There has been an epidemiological transition in morbidity and mortality patterns in developing countries. This study
aimed to determine whether there was an accompanying change in disease presentation in primary care. This was
a cross-sectional study conducted at 12 public primary care clinics in Malaysia. Outpatient medical records were
randomly selected and reviewed to identify patients’ reasons for encounter. The overall retrieval of records was 99.1%
(n=1,753; range 95.7-100.0%). The mean age was 33.1 (SD 22.2) years. For all ages, the most common reasons for
patient encounter (RFE) were cough (21.1%; 95% CI 16.5, 25.8), follow-up care for chronic diseases (19.6%; 95% CI
12.7, 26.6) and fever (18.4%; 95% CI 14.2, 22.5). The top RFE in West Malaysia was follow-up care for chronic diseases
while in East Malaysia, the most common RFE was cough (25.2%; 95% CI 16.8, 33.6) and fever (21.7%; 95% CI 14.3,
29.0). In conclusion, there is a change in the presentation of diseases, with chronic disease emerging as one of the top
RFE in primary care. In adults, for all age groups over 40 years old, care for chronic diseases has overtaken acute disease
care. However, acute respiratory problems remain the overall top RFE at public primary care clinics in Malaysia. There
are major differences in morbidity patterns and reasons for encounter for different age groups and geographical areas
and this could be utilized for better health care planning.
Patients with issues or health problems usually plan to discuss their concerns with their health care providers. If these concerns were not presented or voiced during the health care provider-patient encounter, the patients are considered to have unvoiced needs. This article examines the extent and possible determinants of patients' unvoiced needs in an outpatient setting. A cross-sectional study was conducted in 5 Ministry of Health Malaysia primary health facilities throughout the country. Of 1829 who participated, 5 did not respond to the question on planned issues. Of the 1824 respondents, 57.9% (95% confidence interval = 47.1-68.7) claimed to have issues/problems they planned to share, of whom 15.1% to 26.7% had unvoiced needs. Extent of unvoiced needs differed by employment status, perceived category of health care provider, and study center. Perceived category of health care provider, method of questionnaire administration, and study center were the only significant determinants of unvoiced needs. Unvoiced needs do exist in Malaysia and there is a need for health care providers to be aware and take steps to counter this.
Study site: 5 Ministry of Health Malaysia primary health facilities throughout the country