Managing chronic diseases in the Malaysian primary health care – a need for change

  • AS Ramli
  • SW Taher
Keywords: Malaysia, chronic disease management, primary health care


Chronic diseases are the major cause of death and disability in Malaysia, accounted for 71% of all deaths and 69% of thetotal burden of disease. The WHO in its report Preventing Chronic Disease: A Vital Investment has highlighted the inaction ofmost governments of the low and middle income countries in tackling the problem urgently, is clear and unacceptable. Theacute care paradigm is no longer adequate for the changing pattern of diseases in today’s and tomorrow’s world. An evolutionof primary health care system beyond the acute care model to embrace the concept of caring for long term health problemsis imperative in the wake of the rising epidemic of chronic diseases and its crushing burden resulting in escalating healthcarecosts. Compelling evidence from around the world showed that there are innovative and cost-effective community-basedinterventions to reduce the morbidity and mortality attributable to chronic diseases, but these are rarely translated into highquality population-wide chronic disease care. This paper describes the current situation of chronic disease management inthe Malaysian primary care setting – to highlight the need for change, discuss the barriers to the implementation of effectivechronic disease management programmes in the community, and consider fundamental solutions needed to instigate thechange in our setting.


WHO. The World Health Report 2003: Shaping the future. Geneva: World Health Organisation, 2003. Available from URL: [Accessed 2008 Feb 13].

WHO. Preventing chronic diseases: a vital investment [online].Geneva: World Health Organisation, 2005. Available from URL: [Accessed 2008 Feb 13].

WHO. The impact of chronic disease in Malaysia [online]. Geneva: World Health Organisation, 2005. Available from URL [Accessed 2008 Feb 13].

Yusoff AF, Kaur G, Omar MA, Mustafa AN. Malaysian burden of disease and injury study 2005. Institute for Public Health, National Institute of Health, Malaysia. Available from URL: [Accessed 2008 Feb 13].

Department of Statistics Malaysia [online]. Available from URL: [Accessed 2008 Feb 13].

MOH. NCD Surveillance 2005/06:Report on NCD risk factor in Malaysia. Ministry of Health, Malaysia. Available from URL: [Accessed 2008 Feb 13].

Rampal L, Rampal S, Azhar MZ, Rahman AR. Prevalence, awareness, treatment and control of hypertension in Malaysia: a national study of 16,440 subjects. Public Health. 2008;122(1):11-8.

Rampal L, Rampal S, Khor GL, et al. A national study on the prevalence of obesity among 16,127 Malaysians. Asia Pac J Clin Nutrition. 2007;16(3):561-6.

Safran DG. Defining the future of primary care: what can we learn from patients? Ann Intern Med. 2003;138:248-55.

Wolff JL, Starfield B, Anderson G. Prevalence, expenditure and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002;162(20):2269-76.

Rothman AA, Wagner EH. Chronic illness management: what is the role of primary care? Ann Intern Med. 2003;138:256-61.

Adeyi O, Smith O, Robles S. Public policy and the challenge of chronic noncommunicable diseases. Washington, DC: World Bank; 2007. Available from URL: [Accessed Feb 26 2008].

MOH. Malaysia National Health Accounts, 2006. Planning & Development Division, Ministry of Health, Malaysia.

Merican MI, Rohaizat BY. Health care reforms and changes: the Malaysian experience. Asia Pac J Public Health. 2002;14(1):17-22.

Merican MI, Rohaizat BY, Haniza S. Developing the Malaysian health system to meet the challenges of the future. Med J Malaysia. 2004;59(1):84-93.

Safurah J, Mohd Raili S, Fauziah ZE, et al. Using Teleprimary Care (TPC) data set for predicting utilisation of health services in Malaysia through use of John Hopkins Adjusted Clinical Groups [online]. Available from URL: [Accessed May 5 2008].

The Academy of Family Physicians of Malaysia. 35th Annual General Meeting: Annual Report & Statement of Accounts 2007.

Lee TW, Chan SC, Chua WT, et al. Audit of diabetes mellitus in general practice. Med J Malaysia. 2004; 59(3):317-22.

Chan SC, Chandramani T, Chen TY, et al. Audit of hypertension in general practice. Med J Malaysia. 2005; 60(4):475-82.

Mafauzy M. Diabetes control and complications in private primary healthcare in Malaysia. Med J Malaysia. 2005; 60(2):212-7.

