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
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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
