National Medical Care Statistics 2012 March 2014 ©Ministry of Health Malaysia
Published by The National Healthcare Statistics Initiative (NHSI) National Clinical Research Centre National Institutes of Health 3rd Floor, MMA House 124, Jalan Pahang 53000 Kuala Lumpur Malaysia : (603) 4043 9300/9400 : (603) 4043 9500 :
[email protected] : http://www.crc.gov.my/nhsi
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This report is copyrighted. Reproduction and dissemination of this report in part or in whole for research, educational or non-commercial purposes is authorised without any prior written permission from the copyright holders provided that the source is fully acknowledged. Suggested citation: Sivasampu S, Yvonne Lim, Norazida AR, Hwong WY, Goh PP, Hisham AN. National Clinical Research Centre. National Medical Care Statistics (NMCS) 2012. Kuala Lumpur 2014. This report is also available electronically on the website of the National Healthcare Statistics Initiative at http://www.crc.gov.my/nhsi Funding: The National Healthcare Statistics Initiative was funded by a grant from Ministry of Health Malaysia (MRG Grant No. NMRR-09-842-4718)
Please note that there is potential for minor corrections of data in this report. Please check the online version at http://www.crc.gov.my/nhsi/ for any amendments. Thank you.
TABLE OF CONTENTS LIST OF TABLES LIST OF FIGURES ACKNOWLEDGEMENTS NATIONAL MEDICAL CARE SURVEY 2012 PROJECT TEAM ABBREVIATIONS SYMBOLS EXECUTIVE SUMMARY
iv vi vii viii ix x 1
CHAPTER 1 : INTRODUCTION 1.1 Background 1.2 Objectives 'HÀQLWLRQV 1.4 Research questions
5 6 6 7
CHAPTER 2 : METHODOLOGY 2.1 Sampling frame and sample size calculation 2.2 Survey dates 2.3 Data collection and follow-up 2.4 Research pack and questionnaire 2.5 Data management 2.6 Data analysis 2.7 Ethical issues 2.8 Limitations
9 10 12 12 13 13 17 18 18
CHAPTER 3 : RESPONSE RATE 3.1 The encounters
19 21
CHAPTER 4 : THE DOCTORS 4.1 Characteristics of the doctors
23 24
CHAPTER 5 : THE PATIENTS 5.1 Age-gender distribution of patients 5.2 Patient socio-demographic characteristics 5.3 Mode of payment 0HGLFDOFHUWLÀFDWHDQGGXUDWLRQRIVLFNOHDYH
27 28 28 30
CHAPTER 6 : REASONS FOR ENCOUNTER 6.1 Number of reasons for encounter per visit 6.2 Reasons for encounter by ICPC-2 components 6.3 Reasons for encounter by ICPC-2 chapters 6.4 Most common reasons for encounter in public and private clinics
33 34 34 36 38
CHAPTER 7 : DIAGNOSES 7.1 Number of diagnoses per encounter 7.2 Diagnoses by ICPC-2 component 7.3 Diagnoses by ICPC-2 chapter 7.4 Most common diagnoses managed in public and private clinics
41 42 43 44 46
CHAPTER 8 : MEDICATIONS 8.1 Number of medications prescribed per encounter 8.2 Type of medications prescribed 8.3 Most frequently prescribed medications in public and private clinics
49 50 52 58
CHAPTER 9 : INVESTIGATIONS 9.1 Number of investigations per encounter 9.2 Types of investigations 9.3 Investigations most frequently ordered in public and private clinics 9.4 Diagnoses with investigations ordered
61 62 63 67 69
CHAPTER 10: ADVICE/COUNSELLING AND PROCEDURES 10.1 Number of advice/counselling and procedures 10.2 Types of advice and counselling 10.3 Most common advice/counselling provided in public and private clinics 10.4 Types of procedures 10.5 Most common procedures performed in public and private clinics 10.6 Diagnoses with advice/counselling and procedures
71 72 72 74 75 76 77
CHAPTER 11: FOLLOW-UPS AND REFERRALS 11.1 Number of follow-ups and referrals 11.2 Types of referrals 11.3 Diagnoses most frequently referred to hospital 11.4 Diagnoses most frequently referred to a specialist
79 80 81 82 83
APPENDICES
Appendix 1: NMCS 2012 Survey Form Appendix 2: ICPC-2 and ICPC-2 PLUS Groups Appendix 3: Participants of NMCS 2012 $SSHQGL[ /LVWRIGHÀQLWLRQV
86 88 92
LIST OF TABLES Table 2.1
Sample size for NMCS 2012
11
Table 2.2
Data entry error rate for NMCS 2012
14
Table 3.1
Total clinics sampled and responded for NMCS 2012
20
Table 3.2
Response rate for NMCS 2012
20
Table 3.3
Observed and weighted dataset for NMCS 2012
21
Table 4.1
Characteristics of doctors for NMCS 2012
24
Table 5.1
Characteristics of patient encounters in primary care clinics in 2012
29
Table 5.2
Duration of sick leave issued in primary care clinics in 2012
31
Table 6.1
Reasons for encounter by ICPC-2 components in primary care clinics in 2012
35
Table 6.2
Reasons for encounter by ICPC-2 components and sector
35
Table 6.3
Reasons for encounter by ICPC-2 chapters and common individual reasons for encounter within chapter in primary care clinics in 2012
36
Table 7.1
Diagnoses by ICPC-2 components in primary care clinics in 2012
43
Table 7.2
Diagnoses by ICPC-2 chapters and common individual diagnoses within chapter managed in primary care clinics in 2012
44
Table 7.3
Thirty most common diagnoses managed in public clinics in 2012
47
Table 7.4
Thirty most common diagnoses managed in private clinics in 2012
48
Table 8.1
Number of encounters for which medication was prescribed
50
Table 8.2
Prescribed medications by ATC level 1, 3 and 5 in primary care clinics in 2012
