primary care surveys 2012 - crc · 2013. 10. 29. · 2008/09 2010 no change in the number of public...
TRANSCRIPT
PRIMARY CARE SURVEYS 2012:
Healthcare Statistics Unit
Clinical Research Centre
Outline
• Monitoring of primary care activities
• NHEWS Primary Care 2010 findings
- healthcare facilities, services, activities and workforce
• NMCS 2010 findings
- antibiotic utilisation pattern
- safety issues for usage of antibiotics
- cough and cold prescriptions for children
Where is the data on primary care activities?
Electronic databases on primary care provision
1. Norway: Norwegian Prescription Database – NorPD
2. US: National Ambulatory Medical Care Survey – NAMCS
Can we do it WITHOUT an electronic database?
YES!
BEACH Study in Australia
What is BEACH ? • A continuous national study of general practice
activity
• Began April 1998, now in its 15th year
• Data are used by government, industry, health
planners, researchers & students
• Continuity allows measurement of changes over time
and the effect of policy on practice
….looking at our neighbouring country • The Primary Care Survey is done every 5-yearly in Singapore by the Ministry of
Health
PRIMARY CARE SURVEY
How CRC comes into the picture
National Healthcare Establishment and Workforce (NHEWS)
Healthcare Workforce
Services Facilities
National Medical Care Survey (NMCS)
Drug Utilisation
Process of care
Findings from NHEWS 2010 *No. of responded clinics = 241 (Public); 307 (Private)
Number of Public Primary Care Clinic 2008/09 & 2010
0
20
40
60
80
100
120
140
160
180
200
PERLIS WP KL PINANG MELAKA NS T'GANU KEDAH KELANTAN SEL & WP PUTRA
PAHANG PERAK SABAH & LABUAN
JOHOR SARAWAK
2008/09 2010
No change in the number of public primary care clinics
147
624
154
444
0
200
400
600
800
1000
1200
1400
Prls T'ganu Srwk Klntn Mlk Phg N9 Sbh & WP Lab.
Kdh Png Prk WP KL Jhr Sel & WP P'jy
Nu
mb
er o
f cl
inic
2008/09 2010
Number of Private Primary Care Clinic 2008/09 & 2010
Sharp drop in KL (-28.8%); slight increase in Sarawak (4.76%)
Private Clinics – Type of Practice
78%
22%
Individual Group
More SOLO operated private clinics
Unpublished data from the
2010 NHEWS Primary Care
96%
4%
Less than 24 hours 24 hours
Operating Hours Private Clinics 2010
Percentage of Public & Private Primary Care Clinic by Services
0
20
40
60
80
100
120
Perc
enta
ge o
f cl
inic
(%
)
Public Private
BUT ONLY
20% OF THE
Private GPs
Offered
Smoking
Cessation
Programme
3 out 4
smokers in
Malaysia
want to stop
smoking (quoted from the study “ clearing house for
tobacco control” from
NATIONAL POISON CENTRE USM)
Primary Care Services
Average number of doctors P
UB
LIC
PR
IVA
TE
“Slightly more doctors in PUBLIC set-ups”
2.3
1.6
Patient Consultations
• Wide variation in terms of attendances in private vs public sector
• Average number of attendances /day in public clinic:
236 patients
• Average number of attendances /day in private clinic:
38.6 patients
Unpublished data from the
2010 NHEWS Primary Care
Family Medicine Specialists in Malaysia 2010
0.6
0.14
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
Srwk Sbh & WP Lab.
