher in public clinics 7 per 100 encounters than private clinics 3 per 100 encounters. ‡ 5HIHUUDOVZHUHPRVWRIWHQPDGHWRKRVSLWDOSHUHQFRXQWHUVDQGVSHFLDOLVWSHU encounters. ‡ OOUHIHUUDOVWRDOOLHGKHDOWKSURIHVVLRQDOVZHUHPDGHE\SXEOLFFOLQLFV ‡ PRQJDOOGLDJQRVHVUHIHUUHGWRKRVSLWDOKLJKULVNSUHJQDQFLHVZHUHWKHPRVWFRPPRQ ‡ LDEHWHVPHOOLWXVZDVWKHPRVWIUHTXHQWGLDJQRVLVUHIHUUHGWRDVSHFLDOLVW These data are by far the most comprehensive and detailed information on health care activities of both the public and private primary care clinics in Malaysia. Although the study was restricted to only clinics LQ VWDWHV DQG UHJLRQV VDPSOHG WKH ÀQGLQJV KDYH SURYLGHG D EHWWHU XQGHUVWDQGLQJ RI WKH GLVHDVH SDWWHUQV DQG SURFHVVHV RI FDUH LQ WKH 0DOD\VLDQ SULPDU\ FDUH VHWWLQJ 7KH ÀQGLQJV IURP WKLV VWXG\ together with those from the National Healthcare Establishment and Workforce Survey: Primary Care NHEWS are vital to form a clearer picture of the current primary healthcare system in Malaysia. Chapter 1 Introduction ✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✤

CHAPTER 1: INTRODUCTION

1.1 BACKGROUND

The National Healthcare Statistics Initiative NHSI is a family of surveys which aims to support evidence-based health policy-making and research in Malaysia. It was initiated in 2009 by the Healthcare Statistics Unit HSU in National Clinical Research Centre NCRC Kuala Lumpur in collaborations with various stakeholders. Over the past 4 years, the NHSI has grown and managed to gain recognition due to WKHXVHIXOQHVVRILWVGDWDZKLFKÀOOVLQWKHJDSEHWZHHQUHVHDUFKDQGSROLF\QQXDOUHSRUWVDUHSXEOLVKHG IRUPRVWRIWKHVXUYH\VXQGHU1+6,EDVHGRQWKHLUUHVSHFWLYHÀQGLQJV 7KH1DWLRQDO0HGLFDODUH6XUYH\106LVRQHRIWKHIRXUPHPEHUVRI1+6,7KHÀUVW106ZDV launched in 2010 and have met with numerous challenges which have led to the suspension of the project IRUD\HDU+RZHYHUVRPHZHDNQHVVHVLQLWVPHWKRGRORJ\DQGGDWDTXDOLW\KDYHEHHQLGHQWLÀHGXSRQ consultation with local and international researchers as well as stakeholders during the year of suspension. With more staff and support from the stakeholders, the management team of NMCS managed to publish a short report based on NMCS 2010 data for public consumption. In 2012, the survey was re-initiated with a revised methodology. A Research Evaluation Committee REC comprising of respected academicians from the universities, representatives from Family Health Division and Academy of Family Physician Malaysia as well as Pharmaceutical Services Division and a statistician has been set up to discuss and advise the NMCS team with regards to the planned objectives and methodology. The team has also managed to get good support from the Bettering the Evaluation and Care of Health BEACH management team, a Family Medicine Research Centre team from University of Sydney Australia1 who has given permission for NMCS 2012 questionnaire to be adapted from theirs. NMCS 2012 is hoped to bring about more valuable data to all.

