Patients’ preferences for primary care clinic and provider characteristics and services during the COVID-19 pandemic: A cross-sectional study

Introduction@#The Universal Health Care Law in the Philippines brought cost and quality at the forefront of the healthcare industry, ensuring all Filipinos have the right to health. With family medicine physicians as implementers, it is important to know what the patients/ consumer wants for their clinic. But during the pandemic, challenges were laid bare, highlighting how the health care sector should respond to the country’s health care needs.@*Objectives@#The study aimed to determine patient preferences for primary care clinics and provider characteristics among patients and caregivers from a community-based clinic chain in Cavite and Taguig City@*Methods@#A descriptive, cross-sectional study was conducted among 168 patients who consulted two private primary clinics in Cavite and Taguig in December 2021. After a comprehensive literature review and pilot study, a self-administered survey questionnaire was utilized. Data as frequencies and percentages were analyzed@*Results@#Preferences for primary care clinics were well-equipped clinic, safety protocols, PPE for the healthcare team, pleasing/ accommodating receptionist, separate area for patients with covid like symptoms, located within their community (< 1km away), 15-30 mins waiting time, and morning visit. Top preferences for provider characteristics were physicians who do careful examination and history, spoke in layman’s terms, rational prescription of drugs/tests, trustworthy, with <5 years of experience, 4- 8 clinic hours and to be seen by only one doctor. A pharmacy and x-ray/ultrasound, face to face consultation, affordable services, and consultation fees less than PhP500 (10 USD) were also preferred.@*Conclusion@#This study revealed that the patients’ preference was affected by the pandemic. Results showed that even as there are existing studies, it can change depending on the circumstances, and must change with the times in order to move forward. Taking into consideration these preferences is vital for the survival of the primary care clinic.

Impact of Healthy Lifestyle Education among Patients with Diabetes Mellitus in a Primary Care Clinic

@#Introduction: Four out of five diabetic Malaysians were unable to achieve good glycaemic targets. Insufficient health literacy among patients with diabetes is associated with worse glycaemic control. Thus this research is aimed to determine the impact of the Healthy Lifestyle Education (HLE) course to the diabetic control. Methods: This is a comparative cross-sectional study. Medical records of patients with diabetes who either attended or not attended HLE course at Simpang Health Clinic from April 2018 to September 2018 were reviewed and study data extracted. Wilcoxon signed-ranks test, Pearson chi-square test, Fisher’s exact test and Binary logistic regression were employed. Results: A total of 220 medical records including 106 HLE attendees and 114 non-attendees were recruited. Mean ages of attendees and non-attendees were 57.5±11.9 years and 60.8±9.9 years respectively. The attendees achieved reduction in glycosylated haemoglobin (HbA1c), fasting blood sugar (FBS) and total cholesterol after HLE course (p<0.05). Those non-attendees had significant weight lost but increment in systolic blood pressure, HbA1c, LDL and insulin’s total daily dose (p<0.05). Reduction in Fasting Blood Sugar (FBS) among the HLE Attendees was independently associated with HbA1c reduction [p=0.015, odds ratio (95% CI) = 3.83 (1.30-11.27)]. Conclusion: Our work suggests that HLE has improved glycaemic and lipid control among patients with diabetes. Hence it should be executed at the primary care settings.

Prevalence of musculoskeletal pain in two primary care clinics in a mid-sized town’s urban population in Malaysia

@#Objective: This study assesses the prevalence of musculoskeletal (MSK) pain in patients attending primary care clinics in a medium-sized town in Malaysia and examines the interventions given for the symptoms and the level of the associated disabilities. Method: This investigation comprises a cross-sectional descriptive study of all patients visiting two primary care clinics aged 18 years and above. Patients presenting with joint pain answered a questionnaire assessing demographic data, disabilities (measured by the Stanford HAQ-DI), and treatment options. Results: Of 1,074 patients surveyed, 202 (18.8%) had MSK complaints. The mean age of those with MSK pain was 56.1 years. Incidence increased with age, reaching 78.8% of those over 48 years of age. The knee was the most common site of MSK pain (52.2%), with 20.3% requiring referral for specialist assessment. The median HAQ score was 0.375 and 89.6% of those surveyed had mild disability. Conclusion: MSK pain is a common problem among patients visiting primary care clinics. The most common site of MSK pain was the knee. On formal assessment, the majority of these patients exhibited mild disability. A significant proportion of patients still required specialist referral. This finding would suggest a need for further training on the management of MSK disease at the primary care level to avoid over-burdening the secondary care services.