52
Table 8.3
Prescribed medications by ATC level 1 and sector in primary care clinics in 2012
57
Table 8.4
Thirty most frequently prescribed medications in public clinics in 2012
59
Table 8.5
Thirty most frequently prescribed medications in private clinics in 2012
60
Table 9.1
Types of investigations by ICPC-2 chapters and common individual test within chapter in primary care clinics in 2012
Table 9.2
63
Top 10 diagnoses for which investigation was most frequently ordered in primary care clinics in 2012
69
Table 10.1
Advice/counselling and procedures in primary care clinics in 2012
72
Table 10.2
Types of advice/counseling provided in primary care clinics in 2012
73
Table 10.3
Types of procedures performed in primary care clinics in 2012
Table 10.4
Ten most common diagnoses with advice/counseling
74
in primary care clinics in 2012
77
Table 10.5
Ten most common diagnoses with procedures in primary care clinics in 2012
78
Table 11.1
Follow-up and referrals in primary care clinics in 2012
80
Table 11.2
Types of referrals in public clinics in 2012
81
Table 11.3
Types of referrals in private clinics in 2012
82
Table 11.4
Diagnoses most frequently referred to hospital in 2012
83
Table 11.5
Diagnoses most frequently referred to specialist in 2012
84
LIST OF FIGURES
Figure 5.1
Age-gender distribution of patients in primary care clinics in 2012
28
Figure 5.2
Mode of payment in primary care clinics in 2012
30
Figure 5.3
3HUFHQWDJHRISULPDU\FDUHHQFRXQWHUVLVVXHGPHGLFDOFHUWLÀFDWHLQ
Figure 6.1
Number of patient reasons for encounter in primary care clinics in 2012
34
Figure 6.2
Top 10 reasons for encounter in public clinics in 2012
38
Figure 6.3
Top 10 reasons for encounter in private clinics in 2012
39
Figure 7.1
Number of diagnoses managed per encounter in primary care clinics in 2012
42
Figure 7.2
$JHJHQGHUVSHFLÀFUDWHVRIGLDJQRVHVPDQDJHGSHUHQFRXQWHUV
by sector in 2012
43
Figure 8.1
Number of medications prescribed per encounter in primary care clinics in 2012
50
Figure 8.2
$JHJHQGHUVSHFLÀFSUHVFULSWLRQUDWHVSHUHQFRXQWHUVE\VHFWRULQ
Figure 9.1
Number of investigations ordered per encounter in primary care clinics in 2012
62
Figure 9.2
Top 10 investigations ordered in public clinics in 2012
68
Figure 9.3
Top 10 investigations ordered in private clinics in 2012
68
Figure 10.1
Ten most common advice/counseling provided in public clinics in 2012
74
Figure 10.2
Ten most common advice/counseling provided in private clinics in 2012
74
Figure 10.3
Ten most common procedures performed in public clinics in 2012
76
Figure 10.4
Ten most common procedures performed in private clinics in 2012
76
Acknowledgements The National Healthcare Statistics Initiative team would like to thank the Director-General of Health, Malaysia for his continuous support for this survey and permission to publish this report. Also, our sincere appreciation goes to the following for their participation, assistance, support and contribution:
'HSXW\'LUHFWRU*HQHUDORI+HDOWK 5HVHDUFKDQG7HFKQLFDO6XSSRUW 0LQLVWU\RI+HDOWK 02+ 'HSXW\'LUHFWRU*HQHUDORI+HDOWK 0HGLFDO 02+ 'HSXW\'LUHFWRU*HQHUDORI+HDOWK 3XEOLF+HDOWK 02+ 'LUHFWRURIWKH&OLQLFDO5HVHDUFK&HQWUH1DWLRQDO,QVWLWXWHVRI+HDOWK02+ 'LUHFWRURIWKH)DPLO\+HDOWK'HYHORSPHQW'LYLVLRQ02+ 'LUHFWRURIWKH3ODQQLQJDQG'HYHORSPHQW'LYLVLRQ02+ 'LUHFWRURIWKH3ULYDWH0HGLFDO3UDFWLFH'LYLVLRQ02+ &DZDQJDQ.DZDODQ$PDODQ3HUXEDWDQ Swasta, CKAPS) 6WDWH OHYHO 3ULYDWH 0HGLFDO 3UDFWLFH &RQWURO 8QLWV 8QLW .DZDODQ $PDODQ 3HUXEDWDQ 6ZDVWD UKAPS). 0DOD\VLDQ 0HGLFDO &RXQFLO 0DOD\VLDQ 0HGLFDO $VVRFLDWLRQ $FDGHP\ RI )DPLO\ 3K\VLFLDQV Malaysia.
We thank the 392 medical doctors from both the public and private primary healthcare clinics who participated in the National Medical Care Survey (NMCS) between August and November 2012. This report would not have been possible without their support and contribution from these dedicated professionals. Last but not least, our greatest appreciation to all those who have supported or contributed to the success of the National Medical Care Survey 2012 and the publication of this report. Thank you.
National Healthcare Statistics Initiative (NHSI) Primary Care Team Healthcare Statistics Unit National Clinical Research Centre Ministry of Health, Malaysia
NATIONAL MEDICAL CARE SURVEY 2012 PROJECT TEAM Principal Investigator
Datuk Dr. Noor Hisham Abdullah Dr. Sheamini Sivasampu
Principal Co-Investigator Dr. Goh Pik Pin Dr. Kamaliah Mohd. Noh Professor Dr. Khoo Ee Ming Associate Professor Dr. Ng Chirk Jenn Research Evaluation Committee (REC)
3URIHVVRU'U7DXÀN7HQJ&KHRQJ/LHQJ Dr. Kaviyarasan Sailin Associate Professor Dr. Jamaluddin Abdul Rahman Ms. Siti Fauziah Abu Mr. Lim Ka Keat (September 2011 – September 2012)
Project Managers
Ms. Yvonne Lim Mei Fong Dr. Hwong Wen Yea, Amy
Survey Coordinators
Ms. Aisyah Ali Ms. Sharmini Chandran Mr. Shantha Kumar Chandrasekaran Ms. Kasturi Manoharan
5HVHDUFK2IÀFHUV
Ms. Siti Aminah Ismail Ms. Hanan Hamimi Wahid Ms. Maryam Nazeera Suhaimi Mr. Poovanesva Rao Yang Ketter Rahman Ms. Norazida Ab. Rahman
Data Analysis Ms. Yvonne Lim Mei Fong Database Developers/Administrators
Altus Solutions Sdn. Bhd.
