Asia Pacific Family Medicine - Latest Articles

The usefulness of a clinical 'scorecard' in managing patients with sore throat in general practice

Tony Bakare — 2010-07-29T00:00:00Z

Background: ObjectiveTo evaluate the usefulness of a clinical scorecard in managing sore throat in general practice.DesignValidation study of scorecard for sore throat with a throat swab culture used as the 'gold standard'.Setting: A solo family practice in rural New South Wales, AustraliaParticipants: Patients attending with sore throat.MethodPatients from the age of 5 years and above presenting with the main symptom of a sore throat, and who have not had any antibiotic treatment in the previous two weeks, were invited to participate in the study. The doctor completed a scorecard for each patient participating and took a throat swab for culture. Adult patients (>16yrs) were asked to complete a patient satisfaction questionnaire, while guardians accompanying children (5yr to <16yrs old) were asked to complete a similar, guardian questionnaire.Main outcome measures:1. Ability of a new scorecard to differentiate between bacterial and non-bacterial sore throat.2. Patients' trust in the scorecard. Results: The scorecard has a sensitivity of 93.33%, a specificity of 63.16%, a positive predictive value of 50% and a negative predictive value of 96%. The sensitivity is better than other sore throat scorecards that have been published but with a slightly lower specificity.There was a high level of patient trust in the scorecard was (85.8% agreement). Patients also trusted their doctor's judgement based on the scorecard (90.6% agreement). Conclusion: As the scorecard has a high sensitivity but only a moderate specificity, this means that it is more reliable for negative results, i.e. when the result suggests a viral infection. When the result favours a bacterial sore throat, then a high sensitivity can mean that there are a number of false positives. GPs can be confident in withholding antibiotics when the scorecard indicates a viral infection.

Family physicians understanding about Mantoux test: A survey from a high endemic TB country

Niloufer Sultan Ali — 2010-05-31T00:00:00Z

Background: Tuberculosis is a global health emergency and is a big challenge to diagnose and manage it. Family physicians being first contact health persons should be well competent to diagnose and manage the patients with tuberculosis.AimsThis study was aimed to assess the level of understanding about Mantoux Test amongst Family Physicians in Karachi, Pakistan and to determine the difference of level of understanding by gender and number of tuberculosis patients seen in a month. Methods: A cross sectional survey was conducted among 200 Family Physicians working in Karachi; the largest city and economic hub of Pakistan. Family Physicians who attended Continuous Medical Education sessions were approached after taking consent. Pre-tested, self administered questionnaire was filled consisting of: basic demographic characteristics, questions regarding knowledge about Mantoux Test, its application and interpretation. Data of 159 questionnaires was analyzed for percentages, as rest were incomplete. Chi square test was used to calculate the difference of understanding levels between various groups. Results: Almost two thirds of respondents were males and above 35 years of age. Majority of Family Physicians were private practitioners and seeing more than five tuberculosis patients per month. Overall, a big gap was identified about the knowledge of Mantoux Test among study participants. Only 18.8% of Family Physicians secured Excellent (≥ 80% correct responses). This poor level of understanding was almost equally distributed in all comparative groups (Male = 20.8% versus Female = 15.9%; p - 0.69) and (Seen < 5 tuberculosis patients per month = 18.6% versus seen ≥ 5 tuberculosis patients per month = 19.3%; p - 0.32). A huge majority of Family Physicians (92%) however, showed keen interest in obtaining further knowledge regarding Mantoux Test and amongst them 72% suggested Continued Medical Education sessions as preferable mode of updating themselves. Conclusion: Our study revealed an overall major deficit in understanding and interpretation of Mantoux Test amongst Family Physicians which needs to be addressed. Continues Medical Education sessions for Family Physicians should be organized in regular basis for upgrading their knowledge in this regards.

