Ariffin F, Ramli A S, Daud M H, Haniff J, Abdul-Razak S, Selvarajah S, Lee V K, Tong S F, Bujang M A
Universiti Teknologi MARA (UiTM), Faculty of Medicine, Primary Care Medicine, Selayang campus, Malaysia.
Clinical Epidemiology Unit, National Clinical Research Centre, Ministry of Health Malaysia, Malaysia.
Med J Malaysia. 2017 Apr;72(2):106-112.
Non-communicable diseases (NCD) is a global health threat. the Chronic Care Model (CCM) was proven effective in improving NCD management and outcomes in developed countries. Evidence from developing countries including Malaysia is limited and feasibility of CCM implementation has not been assessed. this study intends to assess the feasibility of public primary health care clinics (PHC) in providing care according to the CCM.
A cross-sectional survey was conducted to assess the public PHC ability to implement the components of CCM. All public PHC with Family Medicine Specialist in Selangor and Kuala Lumpur were invited to participate. A site feasibility questionnaire was distributed to collect site investigator and clinic information as well as delivery of care for diabetes and hypertension.
there were a total of 34 public PHC invited to participate with a response rate of 100%. there were 20 urban and 14 suburban clinics. the average number of patients seen per day ranged between 250-1000 patients. the clinic has a good mix of multidisciplinary team members. All clinics had a diabetic registry and 73.5% had a hypertensive registry. 23.5% had a dedicated diabetes and 26.5% had a dedicated hypertension clinic with most clinic implementing integrated care of acute and NCD cases.
the implementation of the essential components of CCM is feasible in public PHCs, despite various constraints. Although variations in delivery of care exists, majority of the clinics have adequate staff that were willing to be trained and are committed to improving patient care.
非传染性疾病是全球健康威胁。慢性护理模式（CCM）已被证明在改善发达国家的非传染性疾病管理及治疗效果方面有效。包括马来西亚在内的发展中国家的相关证据有限，且尚未评估实施CCM的可行性。本研究旨在评估公立基层医疗诊所（PHC）按照CCM提供护理的可行性。
开展一项横断面调查，以评估公立PHC实施CCM各组成部分的能力。邀请了雪兰莪州和吉隆坡所有配备家庭医学专科医生的公立PHC参与。发放一份场地可行性问卷，以收集场地调查员和诊所信息，以及糖尿病和高血压的护理服务情况。
总共邀请了34家公立PHC参与，回复率为100%。其中有20家城市诊所和14家郊区诊所。每日就诊患者的平均数量在250至1000名患者之间。诊所拥有构成良好的多学科团队成员。所有诊所都有糖尿病登记册，73.5%有高血压登记册。23.5%有专门的糖尿病诊所，26.5%有专门的高血压诊所，大多数诊所对急性病和非传染性疾病病例实施综合护理。
尽管存在各种限制，但在公立PHC中实施CCM的基本组成部分是可行的。虽然护理服务存在差异，但大多数诊所拥有愿意接受培训并致力于改善患者护理的充足工作人员。