ABBREVIATIONS ACE
Angiotensin converting enzyme
ATC
:+2$QDWRPLFDO7KHUDSHXWLF&KHPLFDO&ODVVLÀFDWLRQV\VWHP
BEACH CI CKAPS DG FMS GP
Bettering the Evaluation and Care of Health &RQÀGHQFH,QWHUYDO Cawangan Kawalan Amalan Perubatan Swasta Director General of Health, Ministry of Health, Malaysia Family Medicine Specialist General Practice or Practitioner
HbA1c
Haemoglobin, type A1c
ICPC
,QWHUQDWLRQDO&ODVVLÀFDWLRQRI3ULPDU\&DUH
IQR
Interquartile range
KK
Klinik Kesihatan
LCL
/RZHU&RQÀGHQFH/LPLW
MOH
Ministry of Health, Malaysia
MREC
Medical Research and Ethics Committee, Ministry of Health Malaysia
NCD NCRC NHEWS NHSI
Non-communicable disease National Clinical Research Centre National Healthcare Establishment & Workforce Survey (Primary Care) National Healthcare Statistics Initiative
NIH
National Institutes of Health
NMCS
National Medical Care Survey
NMUS
National Medicines Use Survey
NOS
1RWRWKHUZLVHVSHFLÀHG
REC
Research Evaluation Committee
RFEs
Reasons for encounter
SOCSO UCL UKAPS WHO WONCA WP
Social Security Organisation 8SSHU&RQÀGHQFH/LPLW Unit Kawalan Amalan Perubatan Swasta World Health Organisation World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians Wilayah Persekutuan
SYMBOLS
-
Not applicable
>
More than
More than or equal to
9LHZHG )HEUXDU\@$YDLODEOHIURP KWWS ZZZZKRLQWFODVVLÀFDWLRQVHQ:+2),&)DPLO\SGI )DPLO\0HGLFLQH5HVHDUFK&HQWUH7KH8QLYHUVLW\RI6\GQH\,&3&,QWHUQDWLRQDO&ODVVLÀFDWLRQ of Primary Care. [Viewed January 2014]. Available from: http://sydney.edu.au/medicine/fmrc/icpc-2/ index.php :+2&ROODERUDWLQJ&HQWUHIRU'UXJ6WDWLVWLFV0HWKRGRORJ\*XLGHOLQHVIRU$7&&ODVVLÀFDWLRQDQG DDD Assignment 2012. Oslo 2011. [Viewed February 2014]. Available from: www.whocc.no Pharmaceutical Services Division and Clinical Research Centre, Ministry of Health Malaysia. Malaysian Statistics on Medicine 2008. Kuala Lumpur 2013.
Chapter 3 Response Rate
CHAPTER 3: RESPONSE RATE This chapter describes the survey sample and response rate for NMCS 2012. Table 3.1 shows the number of clinics sampled and number of clinics responded to the survey. A total of 69 public clinics and 120 private clinics participated in NMCS 2012, and listed in Appendix 3. The response rates were then calculated as the number of encounters that were recorded for NMCS 2012 divided by the expected number of encounters in the sample (Table 3.2). Table 3.1: Total clinics sampled and responded for NMCS 2012 Number of clinics
Number of clinics
Percentage of clinics
sampled
responded
responded (%)
Public
39
34
87.2
Private
187
53
28.3
8
8
100.0
Private
107
30
28.0
Public
20
19
95.0
Private
57
24
42.1
Public
4
4
100.0
Private
21
9
42.9
Public
4
4
100.0
Private
11
4
36.4
Public
75
69
92.0
Private
383
120
31.3
Total encounters
Total encounters
Response rate
expected
responded
(%)
State/Region
Sector
Selangor & WP Putrajaya
Public WP Kuala Lumpur
Kelantan
Kota Kinabalu
Kuching
Total
Table 3.2: Response rate for NMCS 2012
State/Region
Sector
Selangor & WP
Public
1,777
4,172
100.0
Putrajaya
Private
5,375
1,766
32.9
384
698
100.0
3,040
717
23.6
931
979
100.0
1,636
892
54.5
Public
253
1,255
100.0
Private
595
218
36.6
Public
566
1,753
100.0
Private
327
147
45.0
Public
3,911
8,857
100.0
Private
10,973
3,740
34.1
Public WP Kuala Lumpur Private Public Kelantan Private Kota Kinabalu
Kuching
Total
"
5HVSRQVHUDWHREWDLQHGIURPSXEOLFFOLQLFVRIDOOÀYHVWDWHVDQGUHJLRQVZHUHRYHUZKHOPLQJDQGH[FHHGHG 100.0%. However, the maximum response rate was reported as 100.0% as in Table 3.2. As for private sector, despite our fervent attempts to persuade the private GPs to participate the response rate for WP Kuala Lumpur was only 23.6%, bringing down the overall response rate for private sector to 34.0%. The low response rate however, has already been anticipated and accounted for. When calculating sample size, the sampling matrix had included an estimation of a 30.0% drop-out rate from the public and a 70.0% drop-out rate from the private sector. This huge estimated rate of drop-out from the private sector was expected based on previous studies conducted comparing public and private health sectors in Malaysia. The reported response rate from private clinics in these studies was between 26.0% to 33.0%.1, 2 3.1
THE ENCOUNTERS
A total of 12,597 encounters were collected for NMCS 2012. Of these, 28 encounters were excluded from DQDO\VLV RILQFRPSOHWHIRUPVDQGRIGDWDLQFRQVLVWHQFLHV7KHÀQDOHQFRXQWHUVIRUDQDO\VLVZHUH 12,569; 8,837 from public and 3,732 from private. The dataset were weighted to adjust for over and under representativeness of data (see section 2.6.1). Table 3.3 shows the observed and weighted total for each GDWDHOHPHQW7KHÀQDOZHLJKWHGSDWLHQWHQFRXQWHUVZHUH DQGWKHZHLJKWHGGDWDVHWZHUHXVHGWR describe the results in this report. Table 3.3: Observed and weighted dataset for NMCS 2012 Observed
Weighted
Variable Overall
Public
Private
Overall
Public
Private
Encounters
12,569
8,837
3,732
141,593
42,340
99,253
Reasons for encounter
21,359
15,452
5,907
233,326
73,616
159,710
Diagnoses
18,904
14,429
4,475
188,944
68,877
120,067
Medications
31,377
21,709
9,668
359,272
103,484
255,788
Investigations
7,687
6,983
704
53,028
34,139
18,889
Advice/counselling and
5,540
4,831
709
40,389
22,372
18,017
10,935
9,951
984
73,672
47,652
26,020
procedures Follow-up and referrals
REFERENCES 1. 2.
Teng CL, Tong SF, Khoo EM, Lee V, Zailinawati AH, Mimi O et al. Antibiotics for URTI and UTI -- prescribing in Malaysian primary care settings. Australian Family Physician. 2011; 40(5):325-9. Mimi O, Tong SF, Nordin S, Teng CL, Khoo EM, A Abdul-Rahman et al. A comparison of morbidity patterns in public and private primary care clinics in Malaysia. Malaysian Family Physician. 2011; 6(1):19-25.
