PRIMARY HEALTHCARE MEDICAL DEVICES

CHAPTER 6 | PRIMARY HEALTHCARE MEDICAL DEVICES ... clinics with laboratory equipments such as bilirubinometer and full blood count analysers were espe...

0 downloads 244 Views 148KB Size
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012

CHAPTER 6

PRIMARY CARE

| PRIMARY HEALTHCARE MEDICAL DEVICES

Medical devices reported in this chapter are those commonly available in primary care setting and part of the integral component in the process of care. Overall the results (Figure 6.1 and 6.2) show that clinics from the public sector recorded higher percentages in the availability of the surveyed medical devices as compared to the private.Amongst all equipments in the public clinics, defibrillators were the least available. The proportion of public clinics with defibrillators was 51.5%. Looking into the private sector, clinics with laboratory equipments such as bilirubinometer and full blood count analysers were especially low in numbers (5.8% and 8.3% respectively). Devices like peak flow meters were found in only 45.0% of the private clinics in a paper by Khoo and Tan in 19981 whereas in this survey, it was slightly higher at 65.0%. Figure 6.1 Percent of Public Clinics with Functioning Medical Devices in 2012

Figure 6.2 Percent of Private Clinics with Functioning Medical Devices in 2012

Breaking down further by states/regions and sector, the number of medical devices per clinic as well as the proportion of functioning devices are as reported in Table 6.1. 31

NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012

PRIMARY CARE

The peak flow meter and nebuliser are indispensable devices in a primary care setting given that asthma has been reported as one of the top 10 diseases seen in both public and private clinics.2 The administration of short acting bronchodilators by means of a nebuliser or metered-dose inhaler and monitoring of peak expiratory flow using peak flow meter is the mainstay of management in acute asthma.3 For every state/region sampled, all respective public clinics had a median of four or more functioning peak flow meters per clinic (Table 6.1). By comparison, the private sector had only a median of one functioning peak flow meter per clinic. As for nebulisers, all clinics in both sectors except public clinics in Kuching recorded a proportion of more than 80.0% of functioning nebulisers. Prevalence of cardiovascular diseases is on the rise in Malaysia and hence, cardiovascular diagnostic and monitoring equipments are essential items in the primary care setting.4 Almost all the electrocardiograms (ECG) in both sectors were reported to be functioning with a median of 1.0 functioning ECG per clinic except for public clinics in Kuching region [median 2.0(IQR 1.5)]. Resuscitation trolley and defibrillators are deemed necessities in all clinics. Our survey has recorded 71 out of 73 resuscitation trolleys to be functioning in the public clinics. All clinics had at least one resuscitation trolley per clinic. Similar observation was observed in the private clinics except for Kelantan which fell short with only a median of 0.6(IQR 1.0) resuscitation trolley per private clinic.As for defibrillators, none of the public clinics in Kota Kinabalu had a functioning defibrillator in their premises. On the other hand, there were only 5 defibrillators reported available in all 120 private clinics of which only 3 were functioning. Glucometers are widely used in the primary care setting to obtain quick results for screening and monitoring of blood sugar.5 While this device is available in almost all of the public clinics, about 5.0% of the glucometers reported in these clinics were non-functioning. The private clinics meanwhile, had a median of 1.0(IQR 1.0) glucometer per clinic. The use of ultrasound machine for diagnostic purposes is on the rise at present in many countries.6 Public clinics in Selangor and WP Putrajaya recorded 92.9% of functioning ultrasound machines whereas clinics in Kelantan had a slightly lower percentage (87.5%). Ultrasound machines in the rest of the states/regions sampled were all operating well. Looking at the private sector however, clinics in Kuching region reported only 66.7% of functioning ultrasound machines while the rest of the states/regions had more than 90.0% functioning ultrasound machines. Similar to the usage of ultrasound machines, X-ray machines are introduced to quicken the process of diagnosis. Table 6.1 shows that all public clinics except two located in Selangor/WP Putrajaya and Kuching had functioning X-ray machines. None of the private clinics in Kuching and Kota Kinabalu regions reported the availability of this machine in their premises. The availability of these devices fastens diagnostic process and hence increases productivity.7 Besides ensuring that the primary care clinics have these devices, it is also important for the healthcare personnel to make sure that the devices are in a good condition and functions well. Table 6.1. Distribution of Functioning Medical Devices per Clinic by State/ Region and Sector in 2012 Peak flow meter No. of functioning Percent (%) devices 161 99.4

