EDITED BY : LIM KK, SIVASAMPU S, GOH PP, HISHAM AN

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NATIONAL MEDICAL CARE STATISTICS 2010

MINISTRY OF HEALTH MALAYSIA

EDITED BY : LIM KK, SIVASAMPU S, GOH PP, HISHAM AN

NATIONAL MEDICAL CARE STATISTICS 2010NATIONAL MEDICAL CARE STATISTICS 2010

National Medical Care Statistics 2010October 2012© Ministry of Health Malaysia

Published by:The National Healthcare Statistics Initiative (NHSI) Clinical Research Centre,Ministry of Health3rd Floor, MMA House 124, Jalan Pahang53000 Kuala LumpurMalaysia

Tel. : (603) 40439300 / 400

Fax : (603) 40439500

e-mail : [email protected]

Website : http://www.crc.gov.my/nhsi

This report is copyrighted. Reproduction and dissemination of this report in part or in whole for research, educational or other non-commercial

purposes are authorised without any prior written permission from the copyright holders provided the source is fully acknowledged. Suggested

citation is Clinical Research Centre. National Medical Care Statistics 2010. Kuala Lumpur 2012.

Funding:

The National Healthcare Statistics Initiative is funded by a grant from the Ministry of Health Malaysia (MRG Grant No. NMRR-09-842-4718)

Please note that there is the potential for minor corrections of data in this report. Please check the online version at www.crc.gov.my for any amendments

ISSN 2289-1811

9 7722 89 1810 08

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PREFACE

With over 800 Klinik Kesihatan (public health clinics) and 5,000 private primary care clinics in Malaysia, primary care serves as the first point

of contact for many of the health needs of Malaysia’s estimated 28 million population. Despite its importance in community healthcare, there

has been little information available on the primary care setting. This vacuum poses a great challenge to the coordination of health services,

collaboration between public and private sector, policy planning and implementation.

It is only with the successful launch of the National Healthcare Establishment and Workforce Survey (NHEWS) Primary Care report in 2009,

that we now have some credible demographic data of primary care facilities available in the country. Two reports (Year 2009 and 2010)

derived from the annual survey have also been published. The next step forward would be to look at the data on disease burden and treatment

modalities used in the primary care setting. It is with this objective that the National Medical Care Survey (NMCS) was carried out to fill the

information gap as it explores the morbidity pattern and treatment being given in the primary care setting.

Thus, I am convinced that this maiden report will be a very useful reference for many stakeholders of the healthcare sector, including

the general public, practitioners, policy makers as well as the industry. In addition, I hope that this report will create more awareness on

the importance of primary care in safeguarding the health of the population and that this would later translate into more support for the

development of primary care in Malaysia.

Last but not least, it is my pleasure to convey my appreciation to all the participants of the survey and the staff from Healthcare Statistics Unit,

Clinical Research Centre who have contributed towards the successful completion of the first National Medical Care Statistics (NMCS) 2010.

I sincerely hope that the primary care practitioners, particularly those from the private sector, would continue to render us your support in the

coming NMCS survey.

Thank you.

…………………………………Dato’ Sri Dr. Hasan Abdul RahmanDirector General of Health, Malaysia

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PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TABLE OF CONTENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

LIST OF TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NATIONAL MEDICAL CARE SURVEY 2010 PROJECT TEAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ABBREVIATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CHAPTER 1 : INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.1 : About National Healthcare Statistics Initiative (NHSI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.2 : About National Medical Care Survey (NMCS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.3 : Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

General Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Specific Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CHAPTER 2 : METHODOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.1 : Survey Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2 : Sampling Frame & Recruitment Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.3 : Study Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.4 : Data Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.5 : Data Entry & Data Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.6 : Identification of Private Primary Care Clinics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.7 : Data Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.8 : Data Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.9 : Limitations of the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CHAPTER 3 : THE RESPONSE RATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CHAPTER 4 : THE ENCOUNTERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CHAPTER 5 : THE REASONS FOR ENCOUNTER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CHAPTER 6 : MANAGEMENT OF MORBIDITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6.1 : Prescribed Medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ATC Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Types of Drugs Prescribed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6.2 : Continuity of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

APPENDIX 1 : PARTICIPANTS OF NMCS 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Public/Ministry of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Private . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

APPENDIX 2 : NMCS 2010 SURVEY FORM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CoNTENTS

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Table 1.1 : Healthcare surveys under the NHSI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 3.1 : Number of respondent public and private clinics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 4.1 : Characteristic of encounters by age group in NMCS 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 4.2 : Characteristic of encounters by sector, sex, nationality and ethnicity in NMCS 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 4.3 : Characteristic of encounters by source of payment in NMCS 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 5.1 : Number of patients’ reasons for encounter in NMCS 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 5.2 : Reasons for encounter by ICPC-2 chapter in NMCS 2010, in descending order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 5.3 : Top 50 reasons for encounter in NMCS 2010, in descending order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 6.1 : Distribution of prescribed medications by ATC level 1 in NMCS 2010, in descending order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 6.2 : Distribution of prescribed medications by ATC level 2 in NMCS 2010, in descending order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 6.3 : Top 100 most prescribed medications in NMCS 2010, in descending order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 6.4 : Follow up proposed by primary care practitioners in NMCS 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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LIST oF TABLES

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ACKNoWLEDGEMENTS

The National Healthcare Statistics Initiative team would like to thank the Director General of Health Malaysia for his continuous support towards this survey and for permission to publish this report.

Also, our sincere appreciation to the following for their participation, assistance, support and contribution:

• Deputy Director General of Health (Research and Technical Support), Ministry of Health (MOH)

• Deputy Director General of Health (Medical), MOH

• Deputy Director General of Health (Public Health), MOH

• Director, Planning and Development Division, MOH

• Director, Family Health Development Division, MOH

• Director, Medical Practice Division, MOH

• Director, Clinical Research Centre, National Institutes of Health, MOH

• Director, Health Informatics Centre, MOH

• State level Private Medical Practice Control Unit (Unit Kawalan Amalan Perubatan Swasta or UKAPS)

• All participating public and private clinics and other institutions that provided data to the National Medical Care Survey (NMCS)

• Malaysian Medical Council, Malaysian Medical Association, Family Medicine Specialists Association of Malaysia, National Specialist Register, Academy of Medicine Malaysia

• All who have supported or contributed to the success of the NMCS and this report

Thank you.

National Healthcare Statistics Initiative (NHSI)Ministry of Health Malaysia

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NATIoNAL MEDICAL CARE SURVEY 2010 PRoJECT TEAM

PRINCIPAL INVESTIGAToR Datuk Dr Noor HisHam abDullaH

PRINCIPAL Co-INVESTIGAToRSDr. sHEamiNi siVasamPuDr. GoH Pik PiN

Co-INVESTIGAToRSDr. NooraiNi babaDr. mD kHaDzir sHEikH aHmaD

PRoJECT LIAISoN oFFICERSDr afiDaH aliDr. zakiaH moHD saiD

PRoJECT MANAGERSDr. NaDia farEEDa GowDH (July 2009 – JaNuary 2011)Dr. sHaroN CHoNG (JaNuary 2011 – auGust 2011)mr. lim ka kEat (sEPtEmbEr 2011 – sEPtEmbEr 2012)

SURVEY CooRDINAToR lEoN Ho liP maN

RESEARCH oFFICERSmr. sHaNtHa kumar CHaNDrasEkaraNmr. PooVaNEsVa rao yaNG kEttEr raHmaN

DATA ANALYSTSmr. lim ka kEatmr. sHaNtHa kumar CHaNDrasEkaraNms. NoraziDa bt ab raHmaN

DATABASE DEVELoPER / ADMINISTRAToR altus solutioNs sDN. bHD.

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ABBREVIATIoNS

ATC WHO Anatomical Therapeutic Chemical Classification system

CRC Clinical Research Centre

CKAPS Cawangan Kawalan Amalan Perubatan Swasta

DG Director General of Health, Ministry of Health, Malaysia

FMS Family Medicine Specialist

GP General practice or practitioner

ICPC International Classification of Primary Care

KK Klinik Kesihatan

MoH Ministry of Health, Malaysia

MREC Medical Research and Ethics Committee, Ministry of Health Malaysia

NHEWS National Healthcare Establishment & Workforce Survey (Primary Care)

NHSI National Healthcare Statistics Initiative

NIH National Institutes of Health

NMUS National Medicine Use Survey

WoNCA World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians

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Chapter 1 | INTRODUCTION

1.1 About NAtioNAl HeAltHcAre StAtiSticS iNitiAtive (NHSi)

The National Healthcare Statistics Initiative (NHSI) is a family of surveys which were conducted with the aim to support evidence-based health

policy making and research in Malaysia. Owing to the support of various stakeholders and recognition of the usefulness of data in bridging the gap

between research and policy, the NHSI has grown in credibility and gained greater participation over the past 4 years. Annual reports are being

published for most of the surveys under the NHSI project based on the respective findings. The NHSI family of healthcare surveys, existing data

sources and survey design are summarised below.

NO. NHSI SURveyS DeSCRIpTION Of SURveyS COmplemeNT DaTa SOURCeS

1. (a) NHeWS Hospital National Healthcare Establishments and Workforce Survey for hospitals

• Captures data on healthcare services provision, facilities available and workforce (doctors and allied health professionals) within hospitals;

• Includes both public and private hospitals in the country.

Healthcare facility administrative and registration database

Health professional registers

(b) NHeWS primary Care National Healthcare Establishments and Workforce Survey for primary care clinics

• Captures data on healthcare services provision, facilities available and workforce (doctors and allied health professionals) within clinics;

• Includes both public and private primary care clinics in the country.

Healthcare facility administrative and registration database

Health professional registers

2. NmUS National Medicine Use Survey

• Captures data on drug utilisation pattern from hospitals (procurement records), primary care clinics (prescription records) and pharmacies (dispensing records).

Healthcare facility administrative records (procurement, dispensing, etc.)

Pharmaceutical manufacturers’ or distributors’ drugs sales records

3. NmDS National Medical Device Survey

• Captures data on available medical technology among registered healthcare establishments in the country

• Used to be a standalone survey. Now incorporated within the National Healthcare Establishment & Workforce Survey.

Healthcare facility administrative records (asset inventory, purchasing, etc.)

Medical device manufacturers’ or distributors’ sales records

Radiation device registration data

4. NmCS National Medical Care Survey

• Captures data on morbidity pattern seen in primary care setting and the process of care being provided.

• The prescription data contributes to the NMUS survey

Routine health service statistics from Health Informatics Centre MOH, Department of Statistics and various patient registers

Population mortality data from Department of Statistics.

Intro

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1.2 About NAtioNAl MedicAl cAre Survey (NMcS)

According to the American Association of Family Physicians1, primary care is defined as the care provided by physicians specifically trained for and

skilled in comprehensive first contact and continuing care for patients irrespective of the problem origin (biological, behavioral or social) and

diagnosis. In short, primary care is the front line of a healthcare system, making healthcare services accessible to general public.

Malaysia has more than 800 government primary care clinics (termed “Klinik Kesihatan”, the vernacular for Health Clinic) and 5,000 private

primary care clinics (commonly known as GP clinics) nationwide. Yet, little is known about the structure of the primary care setting, the morbidity

pattern seen by primary care practitioners and the process of care being provided. Such information is crucial for the planning and development

of the primary care sector in view of the increasing prevalence of non-communicable diseases.

Therefore, to provide a clearer picture of the primary care system in the country the National Medical Care Survey (NMCS) with a focus on

processes and delivery of care was launched in 2010 to complement the National Healthcare Establishments and Workforce Survey (NHEWS)

Primary Care that focussed on the structure (establishment and workforce) of primary care.

1.3 objectiveS

General Objectives

The NMCS 2010 aimed:

1. To collect reliable and valid data on the Malaysian (public and private) primary care setting

2. To assess patient characteristics and morbidity patterns in health service activities

3. To provide accurate and timely data on Malaysian primary care setting to various stakeholders including government bodies, primary care

practitioners, consumers, researchers and the pharmaceutical industry; and

4. To establish a database of doctor/patient encounters in Malaysian primary care setting

Specific Objectives

The NMCS 2010 specifically collected information on clinical activities in the Malaysian primary care setting, including:

• The characteristics of patients

• Reasons for encounter and additional information such as:

- Pharmacological treatment prescribed, including the dose and frequency

- Follow ups in primary care and referrals to secondary or tertiary care

reference

1. American Association of Family Physicians (AAFP). Primary Care. http://www.aafp.org/online/en/home/policy/policies/p/primarycare.html#Parsys0001

Accessed June 2012. Last update 2012.

