Profile of General Practices in Malaysia

In this survey all practices under the headings of “Clinics”, “Medical Practitioners” and “Medical Practitioners - Registered” in the Yellow Pages telephone directories for the thirteen states of Malaysia were selected. Those excluded were clinics or medical practitioners who advertised themselves as specialists in other disciplines. A total of 2291 practices were surveyed and a response rate of 51.2% was obtained. 383(33%) of the general practitioners were trained locally for the first degree. 258(22%) had at least one postgraduate qualification. 69(6%) possessed a postgraduate qualification in primary care medicine. About 80% of general practitioners participated in continuing medical education and 4% did research in the last 3 years. 42% were involved in community activities. 75% ran solo practices. Over 90% of the practices opened six or seven days a week. The mean workload per doctor per day was 44.66. Most practices provided a comprehensive range of services including curative, preventive, dispensing services, counselling, laboratory tests, and home visits. 43% of practices had a computer.

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Effect of a price display intervention on laboratory test ordering behavior of general practitioners

BMC Family Practice ◽

10.1186/s12875-021-01591-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Dennis M. J. Muris ◽

Max Molenaers ◽

Trang Nguyen ◽

Paul W. M. P. Bergmans ◽

Bernadette A. C. van Acker ◽

...

Keyword(s):

Primary Care ◽

The Netherlands ◽

Laboratory Test ◽

General Practitioners ◽

Laboratory Tests ◽

Future Research ◽

Post Intervention ◽

Diagnostic Laboratory ◽

The Mean ◽

Test Ordering

Abstract Background Redundant use of diagnostic tests in primary care has shown to be a contributor to rising Dutch healthcare costs. A price display in the test ordering system of the electronic health records (EHRs) could potentially be a low-cost and easy to implement intervention to a decrease in test ordering rate in the primary care setting by creating more cost-awareness among general practitioners (GPs). The aim of this study was to assess the effect of a price display for diagnostic laboratory tests in the EHR on laboratory test ordering behavior of GPs in the Westelijke Mijnstreek region in the Netherlands. Methods A pre-post intervention study among 154 GPs working in 57 general practices was conducted from September 2019, until March 2020, in the Netherlands. The intervention consisted of displaying the costs of 22 laboratory tests at the time of ordering. The primary outcome was the mean test ordering rate per 1.000 patients per month, per general practice. Results Test ordering rates were on average rising prior to the intervention. The total mean monthly test order volume showed a non-statistically significant interruption in this rising trend after the intervention, with the mean monthly test ordering rate levelling out from 322.4 to 322.2 (P = 0.86). A subgroup analysis for solely individually priced tests showed a statistically significant decrease in mean monthly test ordering rate after implementation of the price display for the sum of all tests from 67.2 to 63.3 (P = 0.01), as well as for some of these tests individually (i.e. thrombocytes, ALAT, TSH, folic acid). Leucocytes, ESR, vitamin B12, anti-CCP and NT-proBNP also showed a decrease, albeit not statistically significant (P > 0.05). Conclusions Our study suggests that a price display intervention is a simple tool that can alter physicians order behavior and constrain the expanding use of laboratory tests. Future research might consider alternative study designs and a longer follow-up period. Furthermore, in future studies, the combination with a multitude of interventions, like educational programs and feedback strategies, should be studied, while potentially adverse events caused by reduced testing should also be taken into consideration.

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A cross-sectional survey of general practitioners’ experiences with, views of, and attitudes towards, practice-based pharmacists

International Journal of Pharmacy Practice ◽

10.1093/ijpp/riab015.029 ◽

2021 ◽

Vol 29 (Supplement_1) ◽

pp. i24-i25

Author(s):

A H Ibrahim ◽

H Barry ◽

C M Hughes

Keyword(s):