Potential drug-drug interactions among medications prescribed to adult Filipinos at a primary care clinic in a government teaching hospital

Background@#A drug-drug interaction (DDI) is a pharmacologic or clinical response to the administration of a drug that can result in adverse outcomes. DDIs are considered preventable adverse drug reactions because these interactions can be learned, predicted and recognized. @*Objective@#To determine potential drug-drug interactions (pDDI) among medications prescribed to adult patients consulting at a primary care clinic in a government teaching hospital. @*Methods@#This was a 6-month retrospective cross-sectional study of drug prescriptions based on medical records of adult Filipinos who were seen and managed at a primary care clinic in a government teaching hospital. Medical charts were systematically selected based on a sampling frame with inclusion and exclusion criteria.@*Results@#A total of 1,490 medical records of adult Filipino patients were included in the study. There were a total of 261 unique prescriptions based on generic formulations and an overall total of 5,978 drugs for a 6-month period of clinic consultations. An average of 4 medications (SD±1.63) were prescribed for every consultation recorded in the medical chart. From the charts that were reviewed, 23% of all adults were given a prescription of 4 drugs (N=348/1490), 26% had 3 drug prescriptions (N=386/1490) and 18% had two drugs, respectively, per clinic visit. Overall, 714/9054 (7.88%) medication pairs were seen to have potential drug interactions. The top three most common drug pairs with pDDI were amlodipine-simvastatin, losartan/hydrochlorothiazide-metformin and aspirin-furosemide. Five hundred twenty-five drug pairs had pharmacodynamic interactions (525/714) while 94 drug pairs (15%) had pharmacokinetic interactions. @*Conclusion@#Potential drug-drug interactions were observed in 8% of medications prescribed to adult Filipinos seen at Family Medicine Clinic in a government hospital. Seventy-four percent (74%) of the drug pairs with pDDIs were pharmacodynamic and 15% were pharmacokinetic interactions.

Physical Health Status among Older Adults Attending Primary Care Clinic at Cheras, Malaysia / Jurnal Sains Kesihatan Malaysia

@#Optimum physical health is important in maintaining independence among older adults. There is limited information regarding physical health status among older adults attending primary care clinics in the local population. The aim of this study was to examine physical health among older adults attending Primary Care Clinic at Cheras, Malaysia. A cross-sectional study was conducted at Primary Care Clinic at Cheras, Malaysia with a total 106 participants (mean age of 68 ± 6.3 years). Participants performed a battery of physical function tests. The results showed that the percentages of participants who performed below recommended norms for the 30secs Chair Stand Test (lower limb strength), Chair Sit and Reach Test (lower limb flexibility), Back Scratch Test (upper limb flexibility), Timed Up and Go (TUG) (functional mobility), Single Leg Stance Test (balance) and 2 mins Walk Test (2MWT) (aerobic endurance) were 32%, 18%, 21%, 29%, 22% and 78% respectively. The results suggest that the majority of older adults visiting primary health care clinics had inadequate physical function in relation to aerobic endurance. Older adults attending primary health care clinics should be encouraged to improve their physical health status, especially aerobic endurance, to optimise their physical independence.

Prevalence of Hypertension and Glycaemic Control in Adult Type-2 Diabetes Patients: A Preliminary Retrospective Cohort Study in Kuantan, Pahang, Malaysia

Introduction: Hypertension (HPT) is the most common co-morbidity among type-2 diabetes mellitus (T2DM) patients which ominously increased their morbidity and mortality from cardiovascular diseases (CVD). We aimed to determine the prevalence and control status of HPT, and also the glycemic control among T2DM patients in a primary care clinic in Kuantan, Pahang. Methods: It was a retrospective study of 154 T2DM patients’ records, aged ≥18 years selected by random sampling. The statistical analysis is done by using Chisquare test, paired sample “t” test and ANOVA “F” test. Results: Among T2DM patients; 47% were Malay, 45% Chinese and 9% Indian. The prevalence of HPT was 72.1% and majority of T2DM patients were women (60%). Out of 82 T2DM aged >60 years, 80.5% were hypertensive. 67.2% of T2DM patients between the age of 40-60 years and 25% age 60 years showed increments in systolic HPT and diastolic HPT which were significant (p<0.0001). Regarding glycemic parameters, 71.4% T2DM patients had poor controlled level of Hb1Ac (≥6.5) and only 20.1% remained controlled after one year (p<0.0001). Conclusions: This pilot study found high prevalence of HPT, increasing prevalence of systolic HPT and diastolic HPT in older age group as well as poor glycemic control among T2DM patients.