Nebuliser

State/Region

Sector

Selangor & WP Putrajaya

Public

162

Private

38

34

89.5

WP Kuala Lumpur

Public

36

35

97.2

Private

25

25

100.0

1.0 (0.0)

Public

79

74

93.7

4.0 (4.0)

Private

13

13

100.0

1.0 (1.0)

Public

16

16

100.0

Private

11

11

Public

23

Private

4

Kelantan Kota Kinabalu Kuching

No. of devices

No. of functioning Percent (%) devices

Median* (IQR)

No. of devices

4.0 (5.0)

78

64

82.1

2.0 (1.0)

1.0 (1.0)

70

68

97.1

1.0 (1.0)

4.0 (1.0)

26

23

88.5

2.0 (2.3)

32

32

100.0

1.0 (0.0)

30

29

96.7

2.0 (1.0)

32

29

90.6

1.0 (0.0)

4.5 (4.0)

11

11

100.0

3.0 (0.8)

100.0

1.0 (0.5)

14

13

92.9

1.0 (1.0)

23

100.0

5.0 (5.8)

19

15

78.9

4.0 (2.3)

4

100.0

1.0 (0.0)

7

7

100.0

1.0 (2.3)

*Median functioning devices per clinic.

32

Median* (IQR)

NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012

PRIMARY CARE

Table 6.1. (continued) Distribution of Functioning Medical Devices by State/ Region and Sector in 2012 Resuscitation trolley

Defibrillator

No. of functioning Percent (%) devices 35 94.6

No. of functioning Percent (%) devices 21 84.0

State/Region

Sector

Selangor & WP Putrajaya

Public

37

Private

36

36

9

Private

Median* (IQR)

No. of devices

1.0 (0.0)

25

100.0

1.0 (1.0)

3

2

66.7

0.0 (0.0)

9

100.0

1.0 (0.0)

7

7

100.0

1.0 (0.8)

23

23

100.0

1.0 (0.0)

2

1

50.0

0.0 (0.0)

Public

19

19

100.0

1.0 (0.0)

7

7

100.0

0.0 (1.0)

Private

15

15

100.0

0.6 (1.0)

0

0

0.00

0.0 (0.0)

Public

4

4

100.0

1.0 (0.0)

2

0

0.0

0.0 (0.0)

Private

6

6

100.0

1.0 (1.0)

0

0

0.0

0.0 (0.0)

Public

4

4

100.0

1.0 (0.0)

4

4

100.0

1.0 (0.0)

Private

3

3

100.0

1.0 (0.8)

0

0

0.0

0.0 (0.0)

WP Kuala Lumpur Public

Kelantan

Kota Kinabalu

Kuching

No. of devices

Median* (IQR) 1.0 (1.0)

*Median functioning devices per clinic.

Table 6.1. (continued) Distribution of Functioning Medical Devices by State/ Region and Sector in 2012 Electrocardiogram

Glucometer

No. of functioning Percent (%) devices

No. of functioning Percent (%) devices

State/Region

Sector

No. of devices

Selangor & WP Putrajaya

Public

46

Private

52

50

96.2

1.0 (0.0)

80

78

97.5

1.0 (1.0)

WP Kuala Lumpur

Public

13

10

76.9

1.0 (0.0)

34

34

100.0

4.0 (2.5)

Private

29

28

96.6

1.0 (0.0)

33

32

97.0

1.0 (0.0)

Public

22

21

95.5

1.0 (0.0)

