Data entry DATA MANAGEMENT

✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✜ ✩ All the errors which were detected coded and non-coded were corrected by referring to the original forms and by discussion among the investigators and the Research Evaluation Committee. Further systematic checks were also conducted during data cleaning to ensure validity and reliability of the data. A protocol with validation rules for cleaning as well as data inconsistency rules was created for data cleaning. ODVVLÀFDWLRQRIGDWDDWDFRGLQJ ,QWHUQDWLRQDOODVVLÀFDWLRQRI3ULPDU\DUH,3 7KH ,QWHUQDWLRQDO ODVVLÀFDWLRQ RI 3ULPDU\ DUH 6HFRQG GLWLRQ ,3 ZDV XVHG WR FODVVLI\ WKH following data elements: ‡ 5HDVRQVIRUHQFRXQWHU ‡ LDJQRVHV ‡ ,QYHVWLJDWLRQV ‡ 3URFHGXUHV ‡ GYLFHFRXQVHOOLQJ The ICPC-2 is accepted by the World Health Organization WHO as a member of the WHO Family of ,QWHUQDWLRQDOODVVLÀFDWLRQV 4 It was published in 1987 by the World Organisation of Family Doctors :21DQGXVHGLQPRUHWKDQFRXQWULHVDVWKHVWDQGDUGIRUGDWDFODVVLÀFDWLRQLQSULPDU\FDUH The ICPC-2 has a bi-axial structure, with 17 chapters based on body systems and seven components with rubrics bearing a letter and two-digit numeric code. ICPC-2 Chapters A General R Respiratory B Blood, immune system S Skin D Digestive T Endocrine, nutritional metabolic F Eye U Urological H Ear W Women’s health, pregnancy, family planning K Circulatory X Female genital L Musculoskeletal Y Male genital N Neurological Z Social problems P Psychological ICPC-2 Components Code 1. Complaints and symptoms 01 - 29 2. Diagnostics, screening and preventive 30 - 49 3. Medication, treatment, procedures 50 - 59 4. Test results 60 - 61 5. Administrative 62 6. Referrals 63 - 69 7. Diagnoses, disease infectious, neoplastic, injuries, congenital, other 70 - 99 ✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✜ ✤ 7KH GDWD ZHUH HQWHUHG DQG FRGHG XVLQJ ,3 386 DQ H[WHQGHG FOLQLFDO WHUPLQRORJ\ FODVVLÀHG according to ICPC-2. ICPC-2 PLUS coding system contains extended terms commonly used in general SUDFWLFHWKDWDUHPRUHVSHFLÀFDQGKHOSVWRHQVXUHDFFXUDWHFODVVLÀFDWLRQWR,3GXULQJGDWDHQWU\ ICPC-2 PLUS was developed in 1995, and is maintained and regularly updated by the Family Medicine Research Centre FMRC of the University of Sydney. 5 Also known as BEACH coding system, ICPC-2 PLUS is primarily used in Australia especially for the national study of general practice activity, the BEACH program. The National Clinical Research Centre has been granted a free research licence from WONCA for the usage of ICPC-2 codes which is valid from February 2011 till end of 2014 whereas the ICPC-2 PLUS was obtained under a free licence from the University of Sydney. 5HVXOWVZHUHUHSRUWHGDWWKH,3FODVVLÀFDWLRQOHYHO6RPHRIWKHGLDJQRVHVZHUHJURXSHGWRJHWKHUE\ FRPELQLQJVHYHUDO,3RU,3386FRGHVSSHQGL[+RZHYHUFODVVLÀFDWLRQRISDWKRORJ\DQG LPDJLQJWHVWDFFRUGLQJWR,3FDQEHYHU\EURDGHJ+EFWHVWLVFODVVLÀHGXQGHU7ORRGWHVW endometabolic. Hence, results for Chapter 9: Investigations were presented as ICPC-2 PLUS. Anatomical Therapeutic Chemical ATC 0HGLFDWLRQVZHUHFRGHGDQGFODVVLÀHGXVLQJWKHQDWRPLFDO7KHUDSHXWLFKHPLFDO7FODVVLÀFDWLRQ system. ATC has been recommended by the WHO and used in many countries including Malaysia, as a global standard for classifying medications for drug utilisation research, evaluating trend of drug consumption and for international comparisons. 6,7 0HGLFDWLRQVDUHFODVVLÀHGLQWRJURXSVDWÀYHGLIIHUHQW levels, with the following example: ‡ HYHODUGLRYDVFXODUV\VWHP ‡ HYHO6HUXPOLSLGUHGXFLQJDJHQWV ‡ HYHOKROHVWHURORIWULJO\FHULGHUHGXFHUV ‡ HYHO+0RUHGXFWDVHLQKLELWRUV ‡ HYHO6LPYDVWDWLQ The ATC licence was purchased from the WHO Collaborating Centre for Drug Statistics Methodology. Medications were entered as free text in generic non-proprietary or brand name, and coded by trained GDWDHQWU\SHUVRQQHODFFRUGLQJWRWKHXLGHOLQHVIRU7ODVVLÀFDWLRQDQGDVVLJQPHQW 6 In certain cases, the doctors might not specify the medications to the generic level hence it could only be coded to ATC level 3 or 4. ✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✜ ✥

