8/6/2019 Group 3 Batch 2008 TBL 3

1/34

11

TBL 3TBL 3Community MedicineCommunity Medicine

PostingPosting

TBL 3TBL 3Community MedicineCommunity Medicine

PostingPosting

Group 3Group 3

MBBS 0809MBBS 0809

26/1/201126/1/2011

Group 3Group 3

MBBS 0809MBBS 0809

26/1/201126/1/2011

8/6/2019 Group 3 Batch 2008 TBL 3

2/34

22

Level of Primary CareLevel of Primary Care

ConceptConcept

Level of Primary CareLevel of Primary Care

ConceptConcept

8/6/2019 Group 3 Batch 2008 TBL 3

3/34

33

8/6/2019 Group 3 Batch 2008 TBL 3

4/34

44

Level of CareLevel of CareLevel of CareLevel of Care

8/6/2019 Group 3 Batch 2008 TBL 3

5/34

55

Primary levelPrimary levelPrimary levelPrimary level

Focus on preventive medicineFocus on preventive medicine Screening activitiesScreening activities

Community clinic, communityCommunity clinic, communitypolyclinic, general practitionerpolyclinic, general practitioner

8/6/2019 Group 3 Batch 2008 TBL 3

6/34

66

Secondary levelSecondary levelSecondary levelSecondary level Level of care in the health careLevel of care in the health care

system that consists of emergencysystem that consists of emergencytreatment and critical caretreatment and critical care

Received referred case from primaryReceived referred case from primary

healthcarehealthcare

District hospitalDistrict hospital

8/6/2019 Group 3 Batch 2008 TBL 3

7/34

77

Tertiary levelTertiary levelTertiary levelTertiary level A specialized, highly technical levelA specialized, highly technical level

of health care that includes diagnosisof health care that includes diagnosis

and treatment of disease andand treatment of disease and

disabilitydisability

Received cases referred byReceived cases referred bysecondary healthcaresecondary healthcare

IJNIJN

8/6/2019 Group 3 Batch 2008 TBL 3

8/34

88

Primary Care ConceptPrimary Care ConceptPrimary Care ConceptPrimary Care Concept

Primary care is:Primary care is:

Essential health care made universallyEssential health care made universallyaccessible to individuals and families inaccessible to individuals and families in

the community by means acceptable tothe community by means acceptable to

them through their full participation andthem through their full participation and

at cost that the community and countryat cost that the community and country

can affordcan afford

8/6/2019 Group 3 Batch 2008 TBL 3

9/34

99

It stresses on:It stresses on:

Its essentiality by observing that primary healthIts essentiality by observing that primary healthis essential health careis essential health care

It accessibility by observing: made universallyIt accessibility by observing: made universallyaccessible to individuals and families in theaccessible to individuals and families in thecommunitycommunity

Its acceptability by observing: by meansIts acceptability by observing: by meansacceptable to themacceptable to them

Its participancy by observing: at a cost that theIts participancy by observing: at a cost that thecommunity and the country can affordcommunity and the country can afford

Its integrality by observing: it forms an integralIts integrality by observing: it forms an integralpart both of the countrys health system of whichpart both of the countrys health system of whichit is the nucleus and the overall social andit is the nucleus and the overall social andeconomic development of the communityeconomic development of the community

8/6/2019 Group 3 Batch 2008 TBL 3

10/34

1010

Organisation & StaffOrganisation & StaffOrganisation & StaffOrganisation & Staff

PKD Vs. Health ClinicPKD Vs. Health ClinicPKD Vs. Health ClinicPKD Vs. Health Clinic

8/6/2019 Group 3 Batch 2008 TBL 3

11/34

Categories PKD Health Office

LEADER OF

DEPARTMENTS

District Health Officer Medical OfficerOf

Health

UNITS Food Safety and Quality Maternal and Child

Health

Drinking Water Quality Reproductive Health

Vector-borne Disease School Health

Infectious Disease Out-patient Dpt.

Water Supply & Env. Health Emergency Dpt.

Legislation & Enforcement Rehabilitation

General Health Pharmacy

Health Promotion Diagnostic imaging

8/6/2019 Group 3 Batch 2008 TBL 3

12/34

PEGAWAI KESIHATAN DAERAH

U54

CARTA ORGANISASI

PEJABAT KESIHATAN DAERAH SEPANG

Pembangunan

Kesihatan

Keluarga

Kesihatan

Environmen

KPPKP U36

Pengurusan

&

Pentadbiran

Klinik Kesihatan Salak

Tinggi

Klinik Kesihatan Sg.