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Chapter 2 | meTHODOlOGy

2.1 Survey tool

A standard questionnaire specifically designed for the survey (Appendix 2) was used. The survey form was self-administered by the participating

doctors. Variables studied were as follows:

CaTeGORIeS Of vaRIableS vaRIableS CapTUReD IN SURvey

Patient demography Age, gender, ethnicity, nationality

Major reason(s) for visit/diagnosis Acute, chronic illnesses, preventive care

Source of payment Out-of-pocket, private insurance, Ministry of Health subsidy, private managed care organisations

drugs prescribed Name, strength, dosage, route, frequency, duration

visit disposition No follow-up planned, return at specified time, referral

2.2 SAMPliNg FrAMe & recruitMeNt StrAtegy

Based on responses from private doctors for the prescription survey in previous National Medicine Use Survey (NMUS)1, the total number of

patients seen per day by a general practitioner was estimated to be 30, with an average of 3 drugs per patient. The prescription survey under

the NMUS was a 7-day survey. In contrast, the NMCS strategy was to shorten data collection to 1 day per clinic and to recruit a higher number of

clinics. This approach was taken in order to reduce workload in clinics and to increase the response rate.

For administrative convenience, the clinics were grouped according to sectors, with each group being approached and briefed separately.

private primary Care Clinics

All private medical clinics registered with the Private Medical Practice Division of the Ministry of Health Malaysia (often referred to as the Cawangan

Kawalan Amalan Perubatan Swasta [CKAPS]) were eligible to be included in the sampling frame of the survey. This sampling frame included both

private primary care clinics as well as private specialist clinics because the registration with Ministry of Health did not differentiate between the

two. Briefings were organised at state-level for the convenience of clinics located in each state. Clinics that were represented during the National

Healthcare Statistics Initiative study briefing were also recruited. Participating clinics were given survey dates and forms. Below is the list of briefing

dates for private primary care clinics in all states.

Met

hodo

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4


NO DaTe lOCaTION TaRGeTeD paRTICIpaTION

1 5 October 2009 Sungai Buloh, Selangor Clinics from Selangor

2 6 October 2009 Sungai Buloh, Selangor Clinics from WP Kuala Lumpur

3 7 October 2009 Serdang, Selangor Clinics from Selangor

4 9 October 2009 Kuala Terengganu Clinics from Terengganu

5 11 October 2009 Kuantan, Pahang Clinics from Pahang

6 11 October 2009 Johor Bharu, Johor Clinics from Johor

7 20 October 2009 Georgetown, Pulau Pinang Clinics from Pulau Pinang

8 24 October 2009 Alor Setar, Kedah Clinics from Kedah & Perlis

9 25 October 2009 Ipoh, Perak Clinics from Perak

10 30 October 2009 Kota Bharu. Kelantan Clinics from Kelantan

11 31 October 2009 Kota Kinabalu, Sabah Clinics from Sabah

12 31 October 2009 Kuching, Sarawak Clinics from Sarawak

13 1 November 2009 Kuching, Sarawak Clinics from Sarawak

14 8 November 2009 Georgetown, Pulau Pinang Clinics from Pulau Pinang

15 14 November 2009 Melaka Clinics from Melaka

16 21 November 2009 Seremban, Negeri Sembilan Clinics from Negeri Sembilan

17 22 November 2009 Ipoh, Perak Clinics from Perak

public primary Care Clinics

The full list of 808 Klinik Kesihatans (KKs) was obtained from the Family Health Development Division and out of this, 150 KKs were selected

through stratified sampling to ensure representation of each state. These 150 clinics were notified and provided the relevant documents. Below is

the list of briefing dates for public primary care clinics in all states.

NO DaTe lOCaTION TaRGeTeD paRTICIpaTION

1 25 January 2010 Ipoh, Perak KKs in Perak

2 3 February 2010 Alor Setar, Kedah KKs in Kedah and Perlis

3 4 February 2010 Kota Bharu, Kelantan KKs in Kelantan

4 5 February 2010 Kuantan, Pahang KKs in Pahang

5 8 February 2010 Johor Bharu, Johor KKs in Johor

6 10 February 2010 Georgetown, Pulau Pinang KKs in Pulau Pinang

7 10 February 2010 Kuching, Sarawak KKs in Sarawak

8 12 February 2010 Kota Kinabalu, Sabah KKs in Terengganu

9 12 February 2010 Seremban, Negeri Sembilan KKs in Negeri Sembilan

10 1 March 2010 Kuala Terengganu KKs KKs in Terengganu

11 4 March 2010 WP Kuala Lumpur KKs KKs in WP Kuala Lumpur

5


2.3 Study PeriodThe study period was from 1/12/09 – 30/4/10 inclusive of 1st Dec and 30th April. Every day within this period was included plus weekends and

public holidays. A total of 151 dates were available.

Survey Date

Each recruited clinic was given a specific date on a first-come-first-serve basis from a list of 1,000 randomly arranged dates within the study

period. The dates were assigned during the study briefings. For clinics that were unrepresented during the briefings, the forms were sent by post

and the next available dates were assigned from the same list of 1,000 dates.

Clinics that were unable to conduct the survey on the given date were advised to do so on the following available date when the clinic was

operational. However, the clinics were advised to inform the research team prior to the change of date.

2.4 dAtA collectioN

General

Reminders were given by telephone to all clinics approximately 1 week prior to the survey date. All clinics were given the option to respond to the survey

either by paper submission or online through a specially designed web-based application. For the latter, a unique username and password to access

this system was given to each clinic. For clinics choosing to respond on paper, they were given 2 weeks to return the forms after the survey date.

For all clinics (public and private) involved in this study, a public notice was provided that was to be displayed in an area where it can be viewed

by all patients. This notice served to inform patients of the clinic’s participation in the ongoing survey and that any patient had the right to opt-out

if they did not wish to be part of the survey.

private primary Care Clinics

Private clinics were asked to record all patient encounters seen in the clinic on the survey day.

public primary Care Clinic

As the KKs varied widely in patient load, a patient sampling strategy based on the Malaysian Identity Card (MyKad) numbers was devised to select

patient encounters for recording in order not to overburden the clinics. MyKad is the compulsory identity document for Malaysian citizens aged 12

and above. For large clinics with more than 100 expected attendances per day, visits by patients with MyKad numbers ending with the digits ‘1’

and ‘6’ were recruited. For clinics with an expected number of attendances ranging between 50 to 100, visits by patients with MyKad numbers

ending in ’0’, ’2’, ’4’, ’5’, ’7’and ’9’ were recruited. For clinics expecting 50 or less attendances per day, all patient visits on that day were included.

2.5 dAtA eNtry & dAtA cleANiNg

Data entry for all paper forms received was done inhouse with random checks performed to ensure data entry quality. Improperly conducted

surveys (wrong dates, not according to protocol) were excluded.

Data cleaning was conducted during the data entry process and continued during data analysis. Data range checks and consistency checks were

built into the data entry module and the age variable was auto-calculated based on the date of birth to reduce error in manual calculation.

2.6 ideNtiFicAtioN oF PrivAte PriMAry cAre cliNicS

At the outset of the study, both private primary care and specialist clinics were included in the survey due to limitations of the sampling frame.

It should be pointed out that, in a concurrent survey under NHSI, namely the NHEWS Primary Care, all participating clinics were required to self-

report whether they were primary care providers or specialists. However, based on the details in this pooled data, the respondents were later

divided into primary care clinics and specialist clinics. Only data from private primary care clinics were analysed and presented in this report. The

issue of separating data did not arise for public clinics as all KKs provided only primary care services. Met

hodo

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2

6


2.7 dAtA codiNg

The reasons for encounter were coded according to the International Classification of Primary Care Second Edition (ICPC-2) codes2 whereas the

prescription drugs were coded according to WHO Anatomical Therapeutic Chemical (ATC) Classification system.3 The Clinical Research Centre

obtained a 2-year free license for the usage of ICPC-2 codes in the Malaysian NHSI project starting 22 February 2011 from the World Organization of

Family Doctors (WONCA). WONCA is made up of national colleges, academies or organisations concerned with the academic aspects of general family

practice.4 The Anatomical Therapeutic Chemical (ATC) license was purchased from the WHO Collaborating Centre for Drug Statistics Methodology.3

2.8 dAtA ANAlySiS

This report is primarily descriptive. Therefore, no test of significance has been presented. Analysis was done using STATA version 11.1 and

the confidence intervals for rate were calculated using Open Epi Calculator Version 7.5.115. The encounter was the primary unit of inference.

Encounters with no reasons for encounter and no drugs recorded were not analysed.

Proportions with 95% confidence intervals were used to describe the distribution of an event that can occur only once at a consultation (e.g.

patient’s age and mode of payment). The proportions may not always add to exactly 100% due to rounding off. Meanwhile, for an event that can

happen more than once in a consultation (e.g. reasons for encounter or medications), data was reported as rates per 100 encounters.

Data was reported as per collected. No weightage was applied to extrapolate the data to national level.

2.9 liMitAtioNS oF tHe Study

1. The survey is a cross sectional study. Therefore, no conclusion can be derived, neither in terms of long term management of chronic diseases nor in terms of disease episodes in primary care setting.

2. The survey is self-administered by participating doctors and therefore accuracy of data depends largely on the accuracy of recording and interpretation. This might not necessarily reflect the actual practice.

3. The survey is encounter-based. If the same patient visits one clinic and then goes to another clinic for an unrelated reason during the same survey day, it will be considered as two encounters.

4. Morbidity patterns observed in the survey collectively only reflected those cases managed in a primary care setting but not that of the incidence or prevalence of diseases in the community.

5. The morbidity patterns reflected only those managed during the recorded encounters. Incidence of co-morbidity in the same patient that was not treated at the encounter would not have been recorded.

6. Prescription data in the survey included only those provided at the recorded encounter. The presence of a drug in a prescription did not necessarily mean that the patient was not already given the drug in a previous encounter. Similarly, the absence of a drug did not necessarily

indicate that the patient will not be given it in a future encounter.

reference

1. Pharmaceutical Services Division and Clinical Research Centre, Ministry of Health Malaysia. Malaysian Statistics on Medicine 2007. Kuala Lumpur 2010

2. Wonca International Classification Committee (WICC). International Classification of Primary Care – 2nd Edition (ICPC-2 English). Available at http://archive.

globalfamilydoctor.com/wicc/pagers/english.pdf. Accessed January 2012.

3. WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment 2011. Oslo, 2010.

4. Global Health Workforce Alliance. WONCA – World Organization of Family Doctors. Available at http://www.who.int/workforcealliance/members_partners/member_list/

wonca/en/index.html. Accessed October 2012.

5. Emory Rollins School of Public Health. 95% Confidence Interval for a Rate version 7.5.11. Available at http://www.sph.emory.edu/~cdckms/exact-rate.html

Accessed July 2012.

7


Chapter 3 | THe ReSpONSe RaTe

This chapter examines the survey samples and response rates. As described in Chapter 2, public clinics were selected through stratified sampling

to ensure representation of each state. Out of 150 public clinics sampled, 122 responded (response rate 81.3%). Meanwhile, 755 out of 1,495

private clinics responded (response rate 50.5%). However, some of these clinics were subsequently found to be specialist or other types such as

aesthetic clinics (Table 3.1) Data from such clinics were removed from analysis.

The full list of the public and private primary care clinics which responded to the survey is available in Appendix 1.

table 3.1: Number of respondent public and private clinics

SeCTOR Type Of SeRvICe pOpUlaTION SampleD ReSpONDeD STaTUS

public primary Care 806 150 122 analysed

private

primary Care 5,108

1,495

652 analysed

Specialist/Others 1,254 103 excluded

A total of 21,914 encounters were collected from 122 public and 652 private primary care clinics. However, 46 encounters were excluded as

these neither contained data on reasons for encounter nor the medications prescribed. Total analysable encounters were 21,868; 4,173 from

public (average 34.2 encounters per clinic) and 17,695 from private (average 27.2 encounters per clinic). The demographic characteristics of

these encounters are shown in Chapter 4.

The

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Chapter 4 | THe eNCOUNTeRS

This chapter describes the demographic pattern of patient encounters recorded in NMCS 2010.