Primary Care ◽

General Practice ◽

Northern Ireland ◽

General Practitioners ◽

Response Rate ◽

Clinical Skills ◽

Community Pharmacists ◽

Care Practice ◽

Full Time ◽

General Practices

Abstract Introduction Five-year pilot schemes were announced in both England and Northern Ireland (NI) to integrate practice-based pharmacists (PBPs) into general practices. The NI scheme anticipates that there will be 300 whole time equivalent PBPs in post by the end of the pilot (2020/2021).[1] There is little existing UK literature on PBPs’ role evolution and few studies have explored general practitioners’ (GPs) experiences of pharmacist integration into primary care practice. Aim To investigate GPs’ experiences with PBPs, their views about the PBP role and its impact upon patients and GPs, and their attitudes towards collaboration with PBPs. Methods A paper-based self-administered questionnaire was mailed to all general practices (n=329) across Northern Ireland (NI) on two occasions during September and October 2019, and was completed by one GP in every practice who had most contact with the PBP. The questionnaire was developed following a comprehensive literature review and comprised four sections (Table 1). Descriptive analyses were conducted using SPSS v26 and responses to open-ended questions were analysed thematically. Results The response rate was 61.7% (203/329). Respondents had a median age of 52.0 years and there was at least one PBP per general practice. All GPs had face-to-face meetings with PBPs, with three-quarters (78.7%, n=159) meeting with the PBP more than once a week. GPs reported that two-thirds of PBPs (62.4%, n=126) were qualified as independent prescribers, with 76.2% of prescribers (n=96) currently prescribing for patients. The most common PBP activities were medication reconciliation and medication reviews. The majority of GPs reported that PBPs always/very often had the required clinical skills (83.6%, n=162) and knowledge (87.0%, n=167) to provide safe and effective care for patients. However, only 31.1% (n=61) stated that PBPs sometimes had the confidence to make clinical decisions. The majority of GPs (>85%) displayed largely positive attitudes towards collaboration with PBPs. Most respondents agreed/strongly agreed that PBPs will have a positive impact on patient outcomes (95.0%, n=192) and can provide a better link between general practices and community pharmacists (96.1%, n=194). However, 24.8% of GPs (n=50) were unclear if the PBP role moved community pharmacists to the periphery of the primary care team. Thematic analysis of the open comments indicated that GPs were in favour of more PBP sessions and full-time posts. Conclusion This study has revealed that the majority of GPs had positive views and attitudes about the PBP role, its impact in primary care and collaboration with PBPs. The findings may have implications for future developments in order to extend integration of PBPs within general practice, including the enhancement of training in clinical skills and decision-making. Our target sample included all general practices within NI and the response rate enhanced generalisability at the practice level. However, the study sample was limited to NI, and some findings may not be relevant to other parts of the UK. Further work is required to explore PBPs’, community pharmacists’ and patients’ views of this role in general practice to corroborate study findings. References 1. Strategic Leadership Group for Pharmacy. Practice-based pharmacists' statement. 2016. (Online) Available at: https://www.health-ni.gov.uk/sites/default/files/publications/health/practice-based-pharmacists.pdf (accessed 06 Oct 2020). 2. Van C, Costa D, Mitchell B, Abbott P, Krass I. Development and validation of a measure and a model of general practitioner attitudes toward collaboration with pharmacists. Res Soc Adm Pharm. 2013; 9(6): 688–699.

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Validity and reliability of an adapted questionnaire measuring knowledge, awareness and practice regarding familial hypercholesterolaemia among primary care physicians in Malaysia

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01845-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ahmad Baihaqi Azraii ◽

Anis Safura Ramli ◽

Zaliha Ismail ◽

Suraya Abdul-Razak ◽

Siti Fatimah Badlishah-Sham ◽

...

Keyword(s):