Fourth Wes Fabb Oration Diversity of primary care in Asia Pacific: pathways to convergence

Zorayda Leopando — 2010-03-26T00:00:00Z

Asia Pacific is one of the 6 regions of the World Organization of Family Doctors (Wonca). It is a region with 16 full and 2 associate members coming from 14 countries. One of the main activities in the region is the regional conference highlighted by the Wes Fabb Oration.This Fourth Wes Fabb Oration has a historical perspective and three main parts: the results of a cross sectional survey done among member organizations and three countries not affiliated yet with Wonca which show Family Medicine as to status, practice, education and research; the regional initiatives and activities which indicate convergence; and, suggested action points which can further promote family medicine development, collaboration, and convergence.

Dietary salt reduction in rural patients with albuminurea using family and community support: the Mima study

Shinji Fujiwara — 2010-02-25T00:00:00Z

Background: Residents of rural communities are often more socially connected compared to urban dwellers. Using family and community support to motivate health behavior change may be useful in rural settings. The objective of this study was to pilot a salt reduction (SR) intervention for rural albuminuria patients using support from family and neighborhood residents compared to a usual care condition. The primary outcome was change in urine albumin-creatinine ratio (ACR). Methods: All consecutive outpatients with an ACR >= 30 mg/gCr were recruited from the Koyadaira Clinic. Patients self-selected their participation in the intervention group (IG) or the control group (CG) because the rural population expressed concern about not being treated at the same time. In the IG, patients and their families were educated in SR for 30 minutes in their home by experienced dieticians. In addition, patients, families and neighborhood residents were also educated in SR for 2 hours at a public town meeting hall, with educational content encouraging reduction in salt intake through interactive activity. The CG received conventional treatment, and ACR and blood pressure (BP) were measured after 3 months. Results: Of the 37 subjects recruited (20 male, 16 female, mean age; 72.8 ± 9.2 years), 36 completed the 3-month follow up and were analyzed. In the IG, ACR decreased significantly from baseline (706 ± 1,081 to 440 ± 656; t = 2.28, p = 0.04) and was reduced compared to the CG (213 ± 323 to 164 ± 162; F = 3.50, p = 0.07), a treatment effect approaching significance. Systolic BP in the IG (145 ± 14 to 131 ± 13 mmHg; t = 3.83, p = 0.002) also decreased significantly compared to the CG (135 ± 13 to 131 ± 14; F = 4.40, p = 0.04). Conclusions: Simultaneous education of patients, their families and neighborhood residents may be important in rural areas for treatments and interventions requiring health behavior change.Trial registrationUMIN000001972

Assessment of menopausal symptoms using modified Menopause Rating Scale (MRS) among middle age women in Kuching, Sarawak, Malaysia

Syed Alwi Syed Abdul Rahman — 2010-02-22T00:00:00Z

Background: Menopausal symptoms can be assessed by several tools, and can be influenced by various socio-demographic factors.ObjectivesTo determine the commonly reported menopausal symptoms among Sarawakian women using a modified Menopause Rating Scale (MRS). Methods: By using modified MRS questionnaire, 356 Sarawakian women aged 40-65 years were interview to document of 11 symptoms (divided into somatic, psychological and urogenital domain) commonly associated with menopause. Results: The mean age of menopause was 51.3 years (range 47 - 56 years). The most prevalent symptoms reported were joint and muscular discomfort (80.1%); physical and mental exhaustion (67.1%); and sleeping problems (52.2%). Followed by symptoms of hot flushes and sweating (41.6%); irritability (37.9%); dryness of vagina (37.9%); anxiety (36.5%); depressive mood (32.6%). Other complaints noted were sexual problem (30.9%); bladder problem (13.8%) and heart discomfort (18.3%). Perimenopausal women (n = 141) experienced higher prevalence of somatic and psychological symptoms compared to premenopausal (n = 82) and postmenopausal (n = 133) women. However urogenital symptoms mostly occur in the postmenopausal group of women. Conclusions: The prevalence of menopausal symptoms using modified MRS in this study correspond to other studies on Asian women however the prevalence of classical menopausal symptoms of hot flushes, sweating was lower compared to studies on Caucasian women.