Table 4.1 shows distribution of encounters in NMCS 2010 by age groups. The age range was reported in accordance with the Department of

Statistics population data1 and National Health and Morbidity Survey III.2 In general, young adults made up the bulk of encounters. The age group

25-29 (10.8%) had the highest proportion of encounters, followed by age groups 30-34 (9.7%) and 20-24 (8.2%). Among children and youth aged

19 years and below, the encounters were highest for children aged 1 – 4 years (7.5% of total encounters) and tended to decrease with increasing

age. On the other hand, the geriatric population (60 years old and above) only contributed 12.5% of the total encounters.

On average, for the purpose of this study, each clinic provided data for about 30 encounters. As there were 652 private clinics versus 122 public

clinics responding to the survey (Chapter 2), the majority of encounters (80.9%) appeared to be from private clinics. Nevertheless, this cannot be

interpreted to mean that private clinics were seeing more patients than the public clinics. Also, only slight differences were observed between the

sexes, with female patients accounting for 51.3% encounters as compared to male patients which were about 48.7%. (Table 4.2)

The majority of patients presenting to primary care clinics were Malaysians with only 6.8% of patients being foreigners. This finding is in proportion

to the estimated number of foreigners in the country (8.2%)1. When the ethnicity for Malaysians were analysed (Table 4.2), the distribution were

also found to be similar to that reported by the Department of Statistics.1 (Malay and Indigenous (Bumiputera) 67.4%; Chinese 24.6%; Indians

7.3%; and others 0.7%)

The most common mode of payment for private primary care services in NMCS 2010 was out-of-pocket payment (56.8%), followed by payment

through private third parties (22.0%). Private third parties refer to employers, panel companies (companies which appoint private clinics to look

after their workers who fall sick), managed care organizations (MCOs) and private insurance companies. Meanwhile, all encounters presented to

public clinics were considered under government subsidy. Some visits to private clinics were reported to be subsidised by government. (Table 4.3)

reference

1. Department of Statistics. Population And Housing Census, Malaysia 2010 (2010 Census). http://www.statistics.gov.my/portal/index.php?option=com_content&view

=article&id=1215&lang=en Accessed June 2012. Last update 05 June 2012.

2. Institute of Public Health. National Health and Morbidity Survey III 2006.

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table 4.1: Characteristic of encounters by age group in NMCS 2010

aGe GROUp 1 NUmbeRpeRCeNT Of eNCOUNTeRS

95 % CI

lOWeR UppeR

<1 year 699 3.23 3.20 3.25

1-4 1,634 7.54 7.50 7.58

5-9 1,003 4.63 4.60 4.66

10-14 845 3.90 3.87 3.93

15-19 1,048 4.84 4.81 4.87

20-24 1,819 8.39 8.35 8.43

25-29 2,339 10.79 10.75 10.84

30-34 2,107 9.72 9.68 9.76

35-39 1,769 8.16 8.12 8.20

40-44 1,617 7.46 7.42 7.50

45-49 1,502 6.93 6.90 6.97

50-54 1,447 6.68 6.64 6.71

55-59 1,142 5.27 5.23 5.30

60-64 885 4.08 4.06 4.11

65-69 634 2.93 2.90 2.95

70-74 626 2.89 2.87 2.91

75-79 324 1.50 1.48 1.51

80 232 1.07 1.06 1.08

SubtotAl 21,672* 100 - -

* indicates presence of missing data

1. Age is verified against date of birth.

11


table 4.2: Characteristic of encounters by sector, sex, nationality and ethnicity in NMCS 2010

CHaRaCTeRISTIC NUmbeRpeRCeNT Of eNCOUNTeRS

95 % CI

lOWeR UppeR

Sector

Public 4,173 19.08 19.02 19.14

Private 17,695 80.92 80.8 81.04

totAl 21,868 100 - -

Sex

Male 10,656 48.73 48.64 48.82

Female 11,211 51.27 51.17 51.36

SubtotAl 21,867* 100 - -

Nationality

Malaysian 20,381 93.2 93.08 93.33

Foreigner 1,487 6.8 6.77 6.83

totAl 21,868 100 - -

ethnicity1

Malay 11,022 54.98 54.88 55.08

chinese 5,938 29.62 29.55 29.70

indian2 1,786 8.91 8.87 8.95

indigenous 1253 6.25 6.22 6.28

others3 48 0.24 0.23 0.25

SubtotAl 20,047* 100 - -


1. Only data for Malaysians (n = 20,381) are included in the analysis for ethnicity.

2. Includes Sikhs/Punjabis

3. Includes Eurasian, mixed parentage, others but not specified, etc.

table 4.3: Characteristic of encounters by source of payment in NMCS 2010

CHaRaCTeRISTIC NUmbeRpeRCeNT Of eNCOUNTeRS

95 % CI

lOWeR UppeR

Mode of payment

gov Subsidy1 4,314 20.17 20.11 20.23

Private ooP2 12,135 56.75 56.64 56.85

Private third Parties3 4,695 21.95 21.89 22.02

Private ooP & Private third Parties4 37 0.17 0.17 0.18

others5 204 0.95 0.94 0.97

SubtotAl 21,385* 100 - -


1. Includes all encounters presented to government clinics and other government subsidy for visits to private clinics

2. Out of pocket (OOP) payment

3. Includes payment under insurance, managed-care organisations and employer (panel)

4. Refers to mixed mode of payment through OOP and private third parties

5. Includes free and others but not specified.

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Chapter 5 | THe ReaSONS fOR eNCOUNTeR

The reasons for encounter (RFE) reflect the motivation for the patient to seek medical care and this was reported in the questionnaire by the

examining doctor as a symptom, a diagnosis or a procedure. All RFEs were coded according to the ICPC-2 code. A total of 27, 748 RFEs were

captured in NMCS 2010, resulting in an average of 1.27 RFEs per encounter. As shown in Table 5.1, the majority of encounters (77.9%) visited

primary care for only one RFE. About 18% of the encounters were for two RFEs whereas the remainder had at least 3 RFEs.

Table 5.2 illustrates the reasons for encounter by ICPC-2 chapters based on body systems. General and unspecified problems refer to symptoms

such as chills, fever, general weakness or diseases which affect multiple body systems such as tuberculosis and malaria.1 Most patients visited

primary care for respiratory problems (35.1 per 100 encounters), followed by musculoskeletal (16.5 per 100 encounters), general and unspecified

(15.3 per 100 encounters), digestive (14.3 per 100 encounters), skin problems (11.4 per 100 encounters), cardiovascular (9.2 per 100 encounters),

endocrine (7.6 per 100 encounters), while 4.3 per 100 encounters were for pregnancy, child bearing and family planning. Collectively, these

problems made up nearly 90% of total RFEs.

Table 5.3 shows the top 50 most frequent RFEs in NMCS 2010. Of these, the highest RFE was upper respiratory tract symptoms (URTI), constituting

about a quarter of all RFEs. Second most frequent RFE was unspecified muscle complaints (7.0%), followed by hypertension (6.3%), dermatitis

(4.9%), gastroenteritis (4.9%), non-insulin dependent diabetes (3.3%), complete medical examination (3.2%), dyspepsia/indigestion (2.6%),

unspecified trauma/injury (2.6%) and antenatal check-up (2.2%). Among the top 10 most frequent RFEs in NMCS 2010, majority were of acute

curative in nature, except hypertension, diabetes and medical examinations.

table 5.1: Number of patients’ reasons for encounter in NMCS 2010

ReaSON TO vISIT NUmbeRpeRCeNT Of eNCOUNTeRS

95 % CI

lOWeR UppeR

one reason 17,040 77.92 77.81 78.04

two reasons 3,949 18.06 18.00 18.11

three reasons 727 3.32 3.30 3.35

Four reasons 132 0.60 0.59 0.61

More than four reasons 20 0.09 0.09 0.10

totAl 21,868 100 - -

reference

1. Wonca International Classification Committee (WICC). International Classification of Primary Care - 2nd Edition (ICPC-2 English). Available at http://archive. globalfamilydoctor.com/

wicc/pagers/english.pdf. Accessed January 2012.

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14


table 5.2: reasons for encounter by ICpC-2 chapters in NMCS 2010, in descending order

ICpC-2 CHapTeR NUmbeR*TOTal Rfe (%)**

(N = 27,748)

RaTe peR 100 eNCOUNTeR (N = 21,868)

95 % CI

lOWeR UppeR

respiratory 7,672 27.65 35.08 35.00 35.16

Musculoskeletal 3,608 13.00 16.50 16.45 16.55

general and unspecified 3,335 12.02 15.25 15.20 15.30

digestive 3,133 11.29 14.33 14.28 14.38

Skin 2,502 9.02 11.44 11.40 11.49

cardiovascular 2,015 7.26 9.21 9.17 9.25

endocrine 1,671 6.02 7.64 7.60 7.68

Pregnancy, child bearing, family planning

946 3.41 4.33 4.30 4.35

Neurological 787 2.84 3.60 3.57 3.62

eye 474 1.71 2.17 2.15 2.19

urology 375 1.35 1.71 1.70 1.73

Female genital 371 1.34 1.70 1.68 1.71

ear 370 1.33 1.69 1.67 1.71

Psychological 355 1.28 1.62 1.60 1.64

blood 68 0.25 0.31 0.30 0.32

Male genital 62 0.22 0.28 0.28 0.29

Social problems 4 0.01 0.02 0.02 0.02

totAl 27,748 100 - - -

* frequency of total reasons for encounter

** calculated based on total reasons for encounter (n = 27, 748)

15


table 5.3: top 50 reasons for encounter in NMCS 2010, in descending order

NO ReaSONS fOR eNCOUNTeR NUmbeR**TOTal pROblem

(%)*** (N = 27,748)


95 % CI

lOWeR UppeR

1 upper respiratory infection, acute 6,482 23.36 29.64 29.57 29.71

2 Muscle symptom / complaint nos* 1,945 7.01 8.89 8.85 8.93

3 Hypertension 1,745 6.29 7.98 7.94 8.02

4 dermatitis, contact/allergic 1,351 4.87 6.18 6.15 6.21

5 gastroenteritis, presumed infection 1,347 4.85 6.16 6.13 6.19

6 diabetes, non-insulin dependent 914 3.29 4.18 4.15 4.20

7complete medical examination /health evaluation

886 3.19 4.05 4.02 4.08

8 dyspepsia / indigestion 715 2.58 3.27 3.25 3.29

9 trauma / injury nos* 708 2.55 3.24 3.21 3.26

10complete medical examination / health evaluation for pregnancy

605 2.18 2.77 2.74 2.78

11 lipid disorder 511 1.84 2.34 2.32 2.36

12 Fever 471 1.70 2.15 2.13 2.17

13 Asthma 435 1.57 1.99 1.97 2.01

14 Stomach function disorder 368 1.33 1.68 1.67 1.70

15 osteoarthrosis, other 366 1.32 1.67 1.66 1.69

16Preventive immunisations / medications

360 1.30 1.65 1.63 1.66

17 conjunctivitis, infectious 324 1.17 1.48 1.47 1.50

18 cystitis / urinary infection, other 314 1.13 1.44 1.42 1.45

19 Muscle pain 256 0.92 1.17 1.15 1.19

20 vertigo / dizziness 225 0.81 1.03 1.02 1.04

21 Acute otitis media / myringitis 224 0.81 1.02 1.01 1.04

22 Headache 182 0.66 0.83 0.82 0.84

23 tonsillitis, acute 165 0.59 0.75 0.74 0.77

24 contraception female, other 160 0.58 0.73 0.72 0.74

25 dermatophytosis 144 0.52 0.66 0.65 0.67

26 back symptom / complaint 143 0.52 0.65 0.64 0.66

27 Migraine 143 0.52 0.65 0.64 0.66

28Partial medical examination / health evaluation

142 0.51 0.65 0.64 0.66 The

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table 5.3: top 50 reasons for encounter in NMCS 2010, in descending order (CONt.)