Pelek

Klinik Kesihatan

Dengkel

Klinik

Desa

Klinik

Desa

Klinik

Desa

Klinik

Desa

Klinik

Desa

Klinik

Desa

Bahagian

Pentadbiran

Bahagian

Kewangan

Bahagian

Perkhidmatan

Bahagian

Hasil

Unit Kesihatan

Am/KPASUnit Keselamatan

dan Kualiti

Makanan

Unit Kawalan

Penyakit BawaanVektor

Unit Bekalan Air dan Kesihatan

Alam SekelilingBAKAS

Unit Kawalan

Mutu Air Minum

PPKP U32

Kawalan Penyakit

dan Tidak

Berjangkit

PPKP U32

Kawalan Penyakit

dan Tidak

Berjangkit

Unit Kawalan

Penyakit

Berjangkit

Unit Penyiasatan

dan Pendakwaan

PEGAWAI KESIHATAN

U52/U48

8/6/2019 Group 3 Batch 2008 TBL 3

13/34

Organization Chart: KKDistrict Health Officer/

Medical Officer of Health

(Specialist in PH/DOH/MOH)

Medical and Health Officer in charge

UD 48/UD54 (MNHO)

Family Medicine Specialist

School Health Team

MCHC

X-Ray

Lab

OPD Unit

Pharmacy

MNHO (UD48)

8/6/2019 Group 3 Batch 2008 TBL 3

14/34

1414

Expanded Scopes &Expanded Scopes &

Support ServiceSupport Service

Expanded Scopes &Expanded Scopes &

Support ServiceSupport Service

Hospital Vs. Health ClinicHospital Vs. Health ClinicHospital Vs. Health ClinicHospital Vs. Health Clinic

8/6/2019 Group 3 Batch 2008 TBL 3

15/34

1515

Expanded Scope ProgrammesExpanded Scope ProgrammesExpanded Scope ProgrammesExpanded Scope Programmes

Reproductive HealthReproductive Health

Diabetic / CVD ScreeningDiabetic / CVD Screening

ElderlyElderly

Tuberculosis ( dots)Tuberculosis ( dots)

HIV/STIHIV/STI-- MSA (Modified syndromic approach)MSA (Modified syndromic approach)

Mental HealthMental Health

Quit SmokingQuit Smoking

AdolescentAdolescent

Methadone replacement therapy (Drug addiction)Methadone replacement therapy (Drug addiction)

8/6/2019 Group 3 Batch 2008 TBL 3

16/34

Expanded scopeExpanded scope

programmesprogrammes

Expanded scopeExpanded scope

programmesprogrammes1.1. Reproductive HealthReproductive Health Planning, reproductive tract infections,Planning, reproductive tract infections,

infertility, menopause/ andropause, marriageinfertility, menopause/ andropause, marriage

counseling, male responsibility/ gender issuescounseling, male responsibility/ gender issues

2.2. Diabetic / CVD ScreeningDiabetic / CVD Screening

assess high risk population for detection ofassess high risk population for detection of

diabetes and cardiovascular disease and todiabetes and cardiovascular disease and tostart on management if necessarystart on management if necessary

Several test done such as random/fastingSeveral test done such as random/fastingblood sugar, cholesterol level.blood sugar, cholesterol level.

8/6/2019 Group 3 Batch 2008 TBL 3

17/34

Expanded scope programsExpanded scope programs

( cont.)( cont.)

Expanded scope programsExpanded scope programs

( cont.)( cont.)3. Quit smoking clinic3. Quit smoking clinic

-- Therapies provided :Therapies provided :--

Nicotine gumsNicotine gums

CounselingCounseling

Nicotine patchNicotine patch

1717

8/6/2019 Group 3 Batch 2008 TBL 3

18/34

Expanded scopeExpanded scope

programs ( cont.)programs ( cont.)