Zainudin BM, Lai CK, Soriano JB, et al. Asthma control in adults in AsiaPacific. Respirology. 2005; 10(5):579-86.

Wong JS, Tan F, Lee PY. The state of lipid control in patients with diabetes in a public health centre. Asia Pac J Public Health. 2007;19(3):16-21.

WHO. Innovative care for chronic conditions: building blocks for action. Geneva: World Health Organisation, 2002. [Accessed February 26 2008].

Friedman N, Skogmo L, Aruffo P. Implementing disease management programmes within an integrated delivery system. Dis Manag Health Outcomes. 1999;6(6): 55-63.

Wagner EH, Davis C, Schaefer J, et al. A survey of leading chronic disease management programmes: are they consistent with the literature? Manag Care Q. 1999;7(3):56-66.

Wagner EH, Austin BT, Davis C, et al. Improving chronic illness care: translating evidence into action. Health Aff. 2001;20(6):64-78.

Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, part 2. JAMA. 2002; 288(15):1909-14.

Epping-Jordan JE, Pruitt SD, Bengoa R, Wagner EH. Improving the quality of health care for chronic conditions. Qual Saf Health Care. 2004;13(4):299-305.

Coleman R, Gill G, Wilkinson D. Noncommunicable disease management in resource-poor settings: a primary care model from rural South Africa. WHO Bulletin. 1998;76(6):633-40.

McCulloch DK, Price MJ, Hindmarch M and Wagner EH. Improvement in diabetes care using an integrated population-based approach in a primary care setting. Dis Manag. 2000;3(2):75-82.

Rossiter LF, Whitehurst-Cook MY, Small RE, et al. The impact of disease management on outcomes and cost of care: a study of low-income asthma patients. Inquiry. 2000;37(2):188-202.

Farmer P, Leandre F, Mukherjee JS, et al. Community-based approaches to HIV treatment in resource-poor setting. Lancet. 2001; 358: 404-9.

Cheah J. Chronic disease management: a Singapore perspective. BMJ. 2001;323:990-3.

Graham L, Sketris I, Burge F, Edwards L. The effect of primary care intervention on management of patients with diabetes and hypertension: a pre-post intervention chart audit. Healthcare Q. 2006;9(2):62-71.

Sommer LS, Marton KI, Barbaccia JC, Randolph J. Physician, nurse and social worker collaboration in primary care for chronically ill seniors. Arch Intern Med. 2000;160(12):1825-33.

Wagner EH. The role of patient care teams in chronic disease management. BMJ. 2000;320:569-72.

Schoen C, Osborn R, Huynh PT, et al. On the front lines of care: primary care doctors’ office systems, experiences and views in seven countries. Health Aff. 2006;25(6):w555-71.

Grimshaw J, Eccles M, Tetroe J. Implementing clinical guidelines: current evidence and future implications. J Cont Edu Health Professions. 2004;24(Suppl 1):S31-37.

Department of Health (UK). The expert patient: a new approach to chronic disease management for the 21st century [online]. Crown Copyright, 2001. Available from URL: [Accessed Feb 26 2008].

Bodenheimer T, Lorig K, Holman H and Grumbach K. Patient selfmanagement of chronic disease in primary care. JAMA. 2002;288(19): 2469-75.

Kannakatu K. Healthcare financing in Malaysia. Asia Pac J Public Health. 2002;14(1):23-8.

Rohaizat BY. Financing Health care in Malaysia: Safety net for the disadvantage groups including pensioners, elderly people, the poor and the disabled. NCD Malaysia. 2004;3(2): 43-6.

Chambers R and Wakley G. Clinical Audit in Primary Care: Demonstrating quality and outcomes. Radcliffe Publishing, 2005.

Gulliford MC, Ashworth M, Robotham D, Mohiddin A. Achievement of metabolic targets for diabetes by English primary care practices under a new system of incentives. Diabet Med. 2007;24(5):505-11.

Steel N, Maisey S, Clark A, et al. Quality of clinical primary care and targeted incentive payments: an observational study. Brit J Gen Pract. 2007;57(539):449-54.

How to Cite
RamliA., & TaherS. (2008). Managing chronic diseases in the Malaysian primary health care – a need for change. Malaysian Family Physician, 3(1), 7. Retrieved from
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