Chapter 4 The Doctors
CHAPTER 4: THE DOCTORS This chapter reports the characteristics of doctors who participated and recorded the primary care visits for NMCS 2012. Data for these doctors were obtained through linkage with National Healthcare and Establishments Workforce Survey: Primary Care (NHEWS) database which captured information on services and workforce in primary care setting, including the doctors’ socio-demographic details. NHEWS TXHVWLRQQDLUHZHUHLQFOXGHGLQWKH10&6UHVHDUFKSDFNDQGWKHGRFWRUVZHUHDVNHGWRÀOOLQERWKVHWVRI questionnaire. Details on NHEWS Primary Care were described elsewhere.1 A total of 408 doctors from public and private clinics participated in the NMCS 2012. The data for the doctors were not weighted and extrapolated due to scarcity of national sample frame of doctors practising in primary care clinics in Malaysia. 4.1
CHARACTERISTICS OF THE DOCTORS
)URP WKH WRWDO RI GRFWRUV ZKR SDUWLFLSDWHG LQ 10&6 GRFWRUV ÀOOHG LQ ERWK 10&6 DQG NHEWS questionnaire thus providing their socio-demographic details. Table 4.1 shows the characteristics of doctors who participated in NMCS 2012. 0DMRULW\RIWKHGRFWRUVZHUHIHPDOHV ,QSXEOLFFOLQLFVRIWKHGRFWRUVZHUHIHPDOHV whereas there were only 39.7% female doctors in private clinics. 2YHUDOOPRVWGRFWRUVDJHGEHWZHHQDQG \HDUVROG PHGLDQ \HDUV,45 \HDUV ,QSXEOLF clinics, nearly half of the doctors (48.0%) were of this age group. In contrast, 62.8% of the doctors in private clinics were 50 years old and older. /HVV WKDQ RI WKH GRFWRUV KDG SRVWJUDGXDWH TXDOLÀFDWLRQ 2I WKHVH PDMRULW\ ZHUH IDPLO\ medicine specialist. 'RFWRUVLQWKHSULYDWHFOLQLFVLQJHQHUDOZRUNHGORQJHUKRXUV PHGLDQKRXUVZHHN WKDQWKRVHLQ the public clinics (median 40 hours/week). Table 4.1: Characteristics of doctors for NMCS 2012 Characteristics
Number
Percentage
350
100.0
Male
127
36.3
Female
223
63.7
350
100.0
78
22.3
30-39
125
35.7
40-49
55
15.7
50-59
55
15.7
37
10.6
408
100.0
Public clinic
259
63.5
Private clinic
149
36.5
Gender
Missing (n = 58) Age group (year) Four
Public
59.8
21.9
7.1
4.5
6.8
Private
89.2
7.0
1.8
1.0
1.0
Number of investigations ordered per encounter
9.2
TYPES OF INVESTIGATIONS
A total of 53,028 investigations were ordered, at a rate of 37.5 per 100 encounters and 28.1 per 100 diagnoses. Table 9.1 shows the distribution of investigations by ICPC-2 chapters and most common test within each chapter in an order of decreasing frequency. Each ICPC-2 chapter represents a group of investigations and only top 20 ICPC-2 chapters were reported in Table 9.1. 7KHWRSJURXSVRILQYHVWLJDWLRQVRUGHUHGFRQVWLWXWHGDOPRVW RIDOOLQYHVWLJDWLRQV 0DMRULW\RIWKHLQYHVWLJDWLRQVUHFRUGHGZHUHODERUDWRU\WHVWV 7KLVLVIROORZHGE\GLDJQRVWLF radiology/imaging tests. (QGRFULQH DQG PHWDEROLF EORRG WHVWV ZHUH WKH PRVW IUHTXHQWO\ RUGHUHG LQYHVWLJDWLRQV Within this group, approximately two-third of the investigations involved tests for diabetes mellitus (glucose, glucose tolerance, HbA1c, fasting, and random glucose tests). 8ULQHWHVWVDQGJHQHUDOEORRGWHVWVZHUHWKHVHFRQGDQGWKLUGPRVWFRPPRQO\UHFRUGHGLQYHVWLJDWLRQV in primary care clinics. Table 9.1: Types of investigations by ICPC-2 chapters and common individual test within chapter in primary care clinics in 2012
Investigation
Number
Percentage
Rate per 100
Rate per 100
of all
encounters
diagnoses
investigations
(95% CI)
(95% CI)
(n = 53,028)
(n = 141,593)
(n = 188,944)
14,771
27.86
10.43 (10.27 - 10.59)
7.82 (7.70 - 7.94)
7,755
14.62
5.48 (5.36 - 5.60)
4.11 (4.02 - 4.19)
7HVW OLSLGVSURÀOH
3,896
7.35
2.75 (2.67 - 2.84)
2.06 (2.00 - 2.13)
Test;HbA1c
2,473
4.66
1.75 (1.68 - 1.82)
1.31 (1.26 - 1.36)
Test;thyroid function
510
0.96
0.36 (0.33 - 0.39)
0.27 (0.25 - 0.29)
Test;cholesterol
128
0.24
0.09 (0.08 - 0.11)
0.07 (0.06 - 0.08)
8
0.02
0.01 (0.00 - 0.01)
0.01 (0.00 - 0.01)
7,150
13.48
5.05 (4.94 - 5.17)
3.79 (3.70 - 3.87)
Test;urine
5,260
9.92
3.72 (3.62 - 3.81)
2.78 (2.71 - 2.86)
Test;urine;albumin
1,696
3.20
1.20 (1.14 - 1.26)
0.90 (0.86 - 0.94)
193
0.36
0.14 (0.12 - 0.16)
0.10 (0.09 - 0.12)
2
0.00
0.00 (0.00 - 0.01)
0.00 (0.00 - 0.00)
5,535
10.44
3.91 (3.81 - 4.01)
2.93 (2.85 - 3.01)
Test;full blood count
2,857
5.39
2.02 (1.95 - 2.09)
1.51 (1.46 - 1.57)
Test;blood
2,151
4.06
1.52 (1.46 - 1.58)
1.14 (1.09 - 1.19)
7HVW EORRGÀOP
178
0.33
0.13 (0.11 - 0.15)
0.10 (0.08 - 0.11)
7HVW EORRGWKLFNÀOP
132
0.25
0.09 (0.08 - 0.11)
0.07 (0.06 - 0.08)
