SHEAMINI SIVASAMPU, AISYAH ALI, SHANTHA KUMAR C, NORAZIDA AB. RAHMANHealthcare Statistics Unit, Clinical Research Centre, Ministry of Health Malaysia

BACKGROUND METHODOLOGY

Clinical Research Centre, 3rd Floor MMA building, 124 Jalan Pahang, 53000 Kuala Lumpur Tel: 03-40439300/400 Fax: 03-40439500 Email: hsu@crc.gov.my

OBJECTIVE

RESULTS

DISCUSSION

CONCLUSION

ACKNOWLEDGEMENT

REFERENCES

In Malaysia, primary healthcare services is provided by both public and private sector. Healthcare services in the urban areas are predominantly provided by the general practitioners whereas the Ministry of Health (MOH) focuses its healthcare delivery to the rural areas.1 Differences between the practices of urban and rural general practitioners have been reported in several countries2,3 but there is a paucity of local studies done on urban-rural distribution of general practitioners and their services in primary care.1,4

This study aims to compare the general practitioners characteristics and services profile between urban and rural general practices in Malaysia.

Urban population made up 71.0% of total population in Malaysia. Kuala Lumpur and Putrajaya have 100.0% level of urbanisation while states with lowest urbanisation levels were Kelantan (42.4%) and Pahang (50.5%).5 Following classification by Department of Statistics, 90.8% (4113/4529) of total general practices population in Malaysia were located in urban areas (Figure 1). Negeri Sembilan had the highest number of general practices set up in rural areas (25.4%, 49/193).

The response rate from clinics in urban areas was 51.2% while 53.6% of total clinics sampled from rural areas responded to our survey. From our study population, 277 clinics out of 307 clinics (90.2%) that participated in our survey were in urban areas. There are more solo practitioners in both urban and rural areas (Figure 2). Such preferences for solo practices has been noted by other studies.2, 6 In contrast to public clinics, general practices have flexible operating hours and clinics schedules.7 However, majority of the general practices operate less than 24 hours per day (Figure 3) with no significant urban-rural differences observed.

General practitioners in urban areas were slightly older with significant mean differences observed for urban-rural comparison (Table 1). All general practices in rural areas provide acute care services. One clinic from urban areas did not provide acute care as they offered medical check-up services only. Less than 5% of the general practices did not provide chronic care services. Preventive services were available in both urban and rural general practices with majority offered medical check-up and maternity services. No significant urban-rural differences were observed for all services provided with exception of maternity service. General practices might not be able to provide preventive care services equivalent to those provided by public clinics , but this study highlighted that four out of six preventive services listed in Table 1 were provided by more than 60.0% of general practices in our study.

This is the first study that compares the distribution of general practice and practitioners between urban and rural areas in Malaysia. General practitioners in urban areas were slightly older than those in rural areas. Age of general practitioners and the availability of maternal services were the only variables with significant differences observed between urban and rural areas. There is no imbalance in the services provided in both urban and rural general practices. Further study is necessary to measure the rurality for accuracy of related studies in Malaysia.

We would like to thank the Ministry of Health and Director General of Health for the permission to carry out and publish this study and the Department of Statistics Malaysia for classifying our sample of general practices to urban-rural classification.

1. Ariff KM, Teng CL. Rural Health care in Malaysia. Austr J Rural Health. 2002; 10(2):99-103.2. Boerma WG, Groenewegen PP, Van Der Zee J. General practice in urban and rural Europe: the range of curative services. Social Science

& Medicine. 1998;47(4):445-453.3. Britt H, Miles DA, Bridges-Webb CB et al. A comparison of country and metropolitan general practice. Med J Aust 1993; 159 (Suppl):S9-S64.4. Khoo EM. A comparative study on the service profiles and practice facilities among urban general practices in east and west Malaysia.

Med J Malaysia. 2000;55(3):341-6. 5. Population distribution and basic demographic characteristics 2010, Department of Statistics Malaysia. Available online at http://www.

statistics.gov.my/portal/download_Population/files/census2010/Taburan_Penduduk_dan_Ciri-ciri_Asas_Demografi.pdf6. Khoo EM, Tan PL. Profile of general practices in Malaysia. Asia Pac J Public health. 1998;10(2):81-87.7. Aljunid SM, Zwi AB. Difference in public private health services in rural district of Malaysia. Med J Malaysia. 1996;51(4):426-36.

Figure 1: Distribution of general practices (GPs) by strata and state in Malaysia, 2010 by urban-rural areas

Table 1: General practitioners’ characteristics and service profiles of general practices

Figure 2: Type of practices in urban and rural areas

Figure 3: GPs operating hours by urban- rural classification

*CKAPS: Cawangan Kawalan Amalan Perubatan Swasta

Inclusion criteria: • CKAPS* list of Registered Private

Medical Practitioner Exclusion criteria: • Specialist clinic • Primary care clinics in universities • Diagnostic/aesthetic clinics

Sample size selection

n = 597

Survey form development

1.Stratification by state 2.Stratification by urban-rural 3.Random sampling of clinics

Survey population: Private primary care clinics

n = 4529

Rural

n = 56

Respondent clinics

n = 30

Urban

n = 541

Respondent clinics

n = 277

Urban-rural classification provided by

Department of Statistics Malaysia

Primary Care Facilities

Analysis and comparison by urban-rural areas

Data collection & data entry

Data cleaning, verification

Data analysis

National Healthcare Establishment and Workforce (NHEWS) Primary Care Database: 2010

Primary Care Services

Primary Care Workforce

Primary Care Devices

CriteriaUrbann (%)

Ruraln (%)

P value c

General practitioners’ characteristicsAge† 50.01 (10.70) 46.61 (8.95) 0.046a

Years of experience† 18.42 (9.97) 15.06 (10.45) 0.065b

GenderMale 256 (66.7) 27 (81.8)

0.071Female 129 (33.6) 6 (18.2)

Service profilesAcute Care Services 276 (99.6) 30 (100.0) 1.000d

Chronic Care Services 272 (98.2) 29 (96.7) 0.463d

Preventive services Pap Smear 195 (70.4) 18 (60.0) 0.241Clinical Breast Examination 206 (74.4) 20 (66.7) 0.363Smoking Cessation 55 (19.9) 8 (26.7) 0.380Occupational Health 93 (33.6) 5 (16.7) 0.059Medical checkup 268 (96.8) 28 (93.3) 0.293d

Maternity 202 (72.9) 28 (93.3) 0.014†Data are presented as mean (standard deviation) a Independent t-test (unequal variances) b Independent t-test (equal variances) c Chi-square test for independence d Fisher’s Exact test