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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
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22
Level of Primary CareLevel of Primary Care
ConceptConcept
Level of Primary CareLevel of Primary Care
ConceptConcept
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33
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44
Level of CareLevel of CareLevel of CareLevel of Care
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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
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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
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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
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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
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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
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1010
Organisation & StaffOrganisation & StaffOrganisation & StaffOrganisation & Staff
PKD Vs. Health ClinicPKD Vs. Health ClinicPKD Vs. Health ClinicPKD Vs. Health Clinic
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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
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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
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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)
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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
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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)
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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.
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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
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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
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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
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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
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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
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2222
Support ServicesSupport ServicesSupport ServicesSupport Services LAB SERVICESLAB SERVICES
PHARMACY SERVICESPHARMACY SERVICES
DIAGNOSTIC AND IMAGING SERVICESDIAGNOSTIC AND IMAGING SERVICES
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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
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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
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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
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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
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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
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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
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QAP Indicators inQAP Indicators in
Primary CarePrimary Care
QAP Indicators inQAP Indicators in
Primary CarePrimary Care
NIA & DSANIA & DSANIA & DSANIA & DSA
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AimsAimsAimsAims
To improve the quality, efficiencyTo improve the quality, efficiency
and effectiveness of the deliveryand effectiveness of the delivery
of health servicesof health services
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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
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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.
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3333
NIA in Primary HealthcareNIA in Primary HealthcareNIA in Primary HealthcareNIA in Primary HealthcareIndicator Standard
Incidence rate of eclampsia
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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