Test;ESR
113
0.21
0.08 (0.07 - 0.10)
0.06 (0.05 - 0.07)
53
0.10
0.04 (0.03 - 0.05)
0.03 (0.02 - 0.04)
Blood test; endocrine/ metabolic Test;glucose & glucose tolerance
Test;cholesterol/ triglycerides Urine test
Urine drug screen Test;albumin creatine ratio Blood test
Blood screen Note: ESR - erythrocyte sedimentation rate
(continued)
Table 9.1 (continued): Types of investigations by ICPC-2 chapters and common individual test within chapter in primary care clinics in 2012
Investigation
Number
Percentage
Rate per 100
Rate per 100
of all
encounters
diagnoses
investigations
(95% CI)
(95% CI)
(n = 53,028)
(n = 141,593)
(n = 188,944)
Test;prolactin
40
0.08
0.03 (0.02 - 0.04)
0.02 (0.02 - 0.03)
Test;albumin
6
0.01
0.01 (0.00 - 0.01)
0.00 (0.00 - 0.01)
Test;electrolytes
5
0.01
0.00 (0.00 - 0.01)
0.00 (0.00 - 0.01)
2
0.00
0.00 (0.00 - 0.0.1)
0.00 (0.00 - 0.00)
4,831
9.11
3.41 (3.32 - 3.51)
2.56 (2.49 - 2.63)
4,831
9.11
3.41 (3.32 - 3.51)
2.56 (2.49 - 2.63)
4,020
7.58
2.84 (2.75 - 2.93)
2.13 (2.06 - 2.19)
4,020
7.58
2.84 (2.75 - 2.93)
2.13 (2.06 - 2.19)
3,543
6.68
2.50 (2.42 - 2.58)
1.88 (1.81 - 1.94)
X-ray;chest
2,920
5.51
2.06 (1.99 - 2.14)
1.55 (1.49 - 1.60)
Ultrasound
378
0.71
0.27 (0.24 - 0.30)
0.20 (0.18 - 0.22)
Ultrasound;abdomen
104
0.20
0.07 (0.06 - 0.09)
0.06 (0.05 - 0.07)
Ultrasound;pelvis
93
0.18
0.07 (0.05 - 0.08)
0.05 (0.04 - 0.06)
X-ray;abdomen
47
0.09
0.03 (0.03 - 0.04)
0.03 (0.02 - 0.03)
Blood test digestive
3,002
5.66
2.12 (2.05 - 2.20)
1.59 (1.53 - 1.65)
Test;liver function
2,485
4.69
1.76 (1.69 - 1.82)
1.32 (1.26 - 1.37)
516
0.97
0.37 (0.33 - 0.40)
0.27 (0.25 - 0.30)
2
0.00
0.00 (0.00 - 0.01)
0.00 (0.00 - 0.00)
1,268
2.39
0.90 (0.85 - 0.95)
0.67 (0.64 - 0.71)
1,260
2.38
0.89 (0.84 - 0.94)
0.67 (0.63 - 0.70)
6
0.01
0.01 (0.00 - 0.01)
0.00 (0.00 - 0.01)
1
0.00
0.00 (0.00 - 0.00)
0.00 (0.00 - 0.00)
Blood test; blood/lymph
943
1.78
0.67 (0.62 - 0.71)
0.50 (0.47 - 0.53)
Test;haemoglobin
689
1.30
0.49 (0.45 - 0.52)
0.37 (0.34 - 0.39)
Test;iron studies
69
0.13
0.05 (0.04 - 0.06)
0.04 (0.03 - 0.05)
Test;INR
52
0.10
0.04 (0.03 - 0.05)
0.03 (0.02 - 0.04)
Test;ferritin
49
0.09
0.04 (0.03 - 0.05)
0.03 (0.02 - 0.03)
Test;haemoglobin epg
44
0.08
0.03 (0.02 - 0.04)
0.02 (0.02 - 0.03)
Test;prothrombin time
21
0.04
0.02 (0.01 - 0.02)
0.01 (0.01 - 0.02)
Test;calcium/magnesium/ phosphate Diagnostic radiology/ imaging; pregnancy Ultrasound;obstetric Other laboratory test NEC; urinary Test;renal function Diagnostic radiology/ imaging
Test;bilirubin Test;gGT Electrical tracing; cardiovascular Electrocardiogram Electrocardiogram; stress test Holter monitor
1RWH 1(&QRWHOVHZKHUHFODVVLÀHG J*7JDPPDJOXWDP\OWUDQVSHSWLGDVH ,15LQWHUQDWLRQDOQRUPDOL]HGUDWLR Haemoglobin EPG = haemoglobin electrophoresis
#
(continued)
Table 9.1 (continued): Types of investigations by ICPC-2 chapters and common individual test within chapter in primary care clinics in 2012 Percentage
Rate per 100
Rate per 100
of all
encounters
diagnoses
investigations
(95% CI)
(95% CI)
(n = 53,028)
(n = 141,593)
(n = 188,944)
15
0.03
0.01 (0.01 - 0.02)
0.01 (0.00 - 0.01)
Test;reticulocyte count
2
0.00
0.00 (0.00 - 0.01)
0.00 (0.00 - 0.00)
Test;blood;platelets
1
0.00
0.00 (0.00 - 0.00)
0.00 (0.00 - 0.00)
873
1.65
0.62 (0.58 - 0.66)
0.46 (0.43 - 0.49)
873
1.65
0.62 (0.58 - 0.66)
0.46 (0.43 - 0.49)
664
1.25
0.47 (0.43 - 0.51)
0.35 (0.33 - 0.38)
664
1.25
0.47 (0.43 - 0.51)
0.35 (0.33 - 0.38)
636
1.20
0.45 (0.42 - 0.49)
0.34 (0.31 - 0.36)
Test;hepatitis B antigen
379
0.72
0.27 (0.24 - 0.30)
0.20 (0.18 - 0.22)
Test;hepatitis B antibody
148
0.28
0.11 (0.09 - 0.12)
0.08 (0.07 - 0.09)
Test;hepatitis C antigen
50
0.10
0.04 (0.03 - 0.05)
0.03 (0.02 - 0.04)
Test;blood;H Pylori
28
0.05
0.02 (0.01 - 0.03)
0.02 (0.01 - 0.02)
Test;hepatitis C antibody
17
0.03
0.01 (0.01 - 0.02)
0.01 (0.01 - 0.01)
Test;faeces;MC&S
11
0.02
0.01 (0.00 - 0.01)
0.01 (0.00 - 0.01)
Test;hepatitis E antibody
1
0.00
0.00 (0.00 - 0.00)
0.00 (0.00 - 0.00)
Test;hepatitis E antigen
1
0.00
0.00 (0.00 - 0.00)
0.00 (0.00 - 0.00)
552
1.04
0.39 (0.36 - 0.42)
0.29 (0.27 - 0.32)
469
0.88
0.33 (0.30 - 0.36)
0.25 (0.23 - 0.27)
83
0.16
0.06 (0.05 - 0.07)
0.04 (0.04 - 0.05)
Blood test; urinary
545
1.03
0.39 (0.35 - 0.42)
0.29 (0.27 - 0.31)
Test;urate/uric acid
393
0.74
0.28 (0.25 - 0.31)
0.21 (0.19 - 0.23)
Test;creatinine
152
0.29
0.11 (0.09 - 0.13)
0.08 (0.07 - 0.09)