NO ReaSONS fOR eNCOUNTeR NUmbeR**TOTal pROblem

(%)*** (N = 27,748)


95 % CI

lOWeR UppeR

29Preventive immunisations /medications (neurological)

124 0.45 0.57 0.56 0.58

30 Acute bronchitis / bronchiolitis 122 0.44 0.56 0.55 0.57

31Preventive immunisations /medications (digestive)

120 0.43 0.55 0.54 0.56

32 boil / carbuncle 119 0.43 0.54 0.53 0.55

33 cough 112 0.40 0.51 0.50 0.52

34 infectious disease, other / nos* 102 0.37 0.47 0.56 0.58

35 Mouth / tongue / lip disease 100 0.36 0.46 0.45 0.47

36 gout 99 0.36 0.45 0.44 0.46

37 low back symptom / complaint 97 0.35 0.44 0.43 0.45

38 influenza 97 0.35 0.44 0.43 0.45

39Partial medical examination / health evaluation (genital female)

97 0.35 0.44 0.43 0.45

40 Abdominal pain / cramps, general 95 0.34 0.43 0.43 0.44

41 Allergy / allergic reaction nos* 89 0.32 0.41 0.40 0.42

42 constipation 84 0.30 0.38 0.38 0.39

43 Sleep disturbance 81 0.29 0.37 0.36 0.38

44 laceration / cut 80 0.29 0.37 0.36 0.37

45 urticaria 80 0.29 0.37 0.36 0.37

46 Menstrual pain 80 0.29 0.37 0.36 0.37

47 Allergic rhinitis 77 0.28 0.35 0.34 0.36

48ischaemic heart disease without angina

76 0.27 0.35 0.34 0.36

49 chickenpox 74 0.27 0.34 0.33 0.35

50 Haemorrhoids 71 0.26 0.32 0.32 0.33

totAl 27,748 100.00 - - -

*nos = not otherwise specified

** frequency of total reasons for encounter

*** calculated based on total reasons for encounter (n = 27, 748)

17


Chapter 6 | maNaGemeNT Of mORbIDITy

6.1 PreScribed MedicAtioN

anatomical therapeutic Chemical (atC) Classification System

The drugs prescribed in a primary care setting were coded according to the ATC classification, which categorises the active ingredients into

different groups according to the body system or organ on which they exert their effects as well as their chemical, pharmacological and therapeutic

properties.

According to the code, each drug is classified at five different levels. first Level is the main group, which consists of mostly organs or body

systems. Each of the 14 main groups in Level 1 are divided at 2nd Level according to their pharmacological and therapeutic effects, which are

further subdivided at 3rd and 4th levels based on their chemical, pharmacological and therapeutic properties. The 5th Level of the code indicates

the chemical substance1.

An example of ATC classification for amlodipine is shown below. The full ATC code for plain amlodipine products is thus C08CA01.

levelS aTC CODe aTC DeSCRIpTION

1 C Cardiovascular system

2 C08 Calcium channel blockers

3 C08C Selective calcium channel blockers with mainly vascular effects

4 C08C a Dihydropyridine derivatives

5 C08C a01 amlodipine

types of Drugs prescribed

A total of 54,532 drugs were prescribed in NMCS 2010, out of which 54,204 drugs (99.4%) were coded according to the ATC classification. The

remaining 328 drugs could not be coded due to illegible writing or spelling errors.

In this report, data is being presented according to the main groups (ATC Level 1 – Table 6.1) and main therapeutic groups (ATC Level 2 – Table

6.2) followed by a list of Top 100 most prescribed medications, in descending order (Table 6.3).

Overall, respiratory system drugs were the highest prescribed (R – 24.1%), with an average of 59.8 encounters (95%CI 59.7 – 59.9) being given

a drug from this group in every 100 encounters. This is followed by drugs for alimentary tract and metabolism (A – 18.5%) and drugs for nervous

system (N – 14.2%) (Table 6.1).

Antihistamines for systemic use (R06 – 13.4%) were the most frequently prescribed main therapeutic group (ATC Level 2), followed by analgesics

(N02 – 12.0%), antibacterials for systemic use (J01 – 11.1%), anti-inflammatory and antirheumatic products (M01 – 9.3%) and cough and cold

preparations (R05 – 4.3%). All 78 ATC Level 2 Codes identified in NMCS 2010 are listed in Table 6.2.

Among all the 54,204 coded drugs, paracetamol (11.1%) was the most prescribed drug, far outnumbering diphenhydramine combination products

(4.3%), chlorphenamine (or chlorpheniramine – 3.8%), mefenamic acid (3.4%) and amoxicillin (3.3%) (Table 6.3).

reference

1. WHO Collaborating Centre for Drug Statistics Methodology, Guidelines for ATC classification and DDD assignment 2011. Oslo, 2010. Man

agem

ent o

f Mor

bidi

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table 6.1 Distribution of prescribed medications by atC Level 1 in NMCS 2010, in descending order

NOaTC l1

aTC level 1 DeSCRIpTION NUmbeR*

pROpORTION Of pReSCRIbeD

meDICaTIONS (%)** (N = 54,204)


95 % CI

lOWeR UppeR

1 r respiratory system 13,068 24.11 59.76 59.66 59.86

2 A Alimentary tract and metabolism 10,039 18.52 45.91 45.82 46.00

3 N Nervous system 7,710 14.22 35.26 35.19 35.34

4 M Musculo-skeletal system 7,239 13.36 33.10 32.02 33.18

5 j Antiinfectives for systemic use 6,657 12.28 30.44 30.37 30.51

6 c cardiovascular system 3,340 6.16 15.27 15.22 15.33

7 d dermatologicals 2,478 4.57 11.33 11.29 11.38

8 HSystemic hormonal preparations, excl. sex hormones and insulins

1,239 2.29 5.67 5.63 5.70

9 b blood and blood forming organs 848 1.56 3.88 3.85 3.90

10 S Sensory organs 781 1.44 3.57 3.55 3.60

11 ggenitourinary system and sex hormones

478 0.88 2.19 2.17 2.21

12 PAntiparasitic products, insecticides and repellents

317 0.58 1.45 1.43 1.47

13 v various 8 0.01 0.04 0.03 0.04

14 lAntineoplastic and immunomodulating agents

2 0.00 0.01 0.01 0.01

totAl coded drugS 54,204 100.00 - - -

* frequency of total coded drugs

** calculated based on total coded drugs (n = 54,204)

19


table 6.2: Distribution of prescribed medications by atC level 2 in NMCS 2010, in descending order

NO aTC l2 aTC level 2 DeSCRIpTIONS NUmbeR*




95 % CI

lOWeR UppeR

1 r06 Antihistamines for systemic use 7,191 13.35 32.88 32.80 32.96

2 N02 Analgesics 6,455 11.98 29.52 29.45 29.59

3 j01 Antibacterials for systemic use 5,992 11.12 27.40 27.33 27.47

4 M01Antiinflammatory and antirheumatic products

5,000 9.28 22.86 22.80 22.93

5 r05 cough and cold preparations 2,316 4.30 10.59 10.55 10.63

6 A02 drugs for acid related disorders 2,315 4.30 10.59 10.54 10.63

7 A03drugs for functional gastrointestinal disorders

2,144 3.98 9.80 9.76 9.85

8 A07Antidiarrheals, intestinal antiinflammatory / antiinfective agents

1,764 3.27 8.07 8.03 8.10

9 r01 Nasal preparations 1,636 3.04 7.48 7.45 7.52

10 A11 vitamins 1,560 2.90 7.13 7.10 7.17

11 H02 corticosteroids for systemic use 1,194 2.22 5.46 5.43 5.49

12 A10 drugs used in diabetes 1,188 2.21 5.43 5.40 5.46

13 r03drugs for obstructive airway diseases

1,104 2.05 5.05 5.02 5.08

14 d07corticosteroids, dermatological preparations

835 1.55 3.82 3.79 3.84

15 r02 throat preparations1 821 1.52 3.75 3.73 3.78

16 M09other drugs for disorders of the musculo-skeletal system2 775 1.44 3.54 3.52 3.57

17 M03 Muscle relaxants 728 1.35 3.33 3.30 3.35

18 c07 beta blocking agents 718 1.33 3.28 3.26 3.31

19 c10 lipid modifying agents 681 1.26 3.11 3.09 3.14

20 N05 Psycholeptics 663 1.23 3.03 3.01 3.05

21 c08 calcium channel blockers 650 1.21 2.97 2.95 3.00

22 c09Agents acting on the renin-angiotensin system

633 1.17 2.89 2.87 2.92

23 M02topical products for joint and muscular pain

596 1.11 2.73 2.70 2.75

24 b03 Antianemic preparations3 573 1.06 2.62 2.60 2.64

25 d01Antifungals for dermatological use

499 0.93 2.28 2.26 2.30

26 S01 ophthalmologicals 492 0.91 2.25 2.23 2.27

27 A12 Mineral supplements 427 0.79 1.95 1.93 1.97

28 N07 other nervous system drugs4 416 0.77 1.90 1.88 1.92

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table 6.2: Distribution of prescribed medications by atC level 2 in NMCS 2010, in descending order (CONt)





95 % CI

lOWeR UppeR

29 c03 diuretics 404 0.75 1.85 1.83 1.87

30 d06Antibiotics and chemotherapeutics for dermatological use

371 0.69 1.70 1.68 1.71

31 j07 vaccines 326 0.61 1.49 1.47 1.51

32 d04Antipruritics, incl. antihistamines, anesthetics, etc.

312 0.58 1.43 1.41 1.44

33 g03Sex hormones and modulators of the genital system

268 0.50 1.23 1.21 1.24

34 A01 Stomatological preparations 264 0.49 1.21 1.19 1.22

35 b01 Antithrombotic agents 237 0.44 1.08 1.07 1.10

36 A06 laxatives 207 0.38 0.95 0.93 0.96

37 P01 Antiprotozoals 204 0.38 0.93 0.92 0.95

38 d02 emollients and protectives 190 0.35 0.87 0.86 0.88

39 S03ophthalmological and otological preparations

170 0.32 0.78 0.77 0.79

40 j02 Antimycotics for systemic use 168 0.31 0.77 0.76 0.78

41 d08Antiseptics and disinfectants, topical

161 0.30 0.74 0.72 0.75

42 g04 urologicals 160 0.30 0.73 0.72 0.74

43 M04 Antigout preparations 133 0.25 0.61 0.60 0.62

44 j05 Antivirals for systemic use 127 0.24 0.58 0.57 0.59

45 S02 otologicals 119 0.22 0.54 0.53 0.55

46 c05 vasoprotectives 115 0.21 0.53 0.52 0.54

47 N06 Psychoanaleptics 106 0.20 0.48 0.48 0.49

48 c01 cardiac therapy5 78 0.14 0.36 0.35 0.36

49 P03ectoparasiticides, incl. scabicides, insecticides and repellents

61 0.11 0.28 0.27 0.29

50 c02 Antihypertensives 60 0.11 0.27 0.27 0.28

51 A13 tonics 55 0.10 0.25 0.24 0.26

52 P02 Anthelmintics 52 0.10 0.24 0.23 0.24

53 g01gynecological antiinfectives and antiseptics

48 0.09 0.22 0.21 0.23

54 A08Antiobesity preparations, excl. diet products

47 0.09 0.21 0.21 0.22

55 H03 thyroid therapy 43 0.08 0.20 0.19 0.20

56 j04 Antimycobacterials 43 0.08 0.20 0.19 0.20

21


table 6.2: Distribution of prescribed medications by atC level 2 in NMCS 2010, in descending order (CONt)





95 % CI

lOWeR UppeR

57 N03 Antiepileptics 43 0.08 0.20 0.19 0.20

58 d10 Anti-acne preparations 42 0.08 0.19 0.19 0.20

59 A16other alimentary tract and metabolism products

36 0.07 0.16 0.16 0.17

60 d11 other dermatological preparations 27 0.05 0.12 0.12 0.13

61 b02 Antihemorrhagics 22 0.04 0.10 0.10 0.10

62 d05 Antipsoriatics 22 0.04 0.10 0.10 0.10

63 A09 digestives, incl. enzymes 19 0.04 0.09 0.08 0.09

64 b05blood substitutes and perfusion solutions

16 0.03 0.07 0.07 0.08

65 N04 Anti-parkinson drugs 16 0.03 0.07 0.07 0.08

66 A05 bile and liver therapy 11 0.02 0.05 0.05 0.05

67 d03Preparations for treatment of wounds and ulcers

11 0.02 0.05 0.05 0.05

68 N01 Anesthetics 11 0.02 0.05 0.05 0.05

69 d09 Medicated dressings 8 0.01 0.04 0.03 0.04

70 v06 general nutrients 8 0.01 0.04 0.03 0.04

71 M05drugs for treatment of bone diseases

7 0.01 0.03 0.03 0.03

72 A04 Antiemetics and antinauseants 2 0.00 0.01 0.01 0.01

73 g02 other gynecologicals6 2 0.00 0.01 0.01 0.01

74 H05 calcium homeostasis7 2 0.00 0.01 0.01 0.01

75 c04 Peripheral vasodilators 1 0.00 0.00 0.00 0.01

76 j06 immune sera and immunoglobulins 1 0.00 0.00 0.00 0.01

77 l02 endocrine therapy 1 0.00 0.00 0.00 0.01

78 l04 immunosuppressants 1 0.00 0.00 0.00 0.01



1. Refers to preparations for common minor infections of mouth and throat, consisting of mainly lozenges

2. Refers to drugs for musculoskeletal system other than anti-inflammatory and antirheumatic products, topical products for joint and muscle pain, antigout preparations and drugs for bone diseases. For example, enzymes preparations and hyaluronic acid injections