Prk Phg Prls Png Jhr Kdh Mlk Klntn Sel & WP P'jy
N9 T'ganu WP KL
No
. of
FMS
per
all
resp
on
ded
clin
ics
Public Private
0
10
20
30
40
50
60
70
80
90
100
PUBLIC PRIVATE
28.1
67.3
71.9
32.7
Male
Female
Distribution of Primary Care Doctors by Gender & Sector (%)
More female doctors in the PUBLIC sector
PER
CEN
TAG
E (%
)
Association between Gender & Sector, 2010
60
29.7
0
10
20
30
40
50
60
70
25 - 34 years old 35 - 44 years old 45 - 54 years old 55 - 64 years old 65 - 74 years old
PUBLIC PRIVATE
PER
CEN
TAG
E (%
)
Distribution of Primary Care Doctors by Age & Sector (%)
More younger doctors in the PUBLIC setting
Unpublished data from the
2010 NHEWS Primary Care
50.1
17.2
0
10
20
30
40
50
60
<1 year 1 - 5 years 6 - 10 years 11 - 15 years 16 - 20 years 21 - 25 years 26 - 30 years >30 years
PUBLIC PRIVATE
PER
CEN
TAG
E (%
)
Distribution of Primary Care Doctors by Working Experience & Sector (%)
Less experienced doctors in the PUBLIC setting
Unpublished data from the
2010 NHEWS Primary Care
Morbidity Prescription
Primary Care
Relations
National Medical Care Survey (NMCS)
Who visits primary care?
What types of cases seen in primary care?
Which sector sees what kind of cases?
How are they being managed?
How do patients pay for care in the private sector?
NMCS publication 2010 In press
2.8
3.2
3.3
4.1
4.2
6.2
6.2
8
8.9
29.6
0 10 20 30 40
ANTENATAL CHECK-UP
TRAUMA / INJURY
DYSPEPSIA / INDIGESTION
MEDICAL CHECK-UP
TYPE 2 DM
GASTROENTERITIS
DERMATITIS, CONTACT
UNCOMPLICATED HPT
MUSCLE SYMPTOM
URTI
% of encounters
Re
aso
ns
for
Enco
un
ter
TOP 10 REASONS FOR ENCOUNTER IN 2010
What type of cases are seen in primary
care?
2.5
2.7
3.1
3.6
4
4.2
5.4
5.5
6.4
8.7
0 2 4 6 8 10
Acute bronchitis/bronchiolitis
Back complaint*
Arthritis*
Lipid disorders
Diabetes*
Depression*
URTI
Immunisation/vaccination*
Check-ups*
Hypertension*
% of encounters
Re
aso
ns
for
Enco
un
ter
Top 10 problems managed in BEACH, Australia 2010-2011
Are we underutilising primary care services for chronic conditions?
ANTIBIOTIC USAGE IN PRIMARY CARE
How many prescriptions contained systemic antibiotics?
Private
• 5455 / 17,695 = 30.8%
Public
• 493 / 4173 = 11.8%
Overall
• 5948/ 21,868 = 27.2%
2010 National Medical Care Survey
Antibiotic is No. 3 Highest Utilised Drug Group
ATC* Description Total %
R06 Antihistamines for systemic use 7,191 13.3
N02 Analgesics 6,455 11.9
J01&
P01AB01 Antibacterials for systemic use 6191 11.4
M01 Antiinflammatory and antirheumatic products 5,000 9.2
R05 Cough and cold preparations 2,316 4.3
A02 Drugs for acid related disorders 2,315 4.3
A03 Drugs for functional gastrointestinal disorders 2,144 4.0
A07 Antidiarrheals, intestinal antiinflammatory / antiinfective agents 1,749 3.2
R01 Nasal preparations 1,636 3.0
A11 Vitamins 1,560 2.9
TOTAL 54,204 100.0
*ATC; The Anatomical Therapeutic Chemical Classification System 2010 National Medical Care Survey
What were the types of antibiotics prescribed? ATC L3 Description Frequency %
J01C Beta-lactams, penicillins 2852 46.1
J01D Other beta-lactams 1204 19.4
J01F Macrolides, Lincosamides & Streptogramins 950 15.3
J01M Quinolones 382 6.2
J01E Sulfonamides & Trimethoprim 287 4.6
J01A Tetracyclines 283 4.6
P01AB01 Metronidazole 199 3.2
J01G Aminoglycosides 17 0.3
J01B Amphenicols 15 0.2
J01X Other antibacterials 2 0.0
Total Antibiotics 6191 100.0 Unpublished data from the
2010 National Medical Care Survey
National Medical Care Survey Healthcare Statistics Unit
Clinical Research Centre
Antibiotics for URTI ICPC Code R74
National Medical Care Survey Healthcare Statistics Unit
Clinical Research Centre
How many (%) of URTI encounters were prescribed antibiotic(s)?
