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Equipments in GP.
Tips and tools for creating and presenting wide format
slides
Equipments
auriscope
disposable gloves
equipment for maintaining an
airway in both adults and
children
in-date medicines for medical
emergencies
ophthalmoscope
practice stationery (including
prescription pads and
letterhead)
sharps container
sphygmomanometer
stethoscope
syringes and needles
in a range of sizes
thermometer
tongue depressors
torch
Medicine
To ensure patient safety, it is important that GPs are familiar with the
medicines that are included in their doctors bag, including the general
usage, suggested dosage and possible side effects. It is recommended
that GPs seek appropriate and ongoing education on these as
required.Amended in May 2013.
Suggested emergency medicines include:
adrenaline
aspirin
atropine sulphate
benztropine mesylate
benzylpenicillin
chlorpromazine or haloperidol
diazepam
ergotamine maleate
frusemide
glucose 50% and/or glucagon
glyceryl trinitrate spray or tablets
hydrocortisone sodium succinate or dexamethasone
metoclopramide hydrochloride
morphine sulphate or appropriate analgesic agent
naloxone hydrochloride
prednisone
promethazine hydrochloride
salbutamol aerosol.
Socio-economic status
Overcrowding and lack of bed availability in public
hospitals
People in rural and remote areas (geographic isolation)
Cultural and religious beliefs
Good Standards of
Care in Primary Care
Section II : Patient-Centered
Services
Basic and essential services, as needed by the primary care
centers population, are provided.
The primary care center informs patients and families about its
care and services and how to access those services.
The primary care center designs patient care processes to reduce
the risk of unsafe patient care.
Patient informed consent is obtained through a process defined
by the primary care center and carried out by trained staff.
acute disease
management
World Health Organization (WHO)|Health systems and services: The role of
acute management.
(based on African Federation for Emergency Medicine and the Academic Emergency Medicine
Consensus Conference scheduled for May 2013)
Creating an acute care service delivery model for low- and middleincome countries that will function in parallel with preventive and
primary services. These acute care services will address both lifethreatening and limb-threatening problems as well as exacerbations of
priority noncommunicable diseases.
Improving coordination between deliverers of acute care services, such
as emergency physicians, surgeons and obstetricians, to deliver critical
acute care services efficiently and effectively.
(based on African Federation for Emergency Medicine and the Academic Emergency Medicine
Consensus Conference scheduled for May 2013)
Summary
Acute care plays a vital role in the prevention of death and disability.
Primary care is not positioned, and is frequently unable, to assume this
role.
This is partly because of lack of appropriate metrics and coordination of
health service delivery.
Understanding acute care as an integrated care platform allows these
splintered areas to move forward with a single agenda as a unified front
Epidemiology of
Dengue Fever
1. Dengue Incidence, Prevention and Control
Program in Malaysia
Rose Nani Mudin
Head of Vector Borne Disease Sector, Ministry of Health Malaysia
2. http://wwwnc.cdc.gov/travel/notices/watch/dengue-malaysia
Poor environmental cleanliness littering habit in the community, inapprpopriate solid waste
disposal
7. Clinical Practice
Guideline (CPG)
http://www.moh.gov.my
http://www.acadmed.org.my
Purposes of CPG
To describe appropriate care based on the best available
scientific evidence and broad consensus
To reduce inappropriate variation in practice
To provide a more rational basis for referral
To provide a focus for continuing education
To promote efficient use of resources
To act as focus for quality control, including audit
To highlight shortcomings of existing literature and
suggest appropriate future research
Validity
Impact
Applicability to the care of individual patient
BIAS
GRADE approach
Further
recognized
imprecision,
indirectness,
inconsistency
and
outcome
reporting
bias
as
dimensions of quality evidence
Quality of evidence: The extent to which our confidence
in an estimate of treatment effect is adequate to
support particular recommendation
4 categories: High, moderate, low, very low
Study
design
Lower if
Higher if
High
Randomized
trial
Study limitations
Moderate
Low
Very low
Inconsistency
Observational
study
Indirectness
Imprecision
Publication bias
Evidence of dose-response
gradient
All plausible confounding
would reduce a
demonstrated effect
Conceptualizing quality
High
Moderate
Low
Very low
Are the
recommendations
pragmatic?
Feasibility of guideline
implementations
Implications to the
health care system
(economic implications)
Are the
recommendations
applicable to your
patient?
Consider patient
demographics
GRADE approach
Strength of recommendation: Reflects the extent to
which we can, across the range of patients for whom
the recommendations are intended, be confident that
desirable effects of a management strategy outweight
undesirable effects
2 categories: Strong or weak/conditional
Strength of recommendations
Desirable effects are
Health benefits
Less burden
Savings
Developing recommendations
Conclusion
CPG play a critical role in guiding the evidence based
clinical practice
We should have skills and knowledge to critically appraise
a guideline before applying it to the care of patients
1. Methodology
2. Levels of evidence
3. Grades of recommendation
PUBLIC HEALTH
ADVISORY
NAIB PENGERUSI
Ahli Klinik Kesihatan (5)
Doctor in charge
Dentist
Medical attendant
Staff nurse
Radiologist
Countries
Year
Ethiopia
0.025
2009
Bangladesh
0.356
2011
Cambodia
0.169
2012
Indonesia
0.204
2012
Thailand
0.393
2010
India
0.702
2012
Malaysia
1.198
2010
Japan
2.297
2010
United States
2.452
2011
United Kingdom
2.801
2013
Australia
3.273
2011
Russian Federation
4.309
2006
Qatar
7.739
2010
United Kingdom
In the United Kingdom, patients can access primary
care services through their localgeneral practice,
community pharmacy, optometrist,dental surgeryand
community hearing care providers.
Services are generally provided free-of-charge through
theNational Health Service (NHS).
In the UK, unlike many other countries, patients do not
normally have direct access to hospital consultants and
the GP controls access to secondary care.
Canada
In Canada, access to primary and other healthcare
services are guaranteed for all citizens through
theCanada Health Act.
Nigeria
In Nigeria, healthcare is a concurrent responsibility of
three tiers of government.
Local governments focus on the delivery of primary care
(e.g. through a system of dispensaries), state
governments manage the various
generalhospitals(secondary care), while the federal
government's role is mostly limited to coordinating the
affairs of theFederal Medical Centresand university
teaching hospitals (tertiary care).
1 Care Concept
1Care is restructured national health system that is
responsive and provides choice of quality health care,
ensuring universal coverage for health care needs of
population based on solidarity and equity
3. Healthcare
Financing Reforms
introduction of health
insurance scheme
2. Organisational Reforms
Public private integration
Public sector autonomy
91
Targets of 1 Care
Universal coverage
Integrated health care delivery system
Affordable & sustainable health care
Equitable (access & financing), efficient, higher quality
care & better health outcomes
Effective safety net
Responsive health care system
Client satisfaction
Benefits to Individuals
Access to both public & private providers
Reduced payment at the point of seeking care
Care nearer to home
Increased quality of care & client satisfaction
Better health outcome
Higher work productivity
Benefits to Employers
Relieve burden to reimburse worker or give loan for medical
spending
Relieve burden to cover work and non-work related illnesses
(beyond SOCSO)
Pay low contributions to cover employee and family
Reduce administration to process medical benefits
Avoid systems in which unnecessary care leads to higher
expenditure e.g. PHI, MCO & Panel doctors
Healthier workforce and higher productivity
References
Ministry of Health Malaysia, 10th Malaysia Plan (20112015)
10th Malaysian Health Plan Conference
Health Situational Analysis for Medical Program 10MP