518
0.98
0.37 (0.34 - 0.39)
0.28 (0.26 - 0.30)
X-ray;foot/feet
87
0.16
0.06 (0.05 - 0.07)
0.05 (0.04 - 0.06)
X-ray;elbow
76
0.14
0.06 (0.04 - 0.07)
0.04 (0.03 - 0.05)
X-ray;hand
54
0.10
0.04 (0.03 - 0.05)
0.03 (0.02 - 0.04)
;UD\ ÀQJHU V WKXPE
38
0.07
0.03 (0.02 - 0.04)
0.02 (0.02 - 0.03)
X-ray;toe(s)
37
0.07
0.03 (0.02 - 0.03)
0.02 (0.02 - 0.03)
Investigation
Test;APTT
Urine test; endocrine/ metabolic Test;urine;endocrine/ metabolic Urine test; pregnancy Test;urine;pregnancy
Number
Microbiological/ immunological test; digestive
Microbiological/ immunological test; blood/ lymph Test;HIV Test;blood group
Diagnostic radiology/ imaging; musculoskeletal
Note: APTT - activated partial thromboplastin time; MC&S - microscopy, culture and sensitivity; +,9KXPDQLPPXQRGHÀFLHQF\YLUXV
(continued)
$
Table 9.1 (continued): Types of investigations by ICPC-2 chapters and common individual test within chapter in primary care clinics in 2012
Investigation
Number
Percentage
Rate per 100
Rate per 100
of all
encounters
diagnoses
investigations
(95% CI)
(95% CI)
(n = 53,028)
(n = 141,593)
(n = 188,944)
X-ray;spine;lumbosacral
36
0.07
0.03 (0.02 - 0.03)
0.02 (0.01 - 0.03)
X-ray;knee
30
0.06
0.02 (0.01 - 0.03)
0.02 (0.01 - 0.02)
X-ray;heel
28
0.05
0.02 (0.01 - 0.03)
0.02 (0.01 - 0.02)
X-ray;spine;cervical
22
0.04
0.02 (0.01 - 0.02)
0.01 (0.01 - 0.02)
Plain X-ray;bone(s)
21
0.04
0.02 (0.01 - 0.02)
0.01 (0.01 - 0.02)
X-ray;ankle
19
0.04
0.02 (0.01 - 0.02)
0.01 (0.01 - 0.02)
Ultrasound;neck
12
0.02
0.01 (0.00 - 0.01)
0.01 (0.00 - 0.01)
X-ray;back
12
0.02
0.01 (0.00 - 0.01)
0.01 (0.00 - 0.01)
X-ray;shoulder
10
0.02
0.01 (0.00 - 0.01)
0.01 (0.00 - 0.01)
X-ray;leg
7
0.01
0.01 (0.00 - 0.01)
0.00 (0.00 - 0.01)
X-ray;forearm
7
0.01
0.01 (0.00 - 0.01)
0.00 (0.00 - 0.01)
X-ray;spine
5
0.01
0.00 (0.00 - 0.01)
0.00 (0.00 - 0.01)
5
0.01
0.01 (0.00 - 0.01)
0.00 (0.00 - 0.01)
X-ray;arm
3
0.01
0.00 (0.00 - 0.01)
0.00 (0.00 - 0.00)
X-ray;clavicle
2
0.00
0.00 (0.00 - 0.00)
0.00 (0.00 - 0.00)
X-ray;wrist
2
0.00
0.00 (0.00 - 0.00)
0.00 (0.00 - 0.00)
X-ray;spine;lumbar
2
0.00
0.00 (0.00 - 0.00)
0.00 (0.00 - 0.00)
X-ray;femur
1
0.00
0.00 (0.00 - 0.00)
0.00 (0.00 - 0.00)
X-ray;metacarpal
1
0.00
0.00 (0.00 - 0.00)
0.00 (0.00 - 0.00)
447
0.84
0.32 (0.29 - 0.35)
0.24 (0.22 - 0.26)
Culture;tuberculosis
403
0.76
0.29 (0.26 - 0.31)
0.21 (0.19 - 0.24)
Test;sputum MC&S
34
0.06
0.03 (0.02 - 0.03)
0.02 (0.01 - 0.03)
Test;throat swab MC&S
10
0.02
0.01 (0.00 - 0.01)
0.01 (0.00 - 0.01)
444
0.84
0.31 (0.29 - 0.34)
0.24 (0.21 - 0.26)
355
0.67
0.25 (0.23 - 0.28)
0.19 (0.17 - 0.21)
66
0.12
0.05 (0.04 - 0.06)
0.04 (0.03 - 0.04)
10
0.02
0.01 (0.00 - 0.01)
0.01 (0.00 - 0.01)
6
0.01
0.01 (0.00 - 0.01)
0.00 (0.00 - 0.01)
X-ray;spine; thoracolumbar
Microbiological/ immunological test; respiratory
Microbiological/ immunological test Test;sexually transmitted infection Test;dengue fever Test;measles virus antibodies Test;alpha fetoprotein Note: MC&S - microscopy, culture and sensitivity
(continued)
Table 9.1 (continued): Types of investigations by ICPC-2 chapters and common individual test within chapter in primary care clinics in 2012
Investigation
Rate per 100
Rate per 100
of all
encounters
diagnoses
investigations
(95% CI)
(95% CI)
(n = 53,028)
(n = 141,593)
(n = 188,944)
6
0.01
0.01 (0.00 - 0.01)
0.00 (0.00 - 0.01)
1
0.00
0.00 (0.00 - 0.00)
0.00 (0.00 - 0.00)
433
0.82
0.31 (0.28 - 0.34)
0.23 (0.21 - 0.25)
Monitoring;foetal
428
0.81
0.30 (0.27 - 0.33)
0.23 (0.21 - 0.25)
Cardiotocography
6
0.01
0.01 (0.00 - 0.01)
0.00 (0.00 - 0.01)
427
0.81
0.30 (0.27 - 0.33)
0.23 (0.21 - 0.25)
427
0.81
0.30 (0.27 - 0.33)
0.23 (0.21 - 0.25)
289
0.54
0.21 (0.18 - 0.23)
0.15 (0.14 - 0.17)
Test;lung function
177
0.33
0.13 (0.11 - 0.15)
0.09 (0.08 - 0.11)
7HVW SHDNÁRZ
110
0.21
0.08 (0.06 - 0.09)
0.06 (0.05 - 0.07)
1
0.00
0.00 (0.00 - 0.00)
0.00 (0.00 - 0.00)
Test;lymphocyte type & count Test;culture and sensitivity Electrical tracing; pregnancy
Other diagnostic procedure; eye Procedures;diagnostic; eye Physical function test; respiratory
Test;spirometry
9.3
Number
Percentage
INVESTIGATIONS MOST FREQUENTLY ORDERED IN PUBLIC AND PRIVATE CLINICS