Primary Care ◽

Work Experience ◽

Primary Care Physicians ◽

Online Survey ◽

Familial Hypercholesterolaemia ◽

Kappa Statistics ◽

Content Validation ◽

Validity And Reliability ◽

Postgraduate Qualification ◽

The Mean

Abstract Background Primary care physicians (PCP) play an important role in detecting Familial Hypercholesterolaemia (FH) early. However, knowledge, awareness and practice (KAP) regarding FH among Malaysian PCP are not well established, and there was no validated tool to assess their FH KAP. Thus, the aim of this study was to adapt an FH KAP questionnaire and determine its validity and reliability among Malaysian PCP. Methods This cross-sectional validation study involved Malaysian PCP with ≥ 1-year work experience in the primary care settings. In Phase 1, the original 19-item FH KAP questionnaire underwent content validation and adaptation by 7 experts. The questionnaire was then converted into an online survey instrument and was face validated by 10 PCP. In Phase 2, the adapted questionnaire was disseminated through e-mail to 1500 PCP. Data were collected on their KAP, demography, qualification and work experience. The construct validity was tested using known-groups validation method. The hypothesis was PCP holding postgraduate qualification (PCP-PG-Qual) would have better FH KAP compared with PCP without postgraduate qualification (PCP-noPG-Qual). Internal consistency reliability was calculated using Kuder Richardson formula-20 (KR-20) and test–retest reliability was tested on 26 PCP using kappa statistics. Results During content validation and adaptation, 10 items remained unchanged, 8 items were modified, 1 item was moved to demography and 7 items were added. The adapted questionnaire consisted of 25 items (11 knowledge, 5 awareness and 9 practice items). A total of 130 out of 1500 PCP (response rate: 8.7%) completed the questionnaire. The mean percentage knowledge score was found to be significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (53.5, SD ± 13.9 vs. 35.9, SD ± 11.79), t(128) = 6.90, p < 0.001. The median percentage awareness score was found to be significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (15.4, IqR ± 23.08 vs. 7.7, IqR ± 15.38), p = 0.030. The mean percentage practice score was significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (69.2, SD ± 17.62 vs. 54.4, SD ± 19.28), t(128) = 3.79, p < 0.001. KR-20 value was 0.79 (moderate reliability) and average Kappa was 0.796 (substantial agreement). Conclusion This study has proven that the 25-item adapted FH KAP questionnaire is valid and reliable. It can be used to measure and establish FH KAP among PCP in Malaysia.

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The Management of Febrile Infants by Primary-Care Pediatricians in Utah: Comparison With Published Practice Guidelines

PEDIATRICS ◽

10.1542/peds.95.5.623 ◽

1995 ◽

Vol 95 (5) ◽

pp. 623-627 ◽

Cited By ~ 1

Author(s):

Paul C. Young

Keyword(s):

Primary Care ◽

Practice Guidelines ◽

Laboratory Tests ◽

Blood Count ◽

Response Rate ◽

Expert Panel ◽

Complete Blood Count ◽

Age Groups ◽

Design Case ◽

Primary Care Pediatricians

Objective. To determine primary-care pediatricians' management of febrile infants and compare them with published practice guidelines. Design. Case scenarios were sent to 194 primary-care pediatricians in Utah, describing three febrile infants, ages 21 days, 60 days, and 20 months, corresponding to the three age groups: 0 to 28 days; 29 to 90 days, and 91 days to 36 months for which the guidelines suggest different strategies. Results. Ninety-four pediatricians responded (response rate, 48%). Compliance with the guidelines was 39% for the 21 day old, 9.6% for the 60 day old, and 75% for the 20 month old. No respondent followed the guidelines for all three infants. Performance of tests to determine if an infant was low risk varied from 3%, for a stool white cell examination in a febrile 2 month old with diarrhea, to 75% for a complete blood count in a 20 month old with a temperature of 40°C. Compliance did not differ between private and academic practitioners. Those in practice less than 5 years (n = 22) were more likely than those with more experience to follow the guidelines for the 21 day old but not the other two infants. Conclusion. Primary-care pediatricians in Utah manage febrile infants with fewer laboratory tests and less hospitalization than recent practice guidelines developed by an expert panel of academic specialists suggest.

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Recruiting and retaining general practitioners to a primary care asthma-intervention study in Australia

Australian Journal of Primary Health ◽

10.1071/py12093 ◽

2014 ◽

Vol 20 (1) ◽

pp. 98 ◽

Cited By ~ 4

Author(s):

Smita Shah ◽

Jessica K. Roydhouse ◽

Brett G. Toelle ◽

Craig M. Mellis ◽

Christine R. Jenkins ◽

...