3. Includes iron preparations, vitamin B12 and folic acid, and other antianemic preparations

4. Refers to drugs for nervous system other than anaesthetics, analgesic, anti-parkinson drugs, anti-epileptics, psycholeptics and psychoanaleptics, e.g. antivertigo preparations

5. Includes cardiac glycosides, antiarrhythmics, cardiac stimulants and vasodilators for cardiac diseases

6. Includes intrauterine devices

7. Includes calcitonin preparations

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table 6.3: top 100 most prescribed medications in NMCS 2010, in descending order

NO aTC CODe aTC DeSCRIpTION NUmbeR*




95 % CI

lOWeR UppeR

1 N02be01 Paracetamol (plain) 6,000 11.07 27.44 27.37 27.51

2 r06AA52 diphenhydramine, combinations 2,312 4.27 10.57 10.53 10.62

3 r06Ab04 chlorphenamine 2,078 3.83 9.50 9.46 9.54

4 M01Ag01 Mefenamic acid 1,827 3.37 8.35 8.32 8.39

5 j01cA04 Amoxicillin 1,769 3.26 8.09 8.05 8.13

6 M01Ab05 diclofenac 1,720 3.17 7.87 7.83 7.90

7 r01bA52 Pseudoephedrine, combinations 1,498 2.76 6.85 6.82 6.88

8 A03bb01 butylscopolamine (hyoscine) 1,077 1.99 4.93 4.90 4.95

9 j01db01 cefalexin 861 1.59 3.94 3.91 3.96

10 H02Ab06 Prednisolone 839 1.55 3.84 3.81 3.86

11 M09Ab enzymes 775 1.43 3.54 3.52 3.57

12 r06Ab02 dexchlorpheniramine 712 1.31 3.26 3.23 3.28

13 A02AA10Magnesium compounds, combinations; antacid

656 1.21 3.00 2.98 3.02

14 r06Ae07 cetirizine 636 1.17 2.91 2.89 2.93

15 A07cAoral rehydration salt formulations

624 1.15 2.85 2.83 2.88

16 M03bc51 orphenadrine, combinations1 585 1.08 2.68 2.65 2.70

17 A10bA02 Metformin 575 1.06 2.63 2.61 2.65

18 j01FA01 erythromycin 572 1.06 2.62 2.59 2.64

19 A02AF02ordinary salt combinations and antiflatulents

569 1.05 2.60 2.58 2.62

20 r05cb02 bromhexine 565 1.04 2.58 2.56 2.60

21 r06AX13 loratadine 543 1.00 2.48 2.46 2.50

22 r05dA20opium alkaloids and derivatives, combinations; cough suppressants

542 1.00 2.48 2.46 2.50

23 r03cc02 Salbutamol; for systemic use 498 0.92 2.28 2.26 2.30

24 M02AcPreparations with salicylic acid derivatives; topical products for joint and muscular pain

491 0.91 2.25 2.23 2.27

25 A11gA01 Ascorbic acid (vit c) 468 0.86 2.14 2.12 2.16

26 M01Ae01 ibuprofen 452 0.83 2.07 2.05 2.09

27 c07Ab03 Atenolol 451 0.83 2.06 2.04 2.08

23


table 6.3: top 100 most prescribed medications in NMCS 2010, in descending order (CONt)





95 % CI

lOWeR UppeR

28 j01cF02 cloxacillin 430 0.79 1.97 1.95 1.99

29 A11dbvitamin b1 in combination with vitamin b6 and/or vitamin b12

427 0.79 1.95 1.93 1.97

30 r06AA02 diphenhydramine 390 0.72 1.78 1.77 1.80

31 A07dA03 loperamide 376 0.69 1.72 1.70 1.74

32 r05dA09 dextromethorphan 369 0.68 1.69 1.67 1.71

33 j01cr02 Amoxicillin and enzyme inhibitor 364 0.67 1.66 1.65 1.68

34 A03AX13Silicones; for functional bowel disorder

355 0.65 1.62 1.61 1.64

35 A07dA01 diphenoxylate2 354 0.65 1.62 1.60 1.64

36 A02bA01 cimetidine 345 0.64 1.58 1.56 1.59

37 d07Ac01 betamethasone; topical 343 0.63 1.57 1.55 1.59

38 c08cA01 Amlodipine 340 0.63 1.55 1.54 1.57

39 A03FA01 Metoclopramide 326 0.60 1.49 1.47 1.51

40 N05Ab04 Prochlorperazine 318 0.59 1.45 1.44 1.47

41 d04AX other antipruritics; topical3 310 0.57 1.42 1.40 1.43

42 S01AA01chloramphenicol; ophthalmologicals

299 0.55 1.37 1.35 1.38

43 c10AA02 lovastatin 297 0.55 1.36 1.34 1.37

44 j01ee01Sulfamethoxazole and trimethoprim

280 0.52 1.28 1.27 1.30

45 M01Ac06 Meloxicam 275 0.51 1.26 1.24 1.27

46 c08cA05 Nifedipine 274 0.51 1.25 1.24 1.27

47 r06Ad02 Promethazine 274 0.51 1.25 1.24 1.27

48 N07cA02 cinnarizine 237 0.44 1.08 1.07 1.10

49 b03bb01 Folic acid 230 0.42 1.05 1.04 1.07

50 A03FA03 domperidone 224 0.41 1.02 1.01 1.04

51 r02A throat preparations4 224 0.41 1.02 1.01 1.04

52 A07bA01 Medicinal charcoal 223 0.41 1.02 1.00 1.03

53 A11eA vitamin b-complex, plain 218 0.40 1.00 0.98 1.01

54 A10bb09 gliclazide 214 0.39 0.98 0.97 0.99

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95 % CI

lOWeR UppeR

55 A10bb01 glibenclamide 213 0.39 0.97 0.96 0.99

56 c03AA03 Hydrochlorothiazide 212 0.39 0.97 0.96 0.98

57 d01Ac20imidazole and triazole derivatives, combinations with corticosteroids

206 0.38 0.94 0.93 0.96

58 c09AA04 Perindopril 204 0.38 0.93 0.92 0.95

59 c10AA01 Simvastatin 204 0.38 0.93 0.92 0.95

60 N02be51Paracetamol, combinations excluding psycholeptics

203 0.37 0.93 0.92 0.94

61 b01Ac06 Acetylsalicylic acid 202 0.37 0.92 0.91 0.94

62 j01AA02 doxycycline 202 0.37 0.92 0.91 0.94

63 P01Ab01 Metronidazole 199 0.37 0.91 0.90 0.92

64 A02bA02 ranitidine 198 0.37 0.91 0.89 0.92

65 A11bA Multivitamins, plain 188 0.35 0.86 0.85 0.87

66 A02bc01 omeprazole 180 0.33 0.82 0.81 0.84

67 r03dA04 theophylline 179 0.33 0.82 0.81 0.83

68 A02bA03 Famotidine 177 0.33 0.81 0.80 0.82

69 A12AA05 calcium lactate 174 0.32 0.80 0.78 0.81

70 M01Ae02 Naproxen 174 0.32 0.80 0.78 0.81

71 j01MA02 ciprofloxacin 172 0.32 0.79 0.77 0.80

72 A12bA02 Potassium citrate 171 0.32 0.78 0.77 0.79

73 M01Ac01 Piroxicam 170 0.31 0.78 0.77 0.79

74 j01db05 cefadroxil 162 0.30 0.74 0.73 0.75

75 H02Ab02dexamethasone; for systemic use

154 0.28 0.70 0.69 0.72

76 c07Ab02 Metoprolol 152 0.28 0.70 0.68 0.71

77 r05cb06 Ambroxol 147 0.27 0.67 0.66 0.68

78 S03cA01dexamethasone and antiinfectives combinations; opthalmologicals and otologicals

147 0.27 0.67 0.66 0.68

79 r02AA02dequalinium; throat preparations5 145 0.27 0.66 0.65 0.67

80 d07AA02 Hydrocortisone; topical 144 0.27 0.66 0.65 0.67

81 r03Ac02 Salbutamol; inhalation 144 0.27 0.66 0.65 0.67

25







95 % CI

lOWeR UppeR

82 r05Xother cold combination preparations6 143 0.26 0.65 0.64 0.66

83 r05db21 cloperastine 141 0.26 0.64 0.63 0.66

84 j01FA09 clarithromycin 140 0.26 0.64 0.63 0.65

85 d02AXother emollients and protectives7 131 0.24 0.60 0.59 0.61

86 j07AM01 tetanus toxoid 131 0.24 0.60 0.59 0.61

87 r03cc03 terbutaline; for systemic use 131 0.24 0.60 0.59 0.61

88 b03AA02 Ferrous fumarate 130 0.24 0.59 0.58 0.60

89 d07cc01betamethasone and antibiotics combinations; topical

124 0.23 0.57 0.56 0.58

90 d06AX01 Fusidic acid; topical 123 0.23 0.56 0.55 0.57

91 H02Ab01betamethasone; for systemic use

116 0.21 0.53 0.52 0.54

92 A01Ac01triamcinolone; for local oral treatment

113 0.21 0.52 0.51 0.53

93 r05cA10 expectorant, combinations 112 0.21 0.51 0.50 0.52

94 r02AA20other antiseptics; throat preparations8 109 0.20 0.50 0.49 0.51

95 c09AA02 enalapril 108 0.20 0.49 0.48 0.50

96 g04bX other urologicals 106 0.20 0.48 0.48 0.49

97 M01AH05 etoricoxib 106 0.20 0.48 0.48 0.49

98 r02AX other throat preparations9 106 0.20 0.48 0.48 0.49

99 r05cb03 carbocisteine 106 0.20 0.48 0.48 0.48

100 j02Ab02 Ketoconazole; for systemic use 104 0.19 0.48 0.47 0.48

totAl coded drugS 54,204 100.00



1. Including combinations with paracetamol

2. Including combinations with atropine

3. Excluding topical anthistamines and anaesthetics

4. Unspecified lozenges

5. Refers to dequalinium lozenges

6. Including cough and cold preparations which were neither expectorants nor cough suppressants, such as methol inhalations, traditional remedies

7. Including soft paraffin and fat products with high water content (creams) such as aqueous creams, emulsifying ointment

8. Refers to antiseptic gargle

9. Refers to herbal lozenges

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6.2 coNtiNuity oF cAre

The majority of encounters were not followed up (74.7%) only 22.9% had follow ups while a small number (0.9%) of encounters were referred

to other doctors/specialists, to hospitals (0.7%) and to others (0.8%). This survey did not capture which health indications were sent for referral.

table 6.4: Follow up proposed by primary care practitioners in NMCS 2010

vISIT DISpOSITION NUmbeR TOTal (%)95 % CI

lOWeR UppeR

No follow up planned 15,803 74.73 74.62 74.85

Follow up planned 4,872 23.04 22.98 23.10

referral to other doctor / specialist1 185 0.87 0.86 0.89

referral to hospital2 141 0.67 0.66 0.68

others3 145 0.69 0.68 0.70

SubtotAl 21,146* 100 - -

* includes presence of missing data

1. Includes referral to other doctors (e.g. doctors in government clinics), physicians, specialists

2. Includes referral to hospital emergency department and hospital follow up

3. Includes referral for procedures (e.g. x-ray, mammogram), allied health professionals (e.g. physiotherapist), others but not specified