56

55

98.2

2.5 (3.0)

Private

20

19

95.0

1.0 (0.5)

44

44

100.0

2.0 (1.0)

Public

4

4

100.0

1.0 (0.0)

11

9

81.8

2.0 (0.8)

Private

11

9

81.8

1.0 (0.8)

18

18

100.0

2.0 (1.0)

Public

10

8

80.0

2.0 (1.5)

64

54

84.4

13.0 (10.0)

Private

4

3

75.0

1.0 (0.8)

7

7

100.0

1.0 (2.3)

Kelantan Kota Kinabalu Kuching

38

82.6

Median* (IQR)

No. of devices

1.0 (0.0)

132

130

98.5

Median* (IQR) 3.5 (2.3 )

*Median functioning devices per clinic.

Table 6.1. (continued) Distribution of Functioning Medical Devices by State/Region and Sector in 2012 Ultrasound machine State/Region

Sector

Selangor & WP Putrajaya

Public

42

WP Kuala Lumpur Kelantan Kota Kinabalu Kuching

No. of devices

No. of functioning Percent (%) devices 39 92.9

General radiology unit (X-ray machine) Median* (IQR)

No. of devices

1.0 (0.0)

13

No. of functioning Percent (%) devices 11 84.6

Median* (IQR) 0.0 (1.0)

Private

33

31

93.9

1.0 (1.0)

13

12

92.3

0.0 (0.0)

Public

5

5

100.0

0.5 (1.0)

3

3

100.0

0.0 (1.0)

Private

11

10

90.9

0.0 (1.0)

7

6

85.7

0.0 (0.0)

Public

24

21

87.5

1.0 (1.0)

4

4

100.0

0.0 (0.0)

Private

20

20

100.0

1.0 (0.5)

2

2

100.0

0.0 (0.0)

Public

4

4

100.0

1.0 (0.0)

1

1

100.0

0.0 (0.8)

Private

10

10

100.0

1.0 (0.0)

0

0

0.0

0.0 (0.0)

Public

4

4

100.0

1.0 (0.0)

4

3

75.0

1.0 (0.8)

Private

3

2

66.7

0.5 (1.0)

0

0

0.0

0.0 (0.0)

*Median functioning devices per clinic.

33

NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012

PRIMARY CARE

Table 6.1. (continued) Distribution of Functioning Medical Devices by State/Region and Sector in 2012 Bilirubinometer

Full blood count machine

No. of devices

No. of functioning devices

Percent (%)

Median* (IQR)

No. of devices

No. of functioning devices

Percent (%)

Median* (IQR)

State/Region

Sector

Selangor & WP Putrajaya

Public

33

31

93.9

1.0 (0.0)

45

43

95.6

1.0 (1.0)

Private

2

0

0.0

0.0 (0.0)

8

5

62.5

0.0 (0.0)

WP Kuala Lumpur

Public

4

4

100.0

0.5 (1.0)

7

7

100.0

1.0 (1.8)

Private

4

3

75.0

0.0 (0.0)

3

2

66.7

0.0 (0.0)

Kelantan

Public

19

16

84.2

1.0 (0.0)

18

18

100.0

1.0 (0.0)

Private

2

2

100.0

0.0 (0.0)

2

2

100.0

0.0 (0.0)

Public

5

4

80.0

1.0 (0.0)

5

4

80.0

1.0 (1.5)

Private

2

2

100.0

0.0 (0.5)

1

1

100.0

0.0 (0.0)

Public

6

5

83.3

1.0 (0.8)

6

5

83.3

1.0 (0.8)

Private

0

0

0.0

0.0 (0.0)

0

0

0.0

0.0 (0.0)

Kota Kinabalu Kuching

*Median functioning devices per clinic.

