65
74.3 85.0
1.5 1.2
0.0 0.0
82.3 28.1
1.4 1.4
r 0.8
0.4
191.5
138.5 26.6
3.5 2.2
0.1 0.0
20.8 10.1
2.2 0.2
r 0.2
0.0
177.9
138.5 26.6
3.5 2.2
0.1 0.0
20.8 10.1
2.2 0.2
r 0.2
0.0
177.9
Chapter 7 : Reasons for Encounter
7.3 REASONS FOR ENCO
F G H
ER BY ICPC-2 CHAPTERS
Table 7.3.1 shows the overall distribution of RFEs when categorised according to ICPC-2 chapters. Note that in some instances, related RFEs within a certain ICPC-2 chapter were collapsed into a single RFE.
• The most common RFEs were respiratory conditions, which accounted for 26.8 of all RFEs 49.2 per 100 patient encounters.
• General and unspecified conditions were the second most frequent RFEs 20.3 of all RFEs. Among these conditions, fever was the most frequently reported reason for visit 62.9 of all
general and unspecified conditions. • Chronic conditions under the endocrine, metabolic and nutritional category accounted for 12.7 of
all RFEs, with 10.9 RFEs per 100 encounters recorded for diabetes and 9.1 per 100 encounters for lipid disorder. For reference, the National Health Morbidity Survey NHMS 2011 reported the
prevalence for diabetes and hypercholesterolemia in Malaysia to be at 15.2 and 35.1, respectively.
2
Table 7.3.1: Reasons
I
or encounter by ICPC-2 chapters and the most common individual reasons
I
or encounter within each chapter in primary care clinics in 2014
RFE ICPC-2 chapter
J
nweighted count
Weighted count
Percent
K L
total RFEs n
M O QR S
563 Rate per 100
encounters 95
T
CI n
M V W OS X Y XZ
Respiratory 12,660
160,
YX [
26.
X
49.2 46.1
\
52.2
Cough 6,022
74,905 12.5
23.0 21.7–24.3 Runny noserhinorrhoea
4,328 53,469
9.0 16.4 15.1–17.7
Painsore throat
]
982 14,030
2.4 4.3 3.5–5.2
Asthma 623
7,834 1.3
2.4 1.9–2.9
General unspeci
L
ied 9,740
121,203 20.3
37.2 35.3
\
39.1
Fever 6,071
76,242 12.8
23.4 22.0–24.8 Medical examination
]
878 10,273
1.7 3.2 2.5–3.8
Blood test 576
6,524 1.1
2.0 1.5–2.5 Dressingpressurecompresstamponad
e ]
310 4,106
0.7 1.3 1.0–1.5
Pain generalmultiple sites 258
3,642 0.6
1.1 0.9–1.3
Endocrine, metabolic and nutritional 7,
X V Y
76,009 12.7
23.3 19.4
\
27.3
Diabetes - non-gestational
]
3,588 35,390
5.9 10.9 9.0–12.7
Diabetes type 2 2,986
29,437 4.9
9.0 7.2–10.8 Diabetes - unspecified
510 5,228
0.9 1.6 1.0–2.3
Lipid disorder 3,194
29,520 4.9
9.1 7.3–10.9 Blood test endocrinemetabolic
664 7,211
1.2 2.2 1.6–2.9
Cardiovascular 6,029
O X S _
X V
9
` X
Y X `
0 15.
X\
20.1
Hypertension - cardiovascular
]
5,518 53,495
9.0 16.4 14.5–18.4
66
National Medical Care Statistics 2014
Table 7.3.1 continued: Reasons
a
or encounter by ICPC-2 chapters and the most common individual reasons
a
or encounter within each chapter in primary care clinics in 2014
RFE ICPC-2 chapter
b
nweighted count
Weighted count
Percent
c d
total RFEs n
f h ij k
563 Rate per 100
encounters 95
l
CI n
f m n
5,
o po q
Digestive 3,903
50,539
o
.5 15.5 14.4
r
16.7
Abdominal pai
t u
1,193 16,010
2.7 4.9 4.4–5.4
Diarrhoea 1,149
15,285 2.6
4.7 4.3–5.1
v
omiting 440
4,988 0.8
1.5 1.3–1.8
Musculoskeletal 2,
w n
o
36,097 6.0
11.1 10.1
r
12.1
Musculoskeletal symptomcomplaints
u
1,533 20,217
3.4 6.2 5.4–7.0
Back problems
u
726 10,720
1.8 3.3 2.8–3.7
Skin 1,930
25,111 4.2
7.7 6.5
r o
x
9
Ras
y u
535 7,006
1.2 2.2 1.5–2.8
Pruritus 474
5,972 1.0
1.8 1.2–2.5
Neurological 1,
h jo
21,
o n z
3.7 6.7 5.9
r
7.5
Headache - a
{{ u
1,015 14,788
2.5 4.5 4.0–5.1
Headache 975
13,901 2.3
4.3 3.8–4.8
v
ertigodizziness 382
5,003 0.8
1.5 1.2–1.9
Pregnancy, childbearing,
d
amily planning
1,902 17,
w no
3.0 5.4 4.4
r
6.4
Medical examination - pregnancy
u
1,567 14,412
2.4 4.4 3.5–5.3
b
rological 602
7,352 1.2
2.3 1.