Strengthening the Paediatricians Project 1: The need, content and process of a workshop to address the Priority Mental Health Disorders of adolescence in countries with low human resource for health

Paul Swamidhas Sudhakar Russell — 2010-02-18T00:00:00Z

ObjectiveWorld Health Organization has identified Priority Mental Health Disorders (PMHD) of adolescence. To effectively address these disorders at the primary care level paediatricians have to be trained in the low-income countries, which often have paucity of mental health resources. We studied: (1) the need of psychiatric training required among paediatricians; (2) if the content and process of the model workshop suits them to identify and treat these disorders. Methods: Forty-eight paediatricians completed evaluation questionnaire at the end of a 3-day workshop on adolescent psychiatry. They participated in a focused group discussion addressing the areas in psychiatry that needs to be strengthened in these workshops, the changes in the content and process of the workshop to bolster their learning. Qualitative and descriptive analyses were appropriately used. Results: Training in adolescent psychiatry was considered necessary among the paediatricians at zonal level frequently to develop their private practice, treat psychiatric disorders confidently, make correct referrals, and learn about counselling. Prioritizing training from under and postgraduate training, integrate psychiatry training with conference, conducting special workshops or Continuing Medical Education were suggested as ways of inculcating adolescent psychiatry proficiency. Mental status examination, psychopathology and management of the PMHD were considered by the respondents as important content that need to be addressed in the program but aspects of behavioural problems and developmental disabilities were also identified as areas of focus to gain knowledge and skill. Appropriate group size, flexibility in management decisions to fit the diverse clinical practice- settings was appreciated. Lack of skills in giving clinical reasoning in relation to PMHD, time management and feedback to individuals were identified as required components in the collaborative effort of this manner. Providing delegates with basic information on adolescent psychiatry prior to the workshop was suggested to make the workshop more valuable. Conclusions: There is a need to expand training for paediatricians from various backgrounds in adolescent psychiatry to strengthen their clinical skills to address the PMHD at the primary-care level. The evaluation suggests that the design and collaborative approach evident in this programme have merit as a model for training paediatricians in adolescent psychiatry in countries with low human resource for health.

Strengthening the Paediatricians Project 2: The effectiveness of a workshop to address the Priority Mental Health Disorders of adolescence in countries with low human resource for health.

Paul Swamidhas Sudhakar Russell — 2010-02-18T00:00:00Z

Background: Paediatricians can be empowered to address the Priority Mental Health Disorders at primary care level. To evaluate the effectiveness of a collaborative workshop in enhancing the adolescent psychiatry knowledge among paediatricians. Methods: A 3-day, 27-hours workshop was held for paediatricians from different regions of India under the auspices of the National Adolescent Paediatric Task Force of the Indian Academy of Paediatrics. A 5-item pretest-posttest questionnaire was developed and administered at the beginning and end of the workshop to evaluate the participants' knowledge acquisition in adolescent psychiatry. Bivariate and multivariate analyses were performed on an intention-to-participate basis. Results: Forty-eight paediatricians completed the questionnaire. There was significant enhancement of the knowledge in understanding the phenomenology, identifying the psychopathology, diagnosing common mental disorder and selecting the psychotropic medication in the bivariate analysis. When the possible confounders of level of training in paediatrics and number of years spent as paediatrician were controlled, in addition to the above areas of adolescent psychiatry, the diagnostic ability involving multiple psychological concepts also gained significance. However, both in the bivariate and multivariate analyses, the ability to refer to appropriate psychotherapy remained unchanged after the workshop. Conclusions: This workshop was effective in enhancing the adolescent psychiatry knowledge of paediatricians. Such workshops could strengthen paediatricians in addressing the priority mental health disorders at the primary-care level in countries with low-human resource for health as advocated by the World Health Organization. However, it remains to be seen if this acquisition of adolescent psychiatry knowledge results in enhancing their adolescent psychiatry practice.