Keyword(s):

Primary Care ◽

General Practitioners ◽

Retention Rate ◽

Controlled Trial ◽

Independent Research ◽

Project Staff ◽

Recruitment Methods ◽

General Practices ◽

Randomised Controlled ◽

First Contact

The need for more evidence-based interventions in primary care is clear. However, it is challenging to recruit general practitioners (GPs) for interventional research. This paper reports on the evaluation of three methods of recruitment that were sequentially used to recruit GPs for a randomised controlled trial of an asthma communication and education intervention in Australia. The recruitment methods (RMs) were: general practices were contacted by project staff from a Department of General Practice, University of Sydney (RM1); general practices were contacted by staff from an independent research organisation (RM2); and general practices were contacted by a medical peer (chief investigator) (RM3). A GP was defined as ‘recruited’ once they consented and were randomised to a group, and ‘retained’ if they provided baseline data and did not notify staff of their intention to withdraw at any time during the 12-month study. RM1 was used for the first 6 months, during which 34 (4%) GPs were recruited and 21 (62%) retained from a total of 953 invitations. RM2 was then used for the next 5 months, during which 32 (6%) GPs were recruited and 26 (81%) were retained. Finally over the next 7 months, RM3 recruited 84 (12%) GPs and retained 75 (89%) GPs. In conclusion, use of a medical peer as the first contact was associated with the highest recruitment and retention rate.

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Irish General Practitioner referrals to psychological therapies

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2015.17 ◽

2015 ◽

Vol 33 (2) ◽

pp. 73-80 ◽

Cited By ~ 2

Author(s):

V. Cullinan ◽

A. Veale ◽

A. Vitale

Keyword(s):

Mental Health ◽

General Practitioners ◽

Mental Health Problems ◽

Response Rate ◽

Evidence Base ◽

Health Problems ◽

Clinical Psychologist ◽

Medical Practitioners ◽

Doctoral Level ◽

Psychological Therapies

ObjectiveGeneral Medical Practitioners play a crucial role in the detection and referral of mental health problems in primary care. This study describes the referral patterns of Irish General Practitioners (GPs) to psychological therapies and profiles the range of psychological therapies available.MethodA 21-item study-specific questionnaire exploring referral processes to psychological therapies was sent to all GPs listed by the Irish College of General Practitioners in one county in Ireland. A 19-item questionnaire exploring details of psychological therapies offered and referral pathways was sent to members of psychological therapy accrediting bodies in the same county.ResultsOf 97 GP respondents (33% response rate), their estimation of the percentage of their patients who have presenting or underlying mental health issues averaged 22%. When asked to indicate which psychological therapies they consider for referrals, psychiatric referrals was the most frequent referral option (94%), followed by Counsellors (69%), Clinical psychologist (60%) and Psychotherapists (30%). GPs indicated they had some or very little knowledge of specific psychological therapies. Of 129 psychological therapists (45% response rate), self-referral and GP referral were their main referral pathways; 80% worked in private practice; highest qualification level was Undergraduate/Higher Diploma (66%), Master Level (39%) and Doctoral Level (5%).ConclusionGPs refer patients presenting with mental health problems to psychiatrists with significantly lower percentages referring to other types of psychological therapists. Findings demonstrate that there is a need for greater education and information-sharing between GPs and providers of accredited psychological therapies to increase knowledge on specific therapies and their evidence base.

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Identifying and de-implementing low-value care in primary care: the GP’s perspective—a cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2020-037019 ◽

2020 ◽

Vol 10 (6) ◽

pp. e037019

Author(s):

Rudolf Bertijn Kool ◽

Eva W Verkerk ◽

Lieke JA Winnemuller ◽

Tjerk Wiersma ◽

Gert P Westert ◽

...