2.6 DATA ANALYSIS

2.6.1 Weighting

The data presented in this report were weighted to adjust for over and under representativeness of any VWUDWDLQWKHVDPSOHDVZHOODVWRDFFRXQWIRUQRQUHVSRQGHQWV7HQZHLJKWLQJVWUDWDZHUHGHÀQHGIRU the study population, by stateregion and sector. The components incorporated in the estimation of total weights are described below. Sampling weight The sampling weight of each stratum calculated as follow: W j = N j n j where N is the total encounters for primary care clinics per day in the stateregion population, and n is the total encounters expected sample for strata j. j = strata according to sector and stateregion Strata according to stateregion and sector StateRegion Sector Stratum Selangor WP Putrajaya Public 1 Private 2 WP Kuala Lumpur Public 3 Private 4 Kelantan Public 5 Private 6 Kota Kinabalu Public 7 Private 8 Kuching Public 9 Private 10 GMXVWPHQWIRUQRQUHVSRQVHSRVWVWUDWLÀFDWLRQZHLJKW To account for less than 100 response rate, adjustment for the non-response is required. The non- response adjustment weight was calculated as a ratio of number of expected encounters as the numerator and number of responding encounters as the denominator. Total weights 7KH ÀQDO ZHLJKW IRU HDFK VWUDWXP ZDV FDOFXODWHG DV WKH VDPSOLQJ ZHLJKW PXOWLSOLHG E\ WKH SRVW VWUDWLÀFDWLRQZHLJKW7KHZHLJKWHGHVWLPDWHVZHUHWKHQFDOFXODWHGE\PXOWLSO\LQJWKHUDZGDWDE\WKH ÀQDOZHLJKW 2.6.2 Statistical Analysis STATA Version 11 StataCorp. 2009. Stata Statistical Software: Release 11. College Station, TX; StataCorp LP. and IBM SPSS Statistics for Windows Version 20.0. Armonk, NY: IBM Corp were used for data analysis. Results were presented as number of observations, proportions, and rate per 100 encounters ✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✜ ✦ DORQJZLWKFRQÀGHQFHLQWHUYDO,5DWHSHUGLDJQRVHVZHUHUHSRUWHGIRUPDQDJHPHQWWKDWFDQ occur at more than once per diagnosis.

2.7 ETHICAL ISSUES

The study was approved by the Medical Research and Ethics Committee MREC, MOH. As per previous study, a public notice was placed at each participating clinic to inform patients that their data would be collected for research purposes. Patients had the right to decline to participate at any point of time throughout the study period.

2.8 LIMITATIONS

1. Only 3 states Selangor and WP Putrajaya, WP Kuala Lumpur, and Kelantan and 2 regions .RWD.LQDEDOXDQG.XFKLQJZHUHVXUYH\HG7KHVWXG\UHVXOWVZLOORQO\UHÁHFWWKHPRUELGLW\DQG prescription pattern in these state and regions and cannot be projected to represent the entire nation. 2. The survey is self-administered and therefore precision of data depends largely on the completeness RIUHFRUGLQJE\UHVSRQGHQWVKHQFHPD\QRWQHFHVVDULO\UHÁHFWWKHDFWXDOSUDFWLFH 7KH VXUYH\ LV HQFRXQWHUEDVHG DQG UHÁHFWV WKH PRUELGLW\ SDWWHUQ REVHUYHG LQ WKH SULPDU\ FDUH setting rather than the prevalence of disease in the community. 7KH PRUELGLW\ SDWWHUQV UHÁHFW RQO\ WKRVH PRUELGLWLHV PDQDJHG GXULQJ WKH UHFRUGHG HQFRXQWHUV There may be co-morbidity in the same patient which was not expected to be managed during the encounter and hence was not recorded. 5. The survey is a cross-sectional study. Therefore, no conclusions may be generated on the outcomes of management of acute and chronic diseases in the primary care setting. Prescriptions, procedures, imaging and referrals reported were those provided at the present point of encounter and did not necessarily indicate that the patient has not already received them in a previous encounter. REFERENCES 1. Atkinson I. Accuracy of data transfer: double data entry and estimating levels of error. J Clin Nurs. 2012; 2119-20:2730-5. 2. Goldberg SI, Niemierko A, Turchin A. Analysis of Data Errors in Clinical Research Databases. AMIA Annu Symp Proc. 2008;2008:242-246. 3. Fontaine P, Mendenhall TJ, Peterson K, Speedie SM. The “Measuring Outcomes of Clinical Connectivity” MOCC Trial: Investigating Data Entry Errors in the Electronic Primary Care Research Network ePCRN J Am Board Fam Med. 2007;202:151-9. :RUOG+HDOWK2UJDQL]DWLRQDPLO\RILQWHUQDWLRQDOFODVVLÀFDWLRQVHQHYD:+29LHZHG HEUXDU\YDLODEOHIURPKWWSZZZZKRLQWFODVVLÀFDWLRQVHQ:+2,DPLO\SGI DPLO\0HGLFLQH5HVHDUFKHQWUH7KH8QLYHUVLW\RI6\GQH\,3,QWHUQDWLRQDOODVVLÀFDWLRQ of Primary Care. [Viewed January 2014]. Available from: http:sydney.edu.aumedicinefmrcicpc-2 index.php :+2ROODERUDWLQJHQWUHIRUUXJ6WDWLVWLFV0HWKRGRORJ\XLGHOLQHVIRU7ODVVLÀFDWLRQDQG DDD Assignment 2012. Oslo 2011. [Viewed February 2014]. Available from: www.whocc.no 7. Pharmaceutical Services Division and Clinical Research Centre, Ministry of Health Malaysia. Malaysian Statistics on Medicine 2008. Kuala Lumpur 2013. Chapter 3 Response Rate