Sains Malaysiana 44(5)(2015): 741–746

The Changing Face of Primary Care: A Cross Sectional Study in Malaysia

(Perubahan Corak Penjagaan Kesihatan Primer: Suatu Kajian Keratan Rentas di Malaysia)

EE MING KHOO¹*, AI THENG CHEONG², SU MAY LIEW¹, WAI KHEW LEE³, AZAH ABDUL SAMAD⁴, AINUL NADZIHA MOHD HANAFIAH⁵ & SONDI SARARAKS⁵

¹Department of Primary Care Medicine, University of Malaya Primary Care Research Group

Faculty of Medicine, University of Malaya, Jalan Lembah Pantai, 50603 Kuala Lumpur

Malaysia

²Department of Family Medicine, Faculty of Medicine and Health Sciences

Universiti Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia

³Luyang Health Clinic, Off Jalan Lintas, 88300 Kota Kinabalu, Sabah, Malaysia

⁴Pantai Health Clinic, Tingkat 15, Wisma Goshen, Plaza Pantai, Off Jalan Pantai Baru,

59200 Kuala Lumpur, Malaysia

⁵Institute for Health Systems Research, Setia Avenue, Setia Alam, 40710 Shah Alam,

Selangor Darul Ehsan, Malaysia

Diserahkan 5 Februari 2014/Diterima: 22 Januari 2015

ABSTRACT

There has been an epidemiological transition in morbidity and mortality patterns in developing countries. This study aimed to determine whether there was an accompanying change in disease presentation in primary care. This was a cross-sectional study conducted at 12 public primary care clinics in Malaysia. Outpatient medical records were randomly selected and reviewed to identify patients’ reasons for encounter. The overall retrieval of records was 99.1% (n=1,753; range 95.7-100.0%). The mean age was 33.1 (SD 22.2) years. For all ages, the most common reasons for patient encounter (RFE) were cough (21.1%; 95% CI 16.5, 25.8), follow-up care for chronic diseases (19.6%; 95% CI 12.7, 26.6) and fever (18.4%; 95% CI 14.2, 22.5). The top RFE in West Malaysia was follow-up care for chronic diseases while in East Malaysia, the most common RFE was cough (25.2%; 95% CI 16.8, 33.6) and fever (21.7%; 95% CI 14.3, 29.0). In conclusion, there is a change in the presentation of diseases, with chronic disease emerging as one of the top RFE in primary care. In adults, for all age groups over 40 years old, care for chronic diseases has overtaken acute disease care. However, acute respiratory problems remain the overall top RFE at public primary care clinics in Malaysia. There are major differences in morbidity patterns and reasons for encounter for different age groups and geographical areas and this could be utilized for better health care planning.

Keywords: Acute disease; chronic disease; primary health care; reasons for encounter

ABSTRAK

Di negara-negara membangun, kini terdapat peralihan epidemiologi dalam corak morbiditi dan kematian. Kajian ini bertujuan untuk menentukan sama ada di peringkat kesihatan primer adakah terdapatnya perubahan corak presentasi penyakit yang seiring dengan peralihan epidemiologi tersebut. Penyelidikan ini adalah kajian keratan rentas yang telah dijalankan di 12 buah klinik kesihatan awam di Malaysia. Rekod perubatan dari jabatan pesakit luar disampel secara rawak dan sebab-sebab kedatangan pesakit-pesakit dinilai. Pada keseluruhannya, pengesanan rekod adalah 99.1% (n=1,753; lingkungan 95.7-100.0%). Purata umur pesakit adalah 33.1 (SD 22.2) tahun. Untuk semua kumpulan umur, sebab kedatangan pesakit yang paling biasa ialah batuk (21.1%; 95% CI 16.5, 25.8), rawatan susulan untuk penyakit kronik (19.6%; 95% CI 12.7, 26.6) dan demam (18.4%; 95% CI 14.2, 22.5). Sebab kedatangan pesakit yang paling utama di Malaysia Barat ialah rawatan susulan untuk penyakit kronik manakala di Malaysia Timur, sebab paling utama ialah batuk (25.2%; 95% CI 16.8, 33.6) dan demam (21.7%; 95% CI 14.3, 29.0). Secara kesimpulannya, terdapat perubahan corak presentasi penyakit di peringkat primer dengan penyakit kronik telah muncul sebagai salah satu sebab utama kedatangan pesakit. Untuk golongan orang dewasa berusia lebih daripada 40 tahun, rawatan untuk penyakit-penyakit kronik telah melebihi penjagaan penyakit akut. Walau bagaimanapun, secara keseluruhannya, masalah pernafasan akut kekal menjadi sebab paling utama untuk kedatangan pesakit di klinik kesihatan awam di Malaysia. Untuk golongan umur dan kawasan geografi yang berbeza, corak morbiditi dan sebab kedatangan pesakit adalah sangat berbeza. Penemuan ini dapat digunakan untuk perancangan penjagaan kesihatan yang lebih baik.

Kata kunci: Penjagaan kesihatan primer; penyakit akut; penyakit kronik; sebab kedatangan pesakit

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*Pengarang untuk surat-menyurat; email: khooem@um.edu.my