Keyword(s):

Primary Care ◽

General Practitioners ◽

Laboratory Tests ◽

Healthcare Professionals ◽

Lumbosacral Spine ◽

Vitamin B ◽

X Rays ◽

Negative Consequences ◽

Cross Sectional ◽

Care Practices

ObjectiveGeneral practitioners have an important role in reducing low-value care as gatekeepers of the health system. The aim of this study was to assess the experiences of Dutch general practitioners regarding low-value care and to identify their needs to decrease low-value primary care.DesignWe performed a cross-sectional study.ParticipantsWe sent a survey to 500 general practitioners.SettingPrimary care in the Netherlands.Primary and secondary outcomesThe survey contained questions about the provision of low-value care and on clinical cases about lumbosacral spine X-rays in patients with low back pain and vitamin B12 laboratory tests without an evidence-based indication. We also asked general practitioners what they needed to reduce low-value care.ResultsA total of 182 general practitioners (37%) responded. 67% indicated that low-value care practices are regularly provided in general practice. 57% of the general practitioners have seen negative consequences of low-value care, in particular side effects of medication. The most provided low-value care practices are medication prescriptions such as antibiotics and laboratory tests such as vitamin B12 tests. The most reported drivers are patient-related. General practitioners want to maintain a good relationship with their patients by offering their patients an intervention instead of watchful waiting. Lack of time also plays a major role. In order to reduce low-value care, general practitioners suggested that educating patients on the value of tests and treatments might help. Supporting general practitioners and other healthcare professionals with clear guidelines as well as having more time for consultation were also mentioned by general practitioners.ConclusionGeneral practitioners are aware of providing unnecessary care despite their role as gatekeepers and have reasons for this. They need support in order to change their practice. This support might consist of better education of healthcare professionals and providing more time for consultation. Local and national media, such as websites and television, could be used to educate patients while guidelines could support professionals in reducing low-value care.

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Seasonal influenza surveillance and vaccine effectiveness at a time of co-circulating COVID-19: Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) and Public Health England (PHE) protocol for winter 2020/21 (Preprint)

10.2196/preprints.24341 ◽

2020 ◽

Author(s):

Simon de Lusignan ◽

Jamie Jamie Lopez Bernal ◽

Rachel Byford ◽

Gayatri Amirthalingam ◽

Fillipa Ferreira ◽

...

Keyword(s):

Public Health ◽

Primary Care ◽

General Practitioners ◽

Royal College ◽

Distribution System ◽

Winter Season ◽

Vaccine Uptake ◽

Influenza Surveillance ◽

Secure Networks ◽

General Practices

BACKGROUND The Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) and Public Health England (PHE) are commencing their 54th season of collaboration at a time when coronavirus 2019 infections (COVID-19) are likely to be co-circulating with usual winter infections. OBJECTIVE To conduct surveillance of influenza, other monitored respiratory conditions, and report vaccine uptake and effectiveness using nationally representative surveillance data extracted from primary care computerised medical records (CMR) systems. Practices also collect virology and serology specimens and participate in trials and other interventional research. METHODS The RCGP RSC network comprises over 1,700 general practices in England and Wales. We extract pseudonymised data twice weekly and are migrating to daily extracts. 1. We collect pseudonymised routine coded clinical data for the surveillance of monitored as well as unexpected conditions; vaccine exposure and adverse events of interest (AEIs), and approved research study outcomes. 2. We provide dashboards to give practices feedback about levels of care and data quality, compared to other network practices. We focus on collecting data about influenza-like-illness (ILI), upper and lower respiratory infections (URTI and LRTI) and suspected coronavirus 2019 disease (COVID-19). 3. Approximately 300 practices, will participate in the 2020/21 in virology and serology surveillance, this will include responsive surveillance and long term follow up of previous COVID-19 infections. 4. Member practices can recruit volunteer patients to trials, including early interventions to improve COVID-19 outcomes and point of care testing. 5. The legal basis for our surveillance with PHE is Regulation 3 of The Health Service (Control of Patient Information) Regulations 2002; other studies require appropriate ethical approval. RESULTS The RCGP RSC network has tripled in size, there were previously 100 virology and 500 practices overall, we now have 322 and 1,724 respectively. The Oxford RCGP Clinical Informatics Digital Hub (ORCHID) secure networks enable the daily analysis of the extended network, currently 1,076 practices are uploaded. We are implementing a central swab distribution system to patients self-swabbing at home, in addition to in-practice sampling. We have migrated to use the systematised nomenclature of medicine clinical terms (SNOMED CT). Throughout spring and summer the network has continued to collect specimens in preparedness for the winter, or any second wave of COVID-19 cases. We have collected 5,404 swabs and detected 623 cases of COVID-19 through extended virological sampling and 19,341 samples collected for serology. This shows our preparedness for the winter season. CONCLUSIONS The COVID-19 has been associated with a groundswell of general practices joining our network. It has also created a permissive environment in which we have developed the capacity and capability of the national primary care surveillance systems and our unique public health institute, Royal College and University collaboration.