Expanded scopeExpanded scope

programs ( cont.)programs ( cont.)4. Elderly4. Elderly

Rehabilitation ServicesRehabilitation Services

Home VisitsHome Visits

Elderly ClubElderly Club

Health EducationHealth Education

Visit to old folks homeVisit to old folks home

5. Tuberculosis5. Tuberculosis

Centre 1: start treatmentCentre 1: start treatment

Centre 2: continues treatment ( dots)Centre 2: continues treatment ( dots)1818

8/6/2019 Group 3 Batch 2008 TBL 3

19/34

Expanded scope programsExpanded scope programs

( cont.)( cont.)

Expanded scope programsExpanded scope programs

( cont.)( cont.)6. HIV/STI6. HIV/STI

CounselingCounseling

Antenatal rapid screening for all pregnantAntenatal rapid screening for all pregnantmothermother

PrePre--marital HIV screeningmarital HIV screening

HAART therapyHAART therapy

7. Mental Health7. Mental Health

Give counseling on how to handle stressGive counseling on how to handle stress

8/6/2019 Group 3 Batch 2008 TBL 3

20/34

Expanded scope programsExpanded scope programs

( cont.)( cont.)

Expanded scope programsExpanded scope programs

( cont.)( cont.)

8. Cancer screening8. Cancer screening

-- Pap smearPap smear

-- Breast examinationBreast examination

-- MammogramMammogram

2020

8/6/2019 Group 3 Batch 2008 TBL 3

21/34

Expanded scopeExpanded scope

programs ( cont.)programs ( cont.)

Expanded scopeExpanded scope

programs ( cont.)programs ( cont.)9. Adolescent clinic9. Adolescent clinic

Counseling for common problemsCounseling for common problems--

smoking, diabetes, drug addictionsmoking, diabetes, drug addiction

Methadone replacement therapyMethadone replacement therapy(Drug addiction)(Drug addiction)

Health Advisory panelsHealth Advisory panels

assist in terms of health information,assist in terms of health information,health activities and programmes.health activities and programmes.

2121

8/6/2019 Group 3 Batch 2008 TBL 3

22/34

2222

Support ServicesSupport ServicesSupport ServicesSupport Services LAB SERVICESLAB SERVICES

PHARMACY SERVICESPHARMACY SERVICES

DIAGNOSTIC AND IMAGING SERVICESDIAGNOSTIC AND IMAGING SERVICES

8/6/2019 Group 3 Batch 2008 TBL 3

23/34

Support servicesSupport servicesSupport servicesSupport services LAB SERVICESLAB SERVICES

clinic:clinic:

FBC, RP, LFT, UA, VDRL, Bld Gp, ESRFBC, RP, LFT, UA, VDRL, Bld Gp, ESR

MGTT, FBS, 2HPP,BFMP, BFFMGTT, FBS, 2HPP,BFMP, BFF

HIV Rapid test, Sr BilirubinHIV Rapid test, Sr Bilirubin

Direct smearDirect smear GC, TV, CandidaGC, TV, Candida

UFEME, Stool for ova& cystUFEME, Stool for ova& cyst

Sputum AFBSputum AFB

Scraping for fungusScraping for fungus

8/6/2019 Group 3 Batch 2008 TBL 3

24/34

Support services(cont.)Support services(cont.)Support services(cont.)Support services(cont.) PHARMACY SERVICESPHARMACY SERVICES

-- Prescribe drugs.Prescribe drugs.

-- Discuss with doctor about amount or types of drugsDiscuss with doctor about amount or types of drugs

need to prescribe if problem occur.need to prescribe if problem occur.

-- Methadone replacement therapy.Methadone replacement therapy.

--

Refer to hospital if drugs need to prescribe.Refer to hospital if drugs need to prescribe. DIAGNOSTIC AND IMAGING SERVICESDIAGNOSTIC AND IMAGING SERVICES

Clinic: xClinic: x--rayray

Hospital: XHospital: X--ray, MRI, CTray, MRI, CT--scanscan

2424

8/6/2019 Group 3 Batch 2008 TBL 3

25/34

2525

Support services: Hospital vs clinicSupport services: Hospital vs clinicSupport services: Hospital vs clinicSupport services: Hospital vs clinic

Clinic Hospital

Lab services Lab services

Pharmacy services Pharmacy services

Diagnostic and imaging services Diagnostic and imaging services

Dietetic and food services( for maternal

and child)

Dietetic and food services

Rehabilitation services

Infection control

Social medical

Sterilize item supply

8/6/2019 Group 3 Batch 2008 TBL 3

26/34

2626

Health Clinic Advisory PanelHealth Clinic Advisory Panel

Vs.Vs.