1.2 OBJECTIVES

General Objectives 1. To collect reliable and valid data in primary care setting. 2. To assess patient characteristics and morbidity pattern and the relationship these factors have with health service activity. 3. To provide accurate and timely data to various stakeholders including government bodies, primary care practitioners, consumers, researchers, and the pharmaceutical industry. 4. To establish an ongoing database of doctorpatient encounter information. 6SHFLÀF2EMHFWLYHV To collect information on clinical activities in primary care setting in Malaysia including: ‡ 7KHFKDUDFWHULVWLFVRISDWLHQWVVHHQ ‡ 0RGHRISD\PHQWIRUSULPDU\FDUHVHUYLFHV ‡ 5HDVRQVSHRSOHVHHNPHGLFDOFDUH ‡ 3UREOHPVPDQDJHGDQGIRUHDFKSUREOHPPDQDJHG o Pharmacological treatment prescribed, including the dose and frequency; o Non-pharmacological treatment provided, including the procedures and counselling; o Investigations ordered, including pathology and imaging; o Follow up in primary care and referrals to secondary or tertiary care; R ,VVXDQFHRIPHGLFDOFHUWLÀFDWHDQGGXUDWLRQRIVLFNOHDYH ✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✥ The study also aims to provide more evidence on the prevalence of non-communicable diseases NCDs in primary care settings and their process of care, in line with the National Strategic Plan for Non- Communicable Disease NSP-NCD 2010 – 2014. In the National Strategic Plan, research has been LGHQWLÀHG DV RQH RI WKH VWUDWHJLHV WR SUHYHQW DQG FRQWURO 1V WKURXJK WKH PRQLWRULQJ RI FOLQLFDO management. 2

1.3 DEFINITIONS

HÀQLWLRQVRQSULPDU\FDUHIRUWKHSXUSRVHRIWKH106UHVHDUFKSURMHFWZHUHDGDSWHGIURPWKH American Association of Family Physicians. 3 The few terms that was taken in: a Primary care 7KHFDUHSURYLGHGE\SK\VLFLDQVVSHFLÀFDOO\WUDLQHGIRUDQGVNLOOHGLQFRPSUHKHQVLYHÀUVWFRQWDFW and continuing care for persons with any undiagnosed sign, symptom, or health concern the “undifferentiated” patient not limited by problem origin biological, behavioural, or social, organ system, or diagnosis. - The care involved includes health promotion, disease prevention, health maintenance, counselling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of health FDUH VHWWLQJV HJ RIÀFH LQSDWLHQW FULWLFDO FDUH ORQJWHUP FDUH KRPH FDUH GD\ FDUH HWF Primary care is performed and managed by a personal physician often collaborating with other health professionals, and utilising consultation or referral as appropriate. b Primary care setting 3ULPDU\FDUHVHWWLQJVHUYHVDVWKHSDWLHQW·VÀUVWSRLQWRIHQWU\LQWRWKHKHDOWKFDUHV\VWHPDQG as the continuing focal point for all needed health care services. Primary care practices provide patients with ready access to their own personal physician or to an established back-up physician when the primary physician is not available. c Primary care doctors - Medical doctors or family medicine specialists FMS who are providing primary care in primary care setting. Primary healthcare in Malaysia are provided by both public and private healthcare providers. Government clinics Klinik Kesihatan are funded by the government while private sector provides service on fee-for- service basis. In this report, the term ‘public clinic’ and ‘private clinic’ are used to describe these two types of primary care clinics.

1.4 RESEARCH QUESTIONS

No. Questions Answered by 1. What types of patients are seen by primary care practitioners? Demographic characteristics 2. What is the source of payment for primary care services? Mode of payment 3. What motivates patients to seek care from primary care setting? Patient’s reasons for visit 4. What are the actual diagnosis problems managed by primary care practitioners? Doctor’s diagnosis Problems managed 5. What are the pharmacological treatments prescribed by primary care practitioners for each diagnosis? Pharmacological interventions ✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✦ No. Questions Answered by 6. What are the procedures and imaging ordered by primary care practitioners for the diagnosis problems? Non-pharmacological interventions 7. What types of counselling are offered by primary care practitioners for the diagnosis problems? Non-pharmacological interventions 8. Is there any continuity of care in primary care setting? Referrals Follow Up 9. What is the extent of the loss of productivity for the morbidities in primary care setting? 0HGLFDOFHUWLÀFDWH0DQGGXUDWLRQRI sick leave Each research question is described in separate chapter in this report. However, patients’ mode of payment DQGWKHLVVXDQFHRIPHGLFDOFHUWLÀFDWHDUHGLVFXVVHGLQWKHVDPHFKDSWHUDVWKHSDWLHQWV·GHPRJUDSKLF characteristics. REFERENCES 1. The University of Sydney, Family Medicine Research Centre. Bettering the Evaluation and Care of Health BEACH. [Viewed January 2014]. Available from: http:sydney.edu.aumedicinefmrc beachindex.php 2. National Strategic Plan for Non-Communicable Disease 2010 – 2014. Ministry of Health Malaysia 2010. 3. American Association of Family Physicians AAFP. Primary Care. [Viewed January 2014]. Available from: http:www.aafp.orgonlineenhomepolicypoliciespprimarycare.html