27


APPENDIX 1 | paRTICIpaNTS Of NmCS 2010

pUblIC/mINISTRy Of HealTH

Wilayah persekutuan Kuala lumpur

1 Klinik Kesihatan Pantai 2 Klinik Kesihatan Sentul

Wilayah persekutuan putrajaya

1 Klinik Kesihatan Putrajaya

Selangor

1 Poliklinik Komuniti Sungai Buloh 8 Poliklinik Komuniti Jenjarom

2 Poliklinik Komuniti Selayang Baru 9 Poliklinik Komuniti Jeram

3 Poliklinik Komuniti Klang 10 Poliklinik Komuniti Seri Kembangan

4 Poliklinik Komuniti Hulu Langat ( Klinik Kesihatan Batu 13 1/4) 11 Poliklinik Komuniti Shah Alam

5 Poliklinik Komuniti Kampung Soeharto 12 Poliklinik Komuniti Sungai Pelek

6 Poliklinik Komuniti Telok Datok 13 Klinik Kesihatan Bestari Jaya

7 Poliklinik Komuniti Kg. Bandar

Kedah

1 Klinik Kesihatan Merbok 8 Klinik Kesihatan Kulim

2 Klinik Kesihatan Bakar Arang 9 Klinik Kesihatan Bandar Alor Setar

3 Klinik Kesihatan Sungai Limau Dalam 10 Poliklinik Komuniti Kota Sarang Semut

4 Poliklinik Komuniti Banai 11 Poliklinik Komuniti Pokok Sena

5 Poliklinik Komuniti Tunjang 12 Poliklinik Komuniti Jalan Putra

6 Poliklinik Komuniti Laka Temin 13 Klinik Kesihatan Kuah

7 Klinik Kesihatan Bandar Baharu 14 Klinik Kesihatan Padang Matsirat

Kelantan

1 Klinik Kesihatan Badang 4 Klinik Kesihatan Gual Ipoh

2 Klinik Kesihatan Pengkalan Chepa 5 Klinik Kesihatan Gaal

3 Klinik Kesihatan Wakaf Bharu

Johor

1 Klinik Kesihatan Bagan 7 Poliklinik Komuniti Parit Jawa

2 Klinik Kesihatan Kulai Besar 8 Klinik Kesihatan Bakri

3 Poliklinik Komuniti Kampung Majidee 9 Poliklinik Komuniti Pontian (Klinik Kesihatan Pontian)

4 Poliklinik Komuniti Ulu Tiram 10 Poliklinik Komuniti Batu Anam

5 Poliklinik Komuniti Air Tawar 2 11 Klinik Kesihatan Ayer Hitam, Batu Pahat

6 Poliklinik Komuniti Bukit Besar

melaka

1 Klinik Kesihatan Ayer Molek 3 Klinik Kesihatan Peringgit

2 Klinik Kesihatan Kuala Sungai Baru 4 Klinik Kesihatan Ujong Pasir

Negeri Sembilan

1 Klinik Kesihatan Jelai 4 Klinik Kesihatan Palong 4,5,6

2 Klinik Kesihatan Lenggeng 5 Klinik Kesihatan Pertang

3 Klinik Kesihatan Lui Muda 6 Klinik Kesihatan Titi

Parti

cipa

nts

of N

MCS

201

0ap

px 1

28


pahang

1 Klinik Kesihatan Bandar Tun Razak 5 Klinik Kesihatan Padang Luas

2 Klinik Kesihatan Chini 6 Klinik Kesihatan Sanggang

3 Klinik Kesihatan Kampung Bantal 7 Klinik Kesihatan Sungai Lembing

4 Klinik Kesihatan Lanchang

perak

1 Klinik Kesihatan Bidor 12 Klinik Kesihatan Kuala Kurau

2 Klinik Kesihatan Bota Kiri 13 Klinik Kesihatan Lambor Kiri

3 Klinik Kesihatan Changkat Jering 14 Klinik Kesihatan Lekir

4 Klinik Kesihatan Changkat Keruing 15 Klinik Kesihatan Lintang

5 Klinik Kesihatan Chenderong Balai 16 Klinik Kesihatan Menglembu

6 Klinik Kesihatan Gopeng 17 Klinik Kesihatan Pokok Assam

7 Klinik Kesihatan Hutan Melintang 18 Klinik Kesihatan Redang Panjang

8 Klinik Kesihatan Jalan Baru 19 Klinik Kesihatan Sungai Bayor

9 Klinik Kesihatan Kampung Gajah 20 Klinik Kesihatan Tanjung Piandang

10 Klinik Kesihatan Kedai Empat 21 Klinik Kesihatan Trong

11 Klinik Kesihatan Tronoh

pulau pinang

1 Klinik Kesihatan Kepala Batas 4 Klinik Kesihatan Sungai Acheh

2 Klinik Kesihatan Mak Mandin 5 Klinik Kesihatan Tasek Gelugor

3 Klinik Kesihatan Nibong Tebal

Sabah

1 Klinik Kesihatan Luyang 6 Poliklinik Komuniti Perancangan

2 Poliklinik Komuniti Bundu Tuhan 7 Poliklinik Komuniti Telaga

3 Poliklinik Komuniti Karakit 8 Poliklinik Komuniti Tinangol

4 Poliklinik Komuniti Paginatan 9 Poliklinik Komuniti Tongod

5 Poliklinik Komuniti Penangah

Sarawak

1 Klinik Kesihatan Balai 12 Klinik Kesihatan Nanga Tau

2 Klinik Kesihatan Batu Danau 13 Klinik Kesihatan Nanga Wak

3 Klinik Kesihatan Batu Kawa 14 Klinik Kesihatan Pakan

4 Klinik Kesihatan Biawak 15 Klinik Kesihatan Sambir

5 Klinik Kesihatan Kuala Balingian 16 Klinik Kesihatan Sematan

6 Klinik Kesihatan Long Sukang 17 Klinik Kesihatan Spaoh

7 Klinik Kesihatan Nanga Ensiring 18 Klinik Kesihatan Tanjung Manis

8 Klinik Kesihatan Nanga Entaih 19 Klinik Kesihatan Tarat

9 Klinik Kesihatan Nanga Patoh 20 Klinik Kesihatan Tian

10 Klinik Kesihatan Nanga Semah 21 Klinik Kesihatan Trusan

11 Klinik Kesihatan Tubau

Terengganu

1 Poliklinik Komuniti Kampong Raja type 3 3 Poliklinik Komuniti Ketengah Jaya

2 Poliklinik Komuniti Al-Muktafi Billah Shah

29


pRIvaTe

Johor

1 Klinik Gan Surgery 46 Klinik Teo ( Klinik Teo & Tan Sdn Bhd )

2 Klinik Joseph Varghese 47 Klinik Ishi

3 Klinik K-K 48 Poliklinik Penawar - Kg Pasir, Tampoi

4 Klinik P. N. Teoh 49 Klinik Praba

5 Klinik Theesan (Taman U) 50 Poliklinik Penawar - Masai

6 Klinik Lee 51 Klinik Daya Singh Sdn Bhd

7 Klinik Naveen 52 Poliklinik Penawar - Tmn Universiti

8 Kelinik Rakyat (Yong Peng) 53 Poliklinik Damai & Surgeri, Tmn Desa Jaya

9 Klinik Toledo 54 Poliklinik Puteri Dan Surgeri (Jln Niaga, Kota Tinggi)

10 Federal Clinic (Century Garden) 55 Poliklinik Penawar (Pusat Bandar, Bandar Penawar)

11 PoliKlinik P & Lee (Taman Intan) 56 Poliklinik Penawar - Tmn Bintang, Senai

12 Klinik Adham Cawangan Kota Tinggi 57 Kelinik Woo & Hong

13 Klinik Anda 58 24 Jam Poliklinik Yap

14 Poliklinik Fatimah (Taman Daya) 59 Klinik Keluarga

15 Klinik Adham Cawangan Indahpura 60 Poliklinik Penawar

16 Klinik Chan & Ng 61 Poliklinik Penawar - Tmn Istimewa Pandan

17 Klinik Foo 62 Klinik Sentosa

18 Klinik Hooi 63 Klinik Sejahtera (Pt. Raja)

19 Klinik Hosanna 64 Poliklinik John

20 Klinik Insan Sdn Bhd (Tmn U) 65 Klinik Pertama ( Tmn Johor Jaya )

21 Klinik Jamaliah 66 Klinik Skudai

22 Klinik Kamal 67 Klinik Githa (Tmn Mesra, Saleng)

23 Klinik Kota, Yong Peng 68 The People Dispensary Sdn Bhd (Klinik People Masai)

24 Kelinik Mersing 69 Klinik Sri Sulong

25 Klinik Murni 70 Poliklinik Penawar (Tmn Tun Sri Lanang)

26 Klinik Penawar & Surgeri, Kluang 71 Poliklinik Jaya Skudai

27 Klinik Tawakal, Rengit 72 Klinik Selesa Jaya

28 Klinik Wira 73 Poliklinik Ihsan (Tmn Kempas)

29 Klinik Zainab 74 Klinik Public, Kulai

30 Poliklinik Dahlia 75 Tay & Tan Medicare Sdn Bhd ( T & T Clinic)

31 Poliklinik Penawar - Tmn Rinting 76 Klinik Australia

32 Poliklinik Tan 77 Klinik Wan Suhaimi

33 Poliklinik Penawar (Tmn Air Biru) 78 Poliklinik Penawar - Tmn Sri Bahagia

34 Klinik Intan, Johor Bahru 79 Poliklinik Taj 24 Jam,Taman Tampoi Utama

35 Poliklinik Universiti 80 Klinik Uma

36 Klinik Sandhu Senai 81 Poliklinik Sejahtera Sdn Bhd

37 Klinik M. Y. Wong 82 Klinik Mohan

38 Klinik Dan Surgeri Taman Daya 83 Klinik Adham ( Senai I )

39 Klinik Yee 84 Poliklinik PTP

40 Klinik Githa, Tmn Kulai Utama 85 Klinik S. T. Ng

41 Klinik Wong (Jln Senohong Dua) 86 Poliklinik Impian

42 Poliklinik Sutera 87 Poliklinik Penawar - Tanjung Sedili

43 Poliklinik Penawar - Tmn Dahlia 88 Poliklinik Mesra

44 Klinik Githa, Kelapa Sawit 89 Poliklinik Penawar (Tmn Kota Masai, Jln Betik)

45 Klinik People (Permas Jaya) 90 Kelinik Malaysia Johor Bahru

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Johor (CONT)

91 Klinik Achutha 121 Klinik Wong (Jln Temenggong)

92 Klinik Dhass Sdn Bhd 122 Klinik Zainon

93 Poliklinik Anggerik 123 Klinik Zalina

94 Poliklinik Hijrah (Tmn Puteri Wangsa) 124 Klinik Perintis Health Care

95 Poliklinik Penawar - Felda Tenggaroh 2 125 Klinik Razak

96 Poliklinik Penawar (Felda Kledang) 126 Klinik Redzuan

97 Poliklinik Penawar (Jalan Suasa, Pasir Gudang) 127 Klinik Sairam

98 Poliklinik Penawar - Kolam Air 128 Klinik Sia Dan Surgeri

99 Poliklinik Penawar - Tmn Daya 129 Poliklinik Koh

100 Kelinik Sri Larkin (Tmn Perindustrian Tebrau) 130 Poliklinik Kuek

101 Klinik Aishah 131 Poliklinik Amin

102 Klinik Chew Dan Surgeri 132 Poliklinik Cempaka (Tmn Air Biru)

103 BP Diagnostic Centre Sdn Bhd (Tmn Century) 133 Poliklinik Medic

104 Klinik Adham (Bandar Putra) 134 Poliklinik Sejahtera

105 Klinik Adham (Caw. Larkin) 135 Poliklinik Penawar (Tmn Johor Jaya)

106 Klinik Hussien 136 Poliklinik Rozikin (Masai)

107 Klinik King 137 The People Dispensary Sdn Bhd (Jln Ibrahim)

108 Klinik Ali 138 Titan Inplant Clinic Tg Langsat

109 Klinik Keluarga (Segamat) 139 Titan P Gudang Inplant Clinic

110 Klinik Amar 140 Klinik i Care

111 Klinik Bakti 141 Klinik Tan & Lum (Benut)

112 Klinik Goh & Surgeri 142 Klinik Tan & Lum (Pekan Nenas)

113 Klinik Kulit Pertama 143 Klinik Aliza Sdn Bhd

114 Klinik Mulia Pasir Gudang 144 Klinik Kwang

115 Klinik Rompin 145 Klinik Malaysia

116 Klinik Makmur 146 Dispensari Huang

117 Klinik Senggarang (Klinik Teo & Tan Sdn Bhd) 147 Klinik Rashid dan Raudhah

118 Klinik Sinaran 148 Klinik Pontian

119 Klinik Tee 149 Poliklinik Zakariya

120 Klinik Parit Yaani

Kedah

1 Klinik Ceria 14 Klinik Lim Chin Chong Sdn Bhd

2 Klinik Cham 15 Klinik Low

3 Klinik Cheng & Su, Tmn Sejati Indah 16 Klinik Pakar Dr Adnan Osman (Poliklinik Pakar Perubatan Jitra)

4 Klinik Cheng & Su, Wisma Bandaran 17 Klinik Pakar Dr Adnan Osman (Poliklinik Pakar Perubatan Jitra)

5 Klinik Cinta Sayang, Tmn Ria jaya 18 Klinik Rapha

6 Klinik Doreen Khoo 19 Klinik Sanan

7 Klinik Dr Rosly 20 Klinik Soma

8 Klinik Faisal Hamdi 21 Klinik Sri Cengal

9 Klinik Fatimah 22 Poliklinik Tanjung

10 Klinik Fernandez Lunas 23 Klinik Teoh Kim Yong

11 Klinik Foong 24 Klinik Ummi

12 Klinik Gurun 25 Klinik Yahya

13 Klinik Lathika 26 Klinik Yeoh & Ong

31


Kedah (CONT)