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How many medications do doctors in primary care use? An observational study of the DU90% indicator in primary care in England.

10.1101/2020.06.16.20132654 ◽

2020 ◽

Author(s):

Chiamaka Chiedozie ◽

Mark Murphy ◽

Tom Fahey ◽

Frank Moriarty

Keyword(s):

Primary Care ◽

Time Trends ◽

Level Variation ◽

Practice Level ◽

Practice Characteristics ◽

Characteristics Method ◽

Prescribing Quality ◽

Observational Cohort ◽

General Practices ◽

The Mean

Aim: To apply the DU90% indicator (the number of unique drugs which make up 90% of a doctor's prescribing) to GP practices prescribing in England to examine time trends, practice-level variation, and relationships with practice characteristics Method: This is an observational cohort study of all general practices in England. It utilises publicly available prescribing data from the National Health Service (NHS) Digital platform for 2013-2017. The DU90% was calculated on an annual basis for each practice based on medication BNF codes. Descriptive statistics were generated per year on time trends and practice-level variation in the DU90%. Multi-level linear regression was used to examine the practice characteristics (relating to staff, patients, and deprivation of the practice area). Results: A total of 7,623 GP practices were included. The mean DU90% ranged from 130.1 to 133.4 across study years, and variation between practices was low (with a 1.4 fold difference between the lowest and highest 5% of practices). A range of medications were included in the DU90% of virtually all practices, including atorvastatin, levothyroxine, omeprazole, ramipril, amlodipine, simvastatin and aspirin. A higher volume of prescribing was associated with a lower DU90%, while having more patients, higher proportions of patients who are female or aged 65+, higher number of GPs working in the practice, and being in a more deprived area were associated with a higher DU90%. Conclusion: GP practices typically use 130 different medications in the bulk of their prescribing. Increasing use of personal formularies may enhance prescribing quality and reduce costs.

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Knowledge and attitudes in dementia held by general practitioners in the primary care setting of Botucatu, São Paulo, Brazil

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x-anp-2020-0051 ◽

2021 ◽

Vol 79 (2) ◽

pp. 107-113

Author(s):

Vânia Ferreira de Sá Mayoral ◽

Paulo José Fortes Villas Boas ◽

Alessandro Ferrari Jacinto

Keyword(s):

Primary Care ◽

General Practitioners ◽

Sao Paulo ◽

São Paulo ◽

Dementia Prevalence ◽

Study Results ◽

Significant Difference ◽

Before And After ◽

The Mean ◽

Randomized Intervention Study

ABSTRACT Background: Alzheimer's disease (AD) is the leading cause of dementia worldwide. Despite alarming evidence on dementia prevalence, the condition is still underdiagnosed by general practitioners (GPs) in primary care. Early detection of the disease is beneficial for patients and relatives, who should be provided comprehensive guidance on dealing with dementia complications, covering medical, family and social aspects, thereby providing an opportunity to plan for the future. Objective: The objective of this study was to assess the knowledge of and attitudes toward dementia held by GPs from a city in the interior of São Paulo State, Brazil. Methods: A non-randomized intervention study was conducted involving six lectures about dementia. Before and after the intervention, the participating physicians completed two quizzes about knowledge of and attitudes towards dementia. The study was carried out in the primary care services of the town and a total of 34 GPs participated in the study. Results: The mean age of the sample was 33.9 (±10.2) years and the majority (76.5%) of the sample had not undertaken medical residency training. The mean number of correct answers on the Knowledge Quiz about dementia before and after the training intervention was 59.6 and 71.2% (p<0.001), respectively. The comparison of the mean responses on the Attitude Quiz revealed no statistically significant difference between the two applications of the instrument, before and after intervention (p=0.059). Conclusions: More training for GPs on dementia should be provided.

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