Individual investigations or tests were ranked in decreasing order irrespective of ICPC-2 chapter and ten most frequently ordered investigations are presented in Figure 9.2 (public clinics) and Figure 9.3 (private clinics). 7KHUHZHUH LQYHVWLJDWLRQVUHFRUGHGLQSXEOLFFOLQLFVDWDUDWHRISHUHQFRXQWHUVDQG 49.6 per 100 diagnoses. %\FRPSDULVRQSULYDWHFOLQLFVUHFRUGHG LQYHVWLJDWLRQVDWDUDWHRI SHUHQFRXQWHUV and 15.7 per 100 diagnoses. 7KH OHDGLQJ LQYHVWLJDWLRQV LQ SXEOLF DQG SULYDWH FOLQLFV ZHUH DOPRVW VLPLODU VHYHQ RI WKHVH investigations were listed among the top ten investigations for both sectors.
Figure 9.2 Top 10 investigations ordered in public clinics in 2012
12.2
Test;glucose & glucose tolerance 9.2
Ultrasound;obstetrics 8.2
Test;renal function
7.8
Test;lipids profile 5.8
Test;full blood count 5.0
Test;liver functions
4.8
Test;HbA1c 4.0
Test;urine 3.3
Test;urine;albumin 1.9
Electrocardiogram 0
2
4
6
8
10
12
14
Rate per 100 encounters
Figure 9.3 Top 10 investigations ordered in private clinics in 2012
3.6
Test;urine 2.6
Test;glucose tolerance
2.2
X-ray;chest
2.0
Test;blood 0.9
Ultrasound;obstetric Test;lipids profile
0.6
Test;renal function
0.6
Test;urine;pregnancy
0.5
Test;HbA1c
0.4
Electrocardiogram
0.4 0
2
4
6
Rate per 100 encounters
!
8
10
12
14
9.4 DIAGNOSES WITH INVESTIGATIONS ORDERED Table 9.2 shows the top 20 diagnoses for which investigations were ordered. ,QYHVWLJDWLRQZDVSDUWRIWKHPDQDJHPHQWSURFHVVIRURIDOOGLDJQRVHVUHSRUWHGLQ10&6 at a rate of 23.0 per 100 encounters. 7KHWRSGLDJQRVHVOLVWHGLQ7DEOH DFFRXQWHGIRURIGLDJQRVHVIRUZKLFKLQYHVWLJDWLRQV were ordered. 'LDEHWHV ZDV WKH PRVW FRPPRQ GLDJQRVLV IRU ZKLFK LQYHVWLJDWLRQ ZDV RUGHUHG 7KLV FRUUHVSRQGV with the leading investigations ordered, which was glucose blood test (see Section 9.2 and Section 9.3). Nearly half of all diabetes cases were accompanied with investigation test. 0DMRULW\RISUHJQDQF\FDVHVZHUHDFFRPSDQLHGZLWKGLDJQRVWLFLQYHVWLJDWLRQVDQGPRVWRIWKHPZHUH XULQHWHVWWRFRQÀUPSUHJQDQF\ Table 9.2: Top 10 diagnoses for which investigation was most frequently ordered in primary care clinics in 2012 Rate per 100 Diagnosis
Number
Percentage(a)
Rate
95% CI
per 100
encounters (n = 141,593)
LCL
UCL
contacts(b)
Diabetes - all*
6,515
20.0
4.60
4.49
4.71
49.3
Hypertension - all*
3,910
12.0
2.76
2.68
2.85
20.3
3,745
11.5
2.65
2.56
2.73
68.7
3,050
9.4
2.16
2.08
2.23
58.4
Lipid disorder
2,549
7.8
1.80
1.73
1.87
21.7
Cystitis/urinary infection
1,297
4.0
0.92
0.87
0.97
62.8
Anaemia - all*
1,146
3.5
0.81
0.76
0.86
57.3
739
2.3
0.52
0.49
0.56
2.3
Perinatal morbidity
487
1.5
0.35
0.31
0.38
72.3
Pregnancy*
416
1.3
0.30
0.27
0.32
84.4
Subtotal
23,855
73.2
16.85
16.65
17.04
-
Total
32,570
100.0
23.00
22.78
23.22
-
Medical examination pregnancy* Medical examination general*
Upper respiratory infection, acute
(a) Percentage of all diagnoses with investigations (b) Percentage of total contacts with the diagnosis that generated at least one order of investigation *Multiple ICPC-2 codes (see Appendix 2) Note: perinatal morbidity = neonatal jaundice
%
Chapter 10 Advice/Counselling And Procedures
CHAPTER 10: ADVICE/COUNSELLING AND PROCEDURES Counselling interventions in clinical settings are employed to assist patients in adopting, changing, or maintaining behaviours affecting health outcomes and health status.1 In primary care, healthcare providers have the opportunities to provide advice on health promotions and lifestyle counselling, but heavy workload and lack of time were often reported by doctors as barriers to this interventions.1,2 In this report, advice/counselling refer to health education, advice or counselling delivered by doctors or other healthcare professionals during patient visit to primary care. This can be related to disease, medication compliance, healthy diet, lifestyle intervention or others. In addition, the number of procedures and type of procedures commonly performed in primary care clinics were also measured. Procedures refer to any therapeutic procedures, rehabilitation or administrative procedures undertaken in the clinic during patient visit. This chapter reports the advice/counselling and procedures provided to the patients at each encounter. For each patient visit, the doctors were asked to record any procedure/counselling/other treatment provided and linked to diagnosis of which this procedure/counselling/other treatment was indicated for. 10.1
NUMBER OF ADVICE/COUNSELLING AND PROCEDURES