27 Mediklinik Ehsan Alor Setar 36 Poliklinik Dr. Azhar & Rakan-rakan

28 Petronas Fertilizer (Kedah) Sdn. Bhd. Industrial Clinic 37 Poliklinik Dr. Azhar & Rakan-rakan, Plaza Kuala Kedah

29 Poliklinik Afiat 38 Poliklinik Dr. Jalaludin

30 Poliklinik Berkat 39 Poliklinik Famili

31 Poliklinik Dr. Azhar & Rakan-rakan 40 Poliklinik Mutiara Cawangan Simpang Kuala

32 Poliklinik Dr. Azhar & Rakan-rakan 41 Poliklinik Mutiara, Tmn Desa Aman

33 Poliklinik Dr. Azhar & Rakan-rakan 42 Poliklinik Sandhu

34 Poliklinik Dr. Azhar & Rakan-rakan 43 Poliklinik Tan

35 Poliklinik Dr. Azhar & Rakan-rakan

Kelantan

1 Aziz Clinic 16 Klinik Lim

2 Klinik A Wahab 17 Klinik Lua, Jln Sultan Yahya Petra

3 Klinik An Nuur 18 Klinik Nik

4 Klinik Ariffin 19 Klinik Perdana - Bgn PKINK

5 Klinik Dr Kamaludin 20 Klinik Perdana Cawangan Islah

6 Klinik Dr Nida 21 Klinik Perdana Melor

7 Klinik Dr Ramzi 22 Klinik Prihatin

8 Klinik Dr. Wan Abdul Kadir 23 Klinik Rahimah

9 Klinik Dr. Yasiman Perdana 24 Klinik Rusli

10 Klinik Farisya 25 Klinik Sayyida Sdn.Bhd.

11 Klinik Fatah & Abdullah 26 Klinik Shafee

12 Klinik Ho 27 Klinik Suhaila

13 Klinik Ikthiar Kota Jambal 28 Klinik Wan Fatimah

14 Klinik Insaf 29 Poliklinik Utama

15 Klinik Kota Bharu

melaka

1 Klinik Dr.Raimah & X-Ray 15 Klinik A Famosa

2 Klinik Keluarga Dr.Fauziah 16 Klinik Nik Amrah & Zaliha Sdn. Bhd

3 Klinik Khaw 17 Klinik Naharajan & Imaging Centre

4 Klinik Noh 18 Klinik Al Azhim

5 Klinik Perubatan Chan 19 Klinik Chin

6 The Merican Dispensary 20 Klinik Tampin

7 Klinik Masjid Tanah 21 Klinik Noor Shila

8 Poliklinik Medic 22 Kelinik Ayer Keroh

9 Klinik Kok Dan Segeri 23 Kelinik Malin Tengkera Sdn. Bhd

10 Klinik Dr Adam 24 Klinik Sohvindir

11 Klinik Ummi 25 Bukit Rambai Health Farm

12 Klinik Dr Halim Sdn Bhd 26 Kelinik Malin

13 Klinik Rohani 27 Kelinik Malin

14 Klinik Maiza 28 Klinik Cheng

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melaka (CONT)