• 3363 / 5512 = 61.0%
Private
• 299 / 970 = 30.8%
Public
• 3662 / 6482 = 56.5%
Overall
National Medical Care Survey Healthcare Statistics Unit
Clinical Research Centre
Unpublished data from the
2010 National Medical Care Survey
How many % of URTI encounters were prescribed
antibiotic(s)?
• 299 / 970 = 30.8%
Public
• 3363 / 5512 = 61.0%
Private
• 3662 / 6482 = 56.5%
Overall
URTI encounters prescribed antibiotics –Findings by Teng et al. in 2008
Some Issues with Antibiotics Utilisation
How many antibiotics were prescribed in each
prescription(containing antibiotics)?
Number of
Antibiotics Public Private
Total
Prescriptions
1 493 5302 5795
2 0 151 151
3 0 2 2
Total 493 5455 5948
2010 National Medical Care Survey
Double antibiotics in a prescription No Oral Antimicrobial Combinations Frequency %
1 Beta-lactams Metronidazole 60 39.7
2 Beta-lactams Beta-lactams 30 20.0
3
Quinolone
Beta-lactam
/Metronidazole/
Tetracyclines 22 14.6
4 Tetracyclines Metronidazole 11 7.3
5 Beta-lactams Macrolides 10 6.6
6 Macrolides Metronidazole 5 3.3
7 Others Others 13 8.6
Total 151 Beta-lactams include penicillins & 1st, 2nd and 3rd generation cephalosporins
Quinolones include ciprofloxacin, ofloxacin
Macrolides include erythromycin, azithromycin, clarithromycin & roxithromycin
Others include beta-lactams, quinolones, metronidazole, tetracyclines, macrolides,TMP-SMX, clindamycin, chloramphenicol.
COUGH AND COLD MEDICINE FOR CHILDREN IN PRIMARY CARE
6.0
41.4
52.6
24.6
1.4
36.6
1.9
31.5
3.9
0
10
20
30
40
50
60
Sedating Less Sedating Sedating Less Sedating Sedating Less Sedating
<2 2 - <6 6 - 12
Per
cen
tage
(%
)
Age Group by Type of Antihistamines
Antihistamine prescribing – percentage of encounters
public (n = 215) private (n = 942)
Our efforts so far…
POSTER PRESENTATION
JOURNAL PUBLICATIONS
Antihypertensive prescription pattern in primary care for Malaysian Elderly
Cough and Cold Medicine in Children:
Prescription Pattern in primary care setting Paediatric Utilisation of Malaysian Primary
Care Service: A Comparison between Public and Private Sector
** all in the submission stage
ORAL PRESENTATIONS
1st APCEEBM 2nd Public Health Conference
14th Asia Pacific Congress on Paediatrics
PUBLIC BRIEFINGS
OTHERS • Presentation during the Annual Scientific Meeting on
Antimicrobial Resistance 2012
• Presentation to our Director General of Health during
the ‘Mesyuarat Jawatankuasa Kawalan Infeksi dan
Antibiotik Kebangsaan’
• Full dataset sharing with the OneCare team and GIS
(Geographic Information System), IKU
Where do we go from here?
NMCS 2012
• Improved questionnaire design
• Improved sampling design
• Improved audit methods
• Feedback to primary care providers
"In its most highly developed form, primary care is the point of entry into the health services system and the locus of responsibility for organizing care for patients and populations over time. There is a universally held belief that the substance of primary care is essentially simple. Nothing could be further from the truth.”
Barbara Starfield (1992) Primary Care: Concept, Evaluation, and Policy.
Oxford University Press, NY (Preface)