Table 6.1. (continued) Distribution of Functioning Medical Devices by State/ Region and Sector in 2012 Doppler foetal monitor No. of functioning Percent (%) devices

Median* (IQR)

No. of devices

No. of functioning devices

Percent (%)

Median* (IQR)

73.9

2.0 (2.3)

126

113

89.7

3.0 (2.3)

8

88.9

0.0 (0.0)

60

57

95.0

1.0 (0.0)

13

92.9

0.0 (3.5)

34

33

97.1

2.5 (4.8)

State/Region

Sector

Selangor & WP Putrajaya

Public

115

85

Private

9

WP Kuala Lumpur

Public

14

Kelantan Kota Kinabalu Kuching

No. of devices

Wheelchair

Private

6

5

83.3

0.0 (0.0)

28

28

100.0

1.0 (0.0)

Public

36

32

88.9

2.0 (1.0)

47

44

93.6

2.0 (1.0)

Private

4

3

75.0

0.0 (0.0)

27

27

100.0

1.0 (0.0)

Public

2

1

50.0

0.0 (0.8)

14

12

85.7

2.5 (4.0)

Private

1

1

100.0

0.0 (0.0)

7

7

100.0

1.0 (0.5)

Public

12

10

83.3

2.0 (5.0)

19

16

84.2

3.0 (8.0)

Private

2

2

100.0

0.5 (1.0)

5

5

100.0

1.0 (0.8)

*Median functioning devices per clinic.

References 1.

Khoo EM, Tan PL. Profile of general practices in Malaysia. Asia Pac J Public Health. 1998;10(2): 81-87

2.

Mimi O, Tong SF, Nordin S, Teng CL, Khoo EM, Abdul-Rahman A, Zailinawati AH, Chen WS, Shihabudin WM, Noridah MS, Fauziah ZE. A comparison of morbidity patterns in public and private primary care clinics in Malaysia. Malaysian Family Physician. 2011; 6(1):19-25

3.

Guidelines on Management of Adult Asthma – A Consensus Statement of the Malaysian Thoraci Society. Malaysian Thoracic Society, 1996. [viewed 23rd September 2013] Available from: http://www.mts.org.my/Guidelines_BronchialAsthma.html.

4.

Institute of Public Health (IPH) 2011. National Health and Morbidity Survey 2011 (NHMS 2011).Vol. II: Non-Communicable Diseases;2011: 188 pages.

5.

Ministry of Health Malaysia, Malaysian Diabetes Association, Academy of Medicine of Malaysia, Malaysian Endocrine and Metabolic Society. Clinical Practice Guidelines on Management of Type 2 Diabetes Mellitus 4th Edition. Ministry of Health Malaysia, May 2009.

6.

Khoo EM. A comparative study on the service profiles and practice facilities among urban general practices in East and West Malaysia. Med J Malaysia. Sept 2000;55(3).

7.

Canadian Labour and Business Centre for Task Force Two: A Physician Human Resource Strategy for Canada. Physician workforce in Canada: Literature Review and Gap Analysis. Ottawa, Canada: January 2003. [viewed 18th September 2013] Available from: http://www.effectifsmedicaux.ca/reports/ literatureReviewGapAnalysis-e.pdf

34

NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012

PRIMARY CARE

Table for Figures Table 6.2. Percent of Clinics with Functioning Medical Devices by Sector in 2012 Public Medical Devices

Private

No. of clinics with functioning devices

Percent (%)

No. of clinics with functioning devices

Percent (%)

 

 

n=(68)

 

n=(120)

Peak flow meter

66

97.1

78

65.0

Nebuliser

67

98.5

119

99.2

Glucometer

66

97.1

117

97.5

Electrocardiogram (ECG)

66

97.1

107

89.2

Resuscitation trolley

65

95.6

83

69.2

Defibrillator

35

51.5

3

2.5

Doppler Fetal Monitor/Daptone

52

76.5

19

15.8

Wheel chair

64

94.1

108

90.0

Full blood count machine

63

92.6

10

8.3

Bilirubinometer

58

85.3

7

5.8

Ultrasound machine

61

89.7

69

57.5

General radiology unit

22

32.4

20

16.7

35