The importance of cancer registry from the primary care clinics in the national cancer registry : case series study / 日本プライマリ・ケア連合学会誌

<b>Purpose</b> : The purpose of this study was to determine how frequently cancer patients would be missed if primary care clinics do not participate in the Japanese National Cancer Survey, and to describe the characteristics of those cancer patients who would be missed.<br><b>Methods</b> : This research is a case series study. We collected cancer patients who were identified in Ryuocho-Kokuminkenkouhoken Clinic and Yuge medical clinic for 26 years and were registered in the Shiga Cancer survey. We then extracted the records of those cancer patients who would be potentially missed from the national cancer registry and investigated the background.<br><b>Results</b> : The total number of cancer patients registered was 441. Of these, 28 (6.3%) patients who did not admit to the hospitals may be missed from the national cancer registry ; ten patients had their cancer diagnosed at an advanced stage and died at home without hospital admission. Two further cases had treatment for cancer (endoscopic resection) completed in the primary care clinic without hospital admission. Twelve patients only attend the hospital outpatient clinic for investigation and died at home without admission. And four patients received only CT scan examination and didn't attend the hospital outpatient clinic and died at home without admission.<br><b>Conclusion</b> : Primary care clinics that deal with the cancer patients treated completely in the clinics or home terminal care should participate in the Japanese National Cancer survey.

Association of Diet Practice and Glycaemic Control among Type 2 Diabetes Mellitus Patients Attending Primary Care Clinic in Kuala Lumpur

Healthy dietary practice is important in preventing diabetes, managing existing diabetes, and preventing, or at least slowing the rate of diabetes complication development. It is, therefore, important at all levels of diabetes prevention. The objective of this study was to determine the association of dietary practice with glycaemic control among Type 2 diabetes mellitus (T2DM) patients, who received treatment from an urban Health Clinic in Kuala Lumpur. A total of 307 patients with T2DM aged 18 years and above participated in this study. A pre-tested structured questionnaire with guided interview was used to collect information on socio-demographic, clinical and dietary practice. Anthropometric and biological measurements were also taken. Descriptive statistics and Chi-square were used in the data analysis. Good glycaemic control was defined as HbA1c level less than 6.5%. The prevalence of good glycaemic control was only 27% (n=83). The highest percentage of good glycaemic control were among male patients (29.1%), aged 60 and above (33.3%), educational level of primary school (35.4%) and those with monthly income group between RM1001 to RM1500 (32.0%). About three quarter of T2DM patient (n=224) had poor control of HbA1c (≥6.5%). Age (p=0.045) and working status (p=0.039) had significant relationship with the level of HbA1c. Dietary practice showed no significant relationship with the HbA1c level. Effective interventional health education strategies are needed, focussing on modification of dietary behaviour in order to achieve glycaemic control among diabetic patients.​

Metabolic Control and Cardiovascular Risk Factors among Type 2 Diabetes in a Primary Care Clinic

Background: Prevalence of diabetes is escalating both globally as well as in Malaysia. With the epidemic of diabetes and its related morbidities and mortalities, health care professionals are facing an unprecedented challenges in controlling the disease. Objective: To determine the metabolic control and the cardiovascular risk factors among type 2 diabetic patients in a primary care setting. Method: This was a cross sectional study conducted in a primary care clinic in Selangor, Malaysia. Inclusion criteria were all type 2 diabetic patients aged 18 and above and were being followed-up for more than six months prior to the recruiting period in May 2009. The demographic data were obtained through faceto- face interview. Height, weight and blood pressure of the patients were taken during the day of data collection. The co-morbidities and laboratory results were obtained from the medical records. Results: Two-hundred patients were recruited. The mean age was 58.6 (SD=10.5) with 79.0% of the patients aged more than 50 years old. The majority of the patients were female (62.5%). One-tenth (11.5%) were smokers. More than half of the patients (64.0%) had co-morbid of hypertension and half of them (50.5%) had dyslipidaemia. A total of 72.5% of the patients had 3 or more cardiovascular risk factors. Less than one fifth of the patients had achieved the target of control for glycaemia, blood pressure, LDL and BMI. Those age 60 and above had significantly higher proportion of patients achieving fasting blood glucose control (p=0.033). Conclusion: The majority of type 2 diabetic patients had multiple cardiovascular risk factors (3 or more risk factors) and had not achieved the recommended goals in metabolic control.

Characteristics of the Patients with Headache at a Primary Care Neurology Clinic

BACKGROUND: We investigated the demographic features and characteristics of headache (HA) in patients visiting a primary care clinic (PCC). METHODS: We prospectively collected the demographic and clinical data of 261 consecutive HA patients in a PCC located in Taejon from Oct. 1996 to Jul. 1998. All patients were interviewed and examined by a single neurologist. The types of HA were classified as migraine, tension-type, mixed, and others. RESULTS: The mean age at the initial visit was 37.2 +/-13.4 years. Women were 3 times more common than men (193 patients vs. 68 patients). More than half of the female patients were housewives (47.5%). Migraine was the most common type of headache (114 patients, 43.7%), followed by mixed type (72 patients, 27.6%) and tension-type headaches (57 patients, 21.8%). 85.7% of patients with HA for more than 1 month had taken medication before their initial visit. Among the 168 patients who reported their attitude toward HA, 55 patients continuously worried about their HA even in the HA-free period. CONCLUSIONS: In a PCC, migraine was the prevailing type of HA. The majority of HA sufferers were housewives.