GP registrar well-being: a cross-sectional survey

Peter Schattner — 2010-02-09T00:00:00Z

ObjectivesTo investigate the major stressors affecting GP registrars, how those at risk can be best identified and the most useful methods of managing or reducing their stress.Design, setting and participantsCross-sectional postal questionnaire of all GP registrars in one large regional training provider's catchment area.Main outcome measuresThe Depression, Anxiety and Stress Scale (DASS), a specifically developed Registrar Stressor Scale consisting of five subscales of potential stressors, plus closed questions on how to identify and manage stress in GP registrars. Results: Survey response rate of 51% (102/199). Rural difficulties followed by achieving a work/life balance were the principal stressors. Ten percent of registrars were mildly or moderately depressed or anxious (DASS) and 7% mild to moderately anxious (DASS). Registrars preferred informal means of identifying those under stress (a buddy system and talks with their supervisors); similarly, they preferred to manage stress by discussions with family and friends, debriefing with peers and colleagues, or undertaking sport and leisure activities. Conclusions: This study supports research which confirms that poor psychological well-being is an important issue for a significant minority of GP trainees. Regional training providers should ensure that they facilitate formal and informal strategies to identify those at risk and assist them to cope with their stress.

Making the 2007-2010 Action Plan work for women in family medicine in the Asia Pacific

Jan Coles — 2010-01-07T00:00:00Z

The Wonca Working Party for Women and Family Medicine (WWPWFM) was organized in 2001 with the following objectives: to identify the key issues for women doctors; to review Wonca policies and procedures for equity and transparency; to provide opportunities to network at meetings and through the group's listserve and website; and to promote women doctors' participation in Wonca initiatives.In October 2008, at the Asia Pacific Regional conference, the Wonca Working Party on Women in Family Medicine (WWPWFM) held a preconference day and conference workshops, building on the success and commitment to initiatives which enhance women's participation in Wonca developed in Ontario, Canada (2006) and at the Singapore World Congress (2007). At this meeting fifty women workshopped issues for women in Family Medicine in the Asia Pacific. Using the Action Plan formulated in Singapore (2007) the participants identified key regional issues and worked towards a solution.Key issues identified were professional issues, training in family medicine and women's health. Solutions were to extend the understanding of women's contributions to family medicine, improved career pathways for women in family medicine and improving women's participation in practices, family medicine organizations and academic meetings.

Health-related quality of life in patients with knee osteoarthritis attending two primary care clinics in Malaysia: a cross-sectional study

Zainal Zakaria — 2009-12-31T00:00:00Z

Background: Measurement of health-related quality of life (HRQOL) among patients with osteoarthritis (OA) helps the health care provider to understand the impact of the disease in the patients' own perspective and make health services more patient-centered. The main aim of this study was to measure the quality of life among patients with symptomatic knee OA attending primary care clinic. We also aimed to ascertain the association between socio-demographic and medical status of patients with knee OA and their quality of life. Methods: A clinic based, cross sectional study using the Short Form-36 (SF-36) questionnaire was conducted in two primary care health clinics in Hulu Langat, Selangor, Malaysia over a period of 8 months. The nurses and medical assistants were involved in recruiting the patients while the family physicians conducted the interview. Results: A total 151 respondents were recruited. The mean age was 65.6 ± 10.8 years with females constituted 119 (78.8%) of the patients. The mean duration of knee pain was 4.07 ± 2.96 years. Half of the patients were overweight and majority, 138 (91.4%), had at least one co-morbidity, the commonest being hypertension. The physical health status showed lower score as compared to mental health component. The domain concerning mental health components showed positive correlation with age. There was a significant negative correlation between age and physical functioning (p < 0.0005) which indicated the deterioration of this domain as patients became older. Male respondents had better scores in most of the QOL dimensions especially in the physical functioning domain (p = 0.03). There was no significant association between QOL with different education levels, employment status and marital status. Patients with higher body mass index (BMI) and existence co-morbidities scored lower in most of the QOL domains. Conclusions: This study has shown that patients with knee OA attending primary care clinics have relatively poor quality of life pertaining to the physical health components but less impact was seen on the patients' mental health.