o r
2.7
Urinary problem
u
228 2,862
0.5 0.9 0.7–1.1
Eye 632
7,322 1.2
2.3 1.9
r
2.6
Symptomcomplaint ey
| u
458 5,095
0.9 1.6 1.2–1.9
Female genital 377
5,214 0.9
1.6 1.3
r
1.9
Menstrual problems
u
193 3,109
0.5 1.0 0.7–1.2
Psychological 296
4,
n o
p
0.7 1.3 0.
o r
1.
o q
Ear 256
3,244 0.5
1.0 0.
o r
1.2 Blood, blood
d
orming organs
}
immune mechanism 221
2,430 0.4
x o
0.5
r
1.0 Male genital
56 639
0.1 0.2 0.1
r
0.3 Social problems
1 2
0.0 0.0 0.0
r
0.0 Total
50,642 597,563
100.0
p o m
x
4
pj o x
1
r poo
x
7
~
Comprise multiple ICPC-2 codes see Appendix 4
• •
•
67
539 15.5
010 4.9
285 4.7
988 1.5
097 11.1
217 6.2
720 3.3
111 7.7
006 2.2
972 1.8
6.7
788 4.5
901 4.3
003 1.5
y 5.4
412 4.4
352 2.3
862 0.9
322 2.3
095 1.6
214 1.6
109 1.0
1.3 244
1.0 430
639 0.2
2 0.0
563 4
7
Chapter 7 : Reasons for Encounter
7.4 MOST COMMON REASONS FOR ENC
ER IN
BLIC AND PRIVATE CLINICS
NMCS 2012 reported that the main reason for utilisation of primary care in the public sector was non- communicable diseases, with hypertension being the top reason for encounter, followed by diabetes and
lipid disorder.
1
Similar pattern was observed in NMCS 2014 Figure 7.4.1. • Patients who visited public clinics reported 191.5 RFEs per 100 encounters, slightly more than
those in private clinics 177.9 per 100 encounters. • A distinct difference observed between the two sectors when comparing the 10 commonest RFEs is
the pattern of diseases presenting to each sector. The top three RFEs reported in public clinics were chronic diseases, whereas in private clinics, patient encounters were mostly for acute
complaints. • Blood tests related to endocrinemetabolic conditions were among the top 10 reasons for visit to
public clinics. This utilisation could be due to periodic check-up on existing non-communicable diseases and demonstrates the utilisation of primary health care other than for consultations and
medications.
Figure 7.4.1: Top 10 reasons
or encounter in public clinics in 2014
omprise multiple ICPC-2 codes see Appendix 4
3.9 4.2
4.4 9.3
12.0 16.2
22.5 31.3
5 10
15 20
25 30
35 40
Blood test endometabolic
¡
¢
Runny noserhinorrhoea Fever
Cough Lipid disorder
£
¤
¥
¡
Rate per 100 encounters
68
National Medical Care Statistics 2014
Figure 7.4.2: Top 10 reasons
¦
or encounter in private clinics in 2014
§
Comprise multiple ICPC-2 codes see Appendix 4
REFERENCES
1. Sivasampu S, Yvonne Lim, Norazida AR, Hwong WY, Goh PP, Hisham AN, editors. National Medical Care Statistics NMCS 2012. Kuala Lumpur Malaysia: National Clinical Research
Centre MY, National Healthcare Statistics Initiative; 2014. 95 p. Report No.: NCRCHSU2013.3. Grant No.: NMRR-09-842-4718. Supported by the Ministry of Health Malaysia.
2. Institute for Public Health IPH. National Health and Morbidity Survey 2011 NHMS 2011.
¨
ol. 2: Non Communicable Diseases; 2011. 188 p. Report No.: MOHSIKU04.12TR. Grant No.: NMRR-
10-757-6837. Supported by the Ministry of Health Malaysia.
4.5 6.2
6.2 6.2
6.3 6.4
7.5 19.4
26.5
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25 30
35 40
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Runny noserhinorrhoea Cough
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Rate per 100 encounters