29 Klinik Dr. Elis 37 Pusat Rawatan An-Nur (Dr.Rosnani)

30 Klinik Dr.Zanawati 38 Goh Clinic

31 Klinik Nik Amrah & Zaliha Sdn Bhd 39 Kelinik Poorni

32 Klinik Noor Shila 40 Klinik Famili

33 Klinik Ujong Pasir 41 Klinik Mutiara

34 Poliklinik Merdeka 42 Occupational Health Centre

35 Poliklinik Mesra 43 Merdeka Health Care Clinic

36 Poliklinik Wahidah

Negeri Sembilan

1 Kelinik Lung 15 Poliklinik Dan Surgeri Rahang (Cawangan Rasah Jaya)

2 Klinik Al\'azhim Tampin 16 Poliklinik Hidayah Sdn. Bhd.

3 Klinik An-Nisa 17 Poliklinik Laksmana Dan Surgeri

4 Klinik Chin & Surgeri 18 Poliklinik Pakar Dan Surgeri

5 Klinik Dr. Kassim 19 Poliklinik Porkodi

6 Klinik Dr. Norliazura 20 Klinik Keluarga Dan Surgeri

7 Klinik Hee 21 Klinik Nirmala

8 Klinik Hee & Annandan Sdn Bhd 22 Klinik Pantai, Rantau

9 Klinik Hee (Batang Melaka) 23 Klinik Rembau

10 Klinik Hee Annandan & Siva 24 Klinik Seremban

11 Klinik Hon 25 Klinik Tan Dan Surgeri

12 Klinik Insan 26 Klinik Waqaf An-Nur

13 Klinik Isza 27 Poliklinik Aman

14 Klinik Jaya

pahang

1 Klinik Asniza 16 Klinik Ratnam

2 Klinik Ban 17 Klinik Rawatan Keluarga

3 Klinik Benta 18 Klinik Rompin

4 Klinik Dr Halim & Nor 19 Klinik Roslina

5 Klinik Fa\'iza Dan Rakan Rakan 20 Klinik Seong

6 Klinik Genting Uni-Med, Gohtong Jaya 21 Klinik Sulaiman

7 Klinik Goh 22 Klinik Sulaiman

8 Klinik Iman 23 Klinik Sulaiman Jerantut

9 Klinik Lee 24 Klinik Sulaiman, Jengka

10 Klinik Looi 25 Klinik Syed Badaruddin

11 Klinik Nasha 26 Klinik Ummu Roihan Sdn Bhd

12 Klinik Ng 27 Klinik Wang

13 Klinik Pekan 28 Klinik Wang

14 Klinik Ragavan 29 Poliklinik Raub & Surgery

15 Sentosa Klinik Kuantan 30 Sentosa Klinik Taman Tas

33


perak

1 B. P. Diagnostic Centre 44 Klinik Rusnah

2 Berchaam Medical Centre 45 Klinik Shatin

3 Ipoh Skin Clinic & General 46 Klinik Simee

4 Kelinik Che Wan 47 Klinik Soong

5 Kelinik K.M. Chao 48 Klinik Su

6 Kelinik Leong 49 Klinik Syifaa

7 Klinik & Dispensari Sharil 50 Klinik Tai

8 Klinik Anand & Viknesh 51 Klinik Tweedie

9 Klinik Bhajan 52 Klinik Utama Ipoh

10 Klinik C K Chan 53 Klinik Vijayapadmam

11 Klinik Chai 54 Klinik Y. L. Khoo Sdn Bhd

12 Klinik Chee 55 Klinik Yasmin

13 Klinik Chin 56 Klinik Yusof

14 Klinik Choo 57 Klinik Zahra

15 Klinik Chua 58 Medi-klinik Teh

16 Klinik Diong Mee Nee 59 New Town Poliklinik

17 Klinik Dr Najiha 60 Peoples kelinik

18 Klinik Family Hill City 61 Perdana Polyclinic Lumut

19 Klinik G.S 62 Policlinic Qualimedic Sdn Bhd

20 Klinik Gurdip 63 Polikelinik Bakti, Parit Buntar

21 Klinik Hee 64 Poliklinik & Surgeri Batu Gajah

22 Klinik Ho 65 Poliklinik Dr. Azhar & Rakan-Rakan

23 Klinik Khong 66 Poliklinik Dr. Azhar & Rakan-Rakan

24 Klinik Kook 67 Poliklinik Dr. C.Y.Ong Sdn. Bhd.

25 Klinik Lam 68 Poliklinik Fair Park

26 Klinik Lenggong 69 Poliklinik Hashim, Sabariah Mohamad

27 Klinik Leong 70 Poliklinik Hidayah

28 Klinik Leong 71 Poliklinik Hidayah

29 Klinik Liew Choo Sin 72 Poliklinik Hidayah, Kamunting

30 Klinik Lim & Lau 73 Poliklinik Ipoh Jaya

31 Klinik Medinosis 74 Poliklinik Johari

32 Klinik Mok & Loh 75 Poliklinik Leong

33 Klinik Murshid & Tharizah Sdn. Bhd 76 Poliklinik Manjit

34 Klinik Nagoke Sdn Bhd 77 Poliklinik Maxwell

35 Klinik Ng 78 Poliklinik Meor

36 Klinik Ng & Rakan Rakan 79 Poliklinik Permai

37 Klinik Rawatan Ahsan 80 Poliklinik Ravi

38 Klinik Razak 81 Poliklinik Seri Iskandar

39 Klinik Reuben 82 Poliklinik Simpang

40 Klinik Revin 83 Poliklinik T M Chan

41 Poliklinik Tan & Wong 84 Public Poliklinik

42 Poliklinik Taqwa Simpang Pulai 85 Tang Clinic

43 Poliklinik V-Care 86 Thong Klinik

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pulau pinang

1 Hyperbaric Oxygen Therapy Centre Sdn. Bhd. 50 Klinik Seri Pulau

2 Island Medical Associates Sdn Bhd 51 Klinik Seri Pulau

3 Island Medical Associates Sdn Bhd 52 Klinik Shaik M. R.

4 Jelutong Poliklinik Khoo 53 Klinik Sidhu

5 Kelinik Khoo 54 Klinik Singapore

6 Kelinik Ratna 55 Klinik Singapore

7 Klinik Amar 56 Klinik Singapore

8 Klinik Amar 57 Klinik Singapore

9 Klinik B S Tan 58 Klinik Siva

10 Klinik Bagan Ajam 59 Klinik Special

11 Klinik Bala 60 Klinik Sri Pinang

12 Klinik Balik Pulau 16 Jam 61 Klinik Sri Rambai

13 Klinik Bersatu 16 Jam 62 Klinik Swaran

14 Klinik Bersatu 24 Jam Air Hitam 63 Klinik Syed Alwi dan Chandran

15 Klinik Bersatu Rifle Range 64 Klinik Syed Alwi dan Chandran

16 Klinik Bersatu, Tmn Ratna 65 Klinik Tan Dan Rakan-Rakan

17 Klinik Bertam 66 Klinik Team Medic

18 Klinik Budi Sungai Ara 67 Klinik Teong

19 Klinik Bukit Jambul 68 Klinik Topcare ( ALMA ) Sdn Bhd

20 Klinik Dr Rashidah 69 Klinik United

21 Klinik Dr. Jammy Suzana 70 Klinik Utama

22 Klinik Dr. Ng S.G. 71 Klinik Wawasan

23 Klinik Glugor 72 Klinik Wawasan

24 Klinik Goh 73 Klinik Yeoh Oon Theam Sdn. Bhd

25 Klinik Goh 74 Klinik Yong & Ng

26 Klinik Halbans 75 Lim Dispensary

27 Klinik Huang 76 Luke Klinik

28 Klinik Inn 77 Poliklinik Alex

29 Klinik Inthira/Joe Fernandez 78 Poliklinik Chiah

30 Klinik jaya 79 Poliklinik Chik

31 Klinik Jaya 80 Poliklinik Desa Permai

32 Klinik Jaya 81 Poliklinik Dr Chan

33 Klinik Joe Fernandez 82 Poliklinik Dr. Azhar & Rakan-Rakan

34 Klinik Joe Fernandez - Tmn Nagasari 83 Poliklinik Dr. Azhar & Rakan-Rakan

35 Klinik Koeh 84 Poliklinik Dr. Velu

36 Klinik Kok 85 Poliklinik Kuan

37 Klinik Krystal 86 Poliklinik Mah

38 Klinik Lee 87 Poliklinik Ng

39 Klinik Lim Siew Kim 88 Poliklinik Ooi

40 Klinik Malaysia 89 Poliklinik Pan-Medic

41 Klinik Munnir 90 Poliklinik Pan-Medic (Farlim)

42 Klinik P.H Yew 91 Poliklinik Reservoir Garden

43 Klinik Pertama 92 Poliklinik Sunway

44 Klinik Pertama 93 Poliklinik Suri

45 Klinik Pertama 94 Reddy Klinik Butterworth

46 Klinik Pillai 95 Selva Klinik

47 Klinik Public 96 Union Clinic (S.A)

48 Klinik Putra 97 Klinik Sein

49 Klinik Rakyat

35


Sabah

1 Foh San Clinic 17 Klinik Nasir & Surgeri

2 Kelinik Keningau Dan Surgery 18 Klinik Nuqman

3 Kelinik Wah Hai Sit 19 Klinik Papar Medical Group

4 Klinik & Surgeri Dr Jingul 20 Klinik Perubatan & Surgeri Dr. Ahmad

5 Klinik & Surgeri Sipitang 21 Klinik Siau

6 Klinik Beaufort & Surgeri (Pusat X-Ray) 22 Klinik Teo

7 Klinik Berkat Beluran 23 Klinik Tokou & Surgeri

8 Klinik Doktor Lee 24 Klinik Y. M. Lo

9 Klinik Dr Kheng 25 Kota Kinabalu Clinic

10 Klinik Dr Lee 26 Permai Polyclinics Lintas Plaza

11 Klinik Keluarga Keningau 27 Permai Polyclinics Sdn. Bhd

12 Klinik Koidupan 28 Poliklinik Rakyat - Cawangan Kota Kinabalu

13 Klinik Malaysia (Cawangan Jalan Pantai) 29 Poliklinik Rakyat - Cawangan Putatan

14 Klinik Malaysia (Cawangan Sesb) 30 Premier Polyclinic Kingfisher

15 Klinik Mariana Sdn. Bhd 31 Sinsuran Clinic

16 Klinik Mutiara Inanam

Sarawak

1 Asia Clinic 11 Klinik L.T. Wong

2 Hans Medical Clinic 12 Klinik Robert Wong

3 Kang\'s Clinic 13 Klinik Tony Sim Tong Aik

4 Klinik Abdul Rahaman Pozan 14 Klinik Waqaf An-Nur Sarawak

5 Klinik Cyril Songan 15 Klinik Yii

6 Klinik Dr. Kon 16 Loh Medical Clinic

7 Klinik Julian Wee 17 Poliklinik Limlee (formerly Poli Klinik)

8 Klinik Khaira 18 Siburan Union Clinic

9 Klinik Kiu 19 Union Clinic

10 Klinik Kotaraya (Demak Laut)

Selangor

1 Kelinik Ho 16 Klinik Medik 24-7, Bandar Country Homes

2 Klinik & Surgeri Chuah 17 Klinik Medisense Cheras

3 Klinik Anita 18 Klinik Ng Sendirian

4 Klinik Bandaran, Section 15 19 Klinik Ng Sendirian

5 Klinik Bangi 20 Klinik Ng Sendirian

6 Klinik Berkat 21 Klinik Puteri Anwar

7 Klinik Cybermedik 22 Klinik Rakyat

8 Klinik Dr Azizah, Tmn Dagang 23 Klinik Sabrina

9 Klinik Dr Lo 24 Klinik Shanti

10 Klinik Eirena 25 Klinik Sri Penawar

11 Klinik Famili Shah Alam 26 Klinik Tune

12 Klinik Kelana Puteri 27 Klinik Utama Kosas

13 Klinik Keluarga Lee 28 Klinik Wakaf An-Nur

14 Klinik Leong 29 Klinik Widuri

15 Klinik Mahkota 30 Klinik Widury

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Selangor (CONT)

31 Klinik Zalfah 40 Poliklinik Mulia Jaya

32 Klinik Zulkifli (Poliklinik & Surgeri) 41 Poliklinik Noriha

33 Kumpulan Perubatan SMP Sdn. Bhd (Klinik Pertama) 42 Poliklinik Penawar

34 Poliklinik Dan Surgeri Serdang 43 Poliklinik Salehudin

35 Poliklinik Duta Jaya 44 Poliklinik Sg Jelok

36 Poliklinik Hidayah 45 Poliklinik Sunli

37 Poliklinik Idaman 46 Pusat Perubatan Julia

38 Poliklinik Khor & Arun, Sg Besi 47 Yoong Clinic Sdn. Bhd

39 Poliklinik Kumpulan City - Dataran Templer 48 Klinik Shifak

Terengganu

1 Klinik Bharu Jerteh 10 Klinik Nabilah

2 Klinik Khuzaini & Raja Himah Sdn. Bhd. 11 Klinik Rantau Petronas

3 Klinik Kumpulan Muslimah 12 Klinik Ramli & Adibah

4 Klinik Rakyat 13 Klinik Ramli & Adibah

5 Klinik Ummi Azizan 14 Klinik Darul Iman

6 Klinik Awana Kijal 15 Klinik Hasbullah

7 Klinik Kong Dan Rakan-Rakan 16 Klinik Rahim Hamzah Halim & Razali Sdn Bhd (Jln Sultan Omar)

8 Klinik Syed Salleh Dan Rakan-Rakan Sdn. Bhd 17 Klinik Rahim Hamzah Halim & Razali Sdn Bhd (Batu 6)

9 Klinik Mamad Sdn Bhd

Wilayah persekutuan Kuala lumpur

1 BP Diagnostic Centre Sdn. Bhd. 16 Klinik H.T. Lee

2 Drs. Tong, Leow, Chiam & Partners (Chong Dispensary) 17 Klinik Idzham Sdn. Bhd, Danau Kota

3Drs. Tong, Leow, Chiam & Partners (Chong Dispensary) - Medan Pasar

18 Klinik Kaulsay

4 Drs. Tong, Leow, Chiam & Partners - Jln Ampang 19 Klinik Khor.

5 Horeb Services Sdn. Bhd. 20 Klinik Kip

6 Klinik & Surgeri Hon 21 Klinik Medicate Jln Raja Chulan

7 Klinik Arun 22 Klinik Medisense.

8 Klinik Baba Sdn. Bhd. 23 Klinik Sentul

9 Klinik Bandar Raya 24 Klinik Tan & Appaduray.

10 Klinik Britain 25 Poliklinik Chen

11 Klinik Chin, Jln Sultan Sulaiman 26 Poliklinik dan Surgeri Khor

12 Klinik Chung & Hon 27 Poliklinik Kumpulan City - Sri Damansara

13 Klinik Dr Fateh Mohd dan Rakan-Rakan 28 Poliklinik Leong & Ho

14 Klinik Dr Monty 29 Poliklinik Permata, Tmn Permata

15 Klinik Fateh Mohd & Rakan-Rakan

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APPENDIX 2 | NmCS 2010 SURvey fORm

One sheet (two pages) for one encounter - front page

Instructions:1. Where check boxes � are provided, check one or more boxes. Where radio buttons are provided, check one box only.

2. Please complete all the relevant sections.

3. Kindly return the completed form(s) by __ /__ / 20__ via either fax at 03-4043 9500 or post using the prepaid envelope to: KEMENTERIAN KESIHATAN MALAYSIA Clinical Research Centre Surveys and Research Projects 3rd Floor, MMA House,124, Jalan Pahang,53000 Kuala Lumpur.4. If you prefer to submit the information electronically, you may do so using our online survey questionnaire accessible at http://www.crc.gov.my/nhsi

5. For any queries, kindly contact the Healthcare Statistics Unit at 03-4043 9300/03-4043 9400 or email [email protected]

CLINIC NAME CLINIC ID

SECTION 1: PATIENT IDENTIFICATION AND CHARACTERISTICS

SECTION 2: CURRENT CONDITION / REASON(S) FOR ENCOUNTER

DATE OF VISIT : ( d d / m m / y y y y ) / /

/ /

Old IC:PATIENT IDENTIFIER

MyKad/ MyKid:

Others

--

Clinic registration number Passport Birth Certificate Mother’s IC Others, specify

SEX Male Female DATE OF BIRTH AGE Years

NATIONALITY

EMPLOYMENT

Malaysian Foreigner, specify : Malay Chinese Indian OthersETHNIC GROUP

HEIGHT

OCCUPATION

PATIENT’S COMPLAINT(S)/ SYMPTOM(S) [Use patient’s own words]

WEIGHTUnemployed Employed cm kg

Fever Cough Sore throat Runny nose Abdominal pain

Diarrhoea Vomiting Dyspepsia/Indigestion Constipation Red eye

Eye pain Ear pain Chest pain Palpitation Insomnia

Back pain Dizziness/Vertigo Headache Menstrual pain

Musculoskeletal injury Muscle pain Accident/Fall Swelling Other symptom(s) specify site: ............................................. specify site: ............................................. specify injury:............................................. specify site:............................................. specify ..........................................................

a. Symptoms

b. Known disease

c. Procedures and Administratives

Hypertension Atopic dermatitis/eczema Allergic dermatitis/eczema Diabetes Mellitus Hypercholestrolaemia

Asthma Osteoarthritis Acute Gastroenteritis (AGE) Gastritis Migraine

Boil Stye Gout Ulcer specify site:................................... Others, specify:........................................

Full medical check-up (FOMEMA/insurance/boarding school/college application)

Antenatal checkup Well baby visit Routine gynae examination Papsmear

Immunization

BCG Hepatitis B DPT Hib OPV/IPV

Wound dressing specify wound:........................................................ Follow-up Referrals Others, specify:........................................

PROVIDER’S DIAGNOSIS [As specific as possible, including chronic conditions]

DIAGNOSTIC/ SCREENING PROCEDURES [Tick all ordered/provided at this visit]

Hypertension Atopic dermatitis/eczema Allergic dermatitis/eczema Acne Diabetes Mellitus

Hypercholestrolaemia Asthma Adverse drug reaction Acute Gastroenteritis (AGE) Gastritis

Migraine Boil Stye Impacted wax Urinary Tract Infection (UTI)

Otitis media Upper Respiratory Tract Infection Tonsillitis Influenza Allergic rhinitis

Gout Chicken poxHaemorrhoid(s) Depressive disorder Anxiety disorder Ischemic Heart Disease (IHD)

Musculoskeletal injury Fungal infection Ulcer Osteoarthritis Accident/Fallspecify :................................................ specify site: ................................................ specify site:................................................. specify joint:.............................................. specify injury: ................................................

Osteoarthritis Others specify joint:.............................................. specify ........................................................

NONE Examinations Full Partial/Pre-op

EKG/ECG HIV test HPV DNA test Papsmear Urinalysis (UA)

Imaging Blood tests Scope procedure Biopsy Othersspecify :................................................ specify :................................................ specify :................................................ specify site:................................................. specify.........................................................

NONE Asthma education Diet/Nutrition Exercise Family planning/Contraception

Growth/Development Injury prevention Stress management Tobacco use/exposure Weight reduction

Durable medical equipment Tissue excision/removal Wound care Cast/Splint/Wrap Others, specify:.......................................

No follow-up plan Return if needed (PRN) Return at specified time Refer to other provider Refer to specialist/hospital

Others, specify ......................................................

Private Household (out of pocket) Private Managed Care Organisation (MCO)/ similar entities Private Employer/Corporations Private Insurance

SOCSO Ministry of Health (MOH) Other government agencies Others, specify ......................................................

HEALTH EDUCATION /COUNSELLING AND OTHER NON-MEDICATION TREATMENT/PROCEDURES [Tick all ordered/provided at this visit]

SECTION 3: VISIT DISPOSITION

SECTION 4: SOURCE OF PAYMENT

VISIT DISPOSITION

SOURCE OF PAYMENT

Finalized Version1.0 last updated on 20/05/2011 Page 1. |__| of 2

NATIONAL MEDICAL CARE SURVEY (NMCS)PRIMARY CARE AND AMBULATORY CARE SERVICES

Office Use:

Centre:

/

generalized localized Rash

Chronic Obstructive Pulmonary Disease (COPD)

38


back page

40


A P U B L I C A T I O N O F T H E

CLIN ICAL RESEARCH CENTREMINISTRY OF HEALTH MALAYSIA

Documents

EDITED BY : LIM KK, SIVASAMPU S, GOH PP, HISHAM AN