Hospitals Visitors BoardHospitals Visitors Board

Health Clinic Advisory PanelHealth Clinic Advisory Panel

Vs.Vs.

Hospitals Visitors BoardHospitals Visitors Board

8/6/2019 Group 3 Batch 2008 TBL 3

27/34

2727

Health Clinic Advisory Panel Hospital Visitor Board

Group of people from the residents

+ health clinic that is appointed by

the Ministry of Health

Group of local residents that is

appointed by the Ministry of Health.

Objective:

to assist in terms of healthinformation, health activities and

programmes.

Objective:

to strengthen relationship between

public and hospital in order toimprove the services provided by

the hospital

Scope:

Driving force for communityinvolvement activity arranged by

the health clinic

Health Management Activities

Scope:

Deal and provide information to thecommunity regarding hospital

services

Members: 13 people Members: 15 people

8/6/2019 Group 3 Batch 2008 TBL 3

28/34

2828

Health Clinic Advisory Panel Hospital Visitor Board

Functions:

Serves as an intermediate

between the community and

Health Department

Serves as a motivator for the

participation of the community

Management of health activities

Functions:

as an intermediate between the

patient in the hospital/ in public and the

hospital administration.

this is to explain the management of

the hospital to the patients to ensure

that all the patients are well briefed on

the on going situation

Organization:

1 chairman

1 vice-chairman

1 secretary1 vice secretary

1 person for account checking

1 treasurer

Organization:

1 president

1 vice-president1 secretary

1 treasurer

8/6/2019 Group 3 Batch 2008 TBL 3

29/34

2929

QAP Indicators inQAP Indicators in

Primary CarePrimary Care

QAP Indicators inQAP Indicators in

Primary CarePrimary Care

NIA & DSANIA & DSANIA & DSANIA & DSA

8/6/2019 Group 3 Batch 2008 TBL 3

30/34

3030

AimsAimsAimsAims

To improve the quality, efficiencyTo improve the quality, efficiency

and effectiveness of the deliveryand effectiveness of the delivery

of health servicesof health services

8/6/2019 Group 3 Batch 2008 TBL 3

31/34

313133

ProblemProblemPrioritisationPrioritisation

Problem AnalysisProblem Analysis

Quality AssuranceQuality Assurance

StudyStudy

Identification ofIdentification of

Remedial ActionsRemedial Actions

Implementation ofImplementation of

Remedial ActionsRemedial Actions

ReRe--evaluation of theevaluation of the

ProblemProblem

Problem identificationProblem identification

Quality AssuranceQuality Assurance

CycleCycle

8/6/2019 Group 3 Batch 2008 TBL 3

32/34

3232

NIA (National Indicator Approach)NIA (National Indicator Approach)NIA (National Indicator Approach)NIA (National Indicator Approach)

It is a check mechanism approach to assistIt is a check mechanism approach to assistmanagers and policy makers to promptlymanagers and policy makers to promptly

recognize shortfall in quality of care for therecognize shortfall in quality of care for thechosen area being measured.chosen area being measured.

The standard is set at national level andThe standard is set at national level andmonitored at national level.monitored at national level.

Investigation will be done if there is shortfall inInvestigation will be done if there is shortfall inquality using protocol made available by ministryquality using protocol made available by ministryand appropriate remedial measure will beand appropriate remedial measure will beimplemented.implemented.

8/6/2019 Group 3 Batch 2008 TBL 3

33/34

3333

NIA in Primary HealthcareNIA in Primary HealthcareNIA in Primary HealthcareNIA in Primary HealthcareIndicator Standard

Incidence rate of eclampsia

8/6/2019 Group 3 Batch 2008 TBL 3

34/34

3434

District Specific Approach (DSA)District Specific Approach (DSA)District Specific Approach (DSA)District Specific Approach (DSA)

The rate of family planning by high risk mothers in theThe rate of family planning by high risk mothers in the

districtdistrict

Anaemia in pregnancyAnaemia in pregnancy

Problems in tracing of high risk and defaulter casesProblems in tracing of high risk and defaulter cases

among antenatal mothersamong antenatal mothers

Waiting time of patientsWaiting time of patients

Early antenatal bookingEarly antenatal booking

Prescription errorsPrescription errors