Table 10.1 shows the proportion of encounters provided with advice/counselling and procedures during visit to primary care clinics. Advice/counselling were provided for 19.3% of all encounters whereas procedures were part of management process for only 2.3% of encounters. Table 10.1: Advice/counselling and procedures in primary care clinics in 2012 Overall Variable
Advice/counselling Procedures
10.2
Public
Private
Number of encounters
Percent of encounters (95% CI) (n = 42,340)
Number of encounters
Percent of encounters (95% CI) (n = 99,253)
19.3 (19.1 - 19.5)
15,747
11.1 (11.0 - 11.3)
11,510
8.1 (8.0 - 8.3)
2.3 (2.2 - 2.4)
623
0.4 (0.4 - 0.5)
2,595
1.8 (1.8 - 1.9)
Number of encounters
Percent of encounters (95% CI) (n = 141,593)
27,257 3,219
TYPES OF ADVICE AND COUNSELLING
Table 10.2 displays the types of advice/ counselling provided to patients attending primary care clinics. 0DMRULW\RIWKHDGYLFHFRXQVHOOLQJSURYLGHGZHUHIRUJHQHUDODGYLFHFRXQVHOOLQJ WKDWLQFOXGH DGYLFHHGXFDWLRQRQGLHWPHGLFDWLRQVH[HUFLVHUHVWÁXLGVLQWDNHDQGK\JLHQH $GYLFHFRXQVHOOLQJRISV\FKRORJLFDODVSHFWDFFRXQWHGIRURIDOODGYLFHFRXQVHOOLQJSURYLGHGLQ primary care clinics. Lifestyle advice accounted for majority of the cases. Others were related to quit smoking, alcohol, illicit drugs, stress management or other psychological advice. $PRQJVRPHRIWKHPRVWFRPPRQO\SURYLGHGDGYLFHFRXQVHOOLQJRQWKHHQGRFULQHPHWDEROLFGLVHDVH were diabetic health education, foot care and diabetic diet.
Table 10.2: Types of advice/counselling provided in primary care clinics in 2012
Percentage Advice/counselling
Number
of all advice/ counselling
Advice/counselling; general/
Rate per 100
Rate per 100
encounters
diagnoses
(95% CI)
(95% CI)
(n = 141,593)
(n = 188,944)
18,196
49.47
12.85 (12.68 - 13.03)
9.63 (9.50 - 9.76)
5,243
14.25
3.70 (3.61 - 3.80)
2.78 (2.70 - 2.85)
4,875
13.25
3.44 (3.35 - 3.54)
2.58 (2.51 - 2.65)
1,789
4.86
1.26 (1.21 - 1.32)
0.95 (0.90 - 0.99)
1,720
4.68
1.22 (1.16 - 1.27)
0.91 (0.87 - 0.95)
1,540
4.19
1.09 (1.03 - 1.14)
0.82 (0.78 - 0.86)
736
2.00
0.52 (0.48 - 0.56)
0.39 (0.36 - 0.42)
Advice/counselling; digestive
634
1.72
0.45 (0.41 - 0.48)
0.34 (0.31 - 0.36)
Advice/counselling; skin
598
1.63
0.42 (0.39 - 0.46)
0.32 (0.29 - 0.34)
487
1.32
0.35 (0.31 - 0.38)
0.26 (0.24 - 0.28)
349
0.95
0.25 (0.22 - 0.27)
0.19 (0.17 - 0.21)
235
0.64
0.17 (0.15 - 0.19)
0.13 (0.11 - 0.14)
140
0.38
0.10 (0.08 - 0.12)
0.08 (0.06 - 0.09)
82
0.22
0.06 (0.05 - 0.07)
0.04 (0.04 - 0.05)
Advice/counselling; ear
70
0.19
0.05 (0.04 - 0.06)
0.04 (0.03 - 0.05)
Advice/counselling; social
38
0.10
0.03 (0.02 - 0.04)
0.02 (0.01 - 0.03)
34
0.09
0.03 (0.02 - 0.03)
0.02 (0.01 - 0.03)
6
0.02
0.01 (0.00 - 0.01)
0.00 (0.00 - 0.01)
2
0.00
0.00 (0.00 - 0.01)
0.00 (0.00 - 0.00)
36,782
100
25.98 (25.75 - 26.21)
19.47 (19.29 - 19.65)
XQVSHFLÀHG Advice/counselling; psychological Advice/counselling; endocrine/ metabolic Advice/counselling; respiratory Advice/counselling; pregnancy Advice/counselling; cardiovascular Advice/counselling; musculoskeletal
Advice/counselling; blood/ lymph Advice/counselling; eye Advice/counselling; genital; female Advice/counselling; urinary Advice/counselling; neurological
Advice/counselling; genital; male &ODULÀFDWLRQ'LVFXVVLRQ5)( Demand Consultation primary care provider Total advice/counselling
10.3
MOST COMMON ADVICE/COUNSELLING PROVIDED IN PUBLIC AND PRIVATE CLINICS
Ten most frequently provided advice/counselling were summarised in Figure 10.1 (public clinics) and Figure 10.2 (private clinics). From the total of 36,782 advices/counselling reported, 21,736 (59.0%) were SURYLGHGDWSXEOLFFOLQLFV0RVWRIWKHDGYLFHFRXQVHOOLQJSURYLGHGZHUHJHQHUDORUXQVSHFLÀHGRIZKLFK mainly related to diet, exercise, rest, and hygiene. Figure 10.1 Ten most common advice/counselling provided in public clinics in 2012
Advice/counselling;general/unspecified
,
Advice/counselling;endocrine/metabolic
.
Advice/counselling;psychological
'
.
Advice/counselling;pregnancy
-
Advice/counselling;cardiovascular
,
Advice/counselling;respiratory
+
Advice/counselling;digestive
&
Advice/counselling;blood/lymph
'
&
Advice/counselling;skin Advice/counselling;musculoskeletal
'
.
/
(
,
)
*
)
'
&
'
*
'
&
'
'
'
'
-
)
(
0
1
2
3
4
3
+
5
&
&
3
6
7
8
9
6
2
3
5
:
Figure 10.2 Ten most common advice/counselling provided in private clinics in 2012
Advice/counselling;general/unspecified
C
Advice/counselling;psychological
A
Advice/counselling;endocrine/metabolic
A
Advice/counselling;respiratory
