Guidelines Adherence and Hypertension Control in an Outpatient Cardiology Clinic in Malaysia

Ahmad, Nafees; Tangiisuran, Balamurugan; Meng, Ong Loke; Aziz, Noorizan Abd; Khan, Amer Hayat

doi:10.4314/tjpr.v11i4.19

Cited by 12 publications

(11 citation statements)

References 15 publications

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“…The total guideline adherence of doctors was 71.3% in the management of dyslipidemia along with diabetes mellitus. The results of the current study is quite similar with the study conducted in Penang General Hospital which shows adherence 67% in the cardiology ward of Penang General Hospital (Ahmad, Nafees et al, 2012). The guideline adherence of doctors on Coronary Heart Disease was about 65.6%.…”

Section: Discussionsupporting

confidence: 86%

Guideline adherence and control of diabetes mellitus with or without co-morbidities in various wards of a tertiary hospital in Malaysia

et al. 2014

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To assess the adherence of physicians involved in the management of diabetes mellitus with or without co-morbidities with reference to Clinical Practice Guideline 2009 given by Ministry of Health Malaysia in the tertiary care hospital, Pinang General Hospital Malaysia. Cross-sectional study was done at tertiary care hospital, Penang, Malaysia. The total 51 physicians and 1020 patients prescriptions written by same physicians were taken from the record of the Penang General Hospital (20 prescriptions for each enrolled physician). All 1020 patients were suffering from diabetes mellitus with or without co-morbidities. These patients were recruited from the different wards of the Penang General Hospital. Depending on the recommendations of CPG 2009 the prescriptions of patients were divided into adherent and non-adherent prescriptions. The overall good level of physician adherence was seen with respect to the recommendations of CPG 2009 in all prescriptions. A statistically significant negative association (?= 0.094, p-value=0.003) was observed between diabetes mellitus control and co-morbidities. CPG adherent had statistically weak negative association (?= -0.081, p-value=0.010) with patients having co-morbidities. No statistically significant association was observed between CPG adherence and any other co-morbidity. The study explored the several features of prescription pattern of physicians involved in the management of diabetes mellitus with or without co-morbidities and recognized the need for improvement in their prescription pattern for treating the diabetes mellitus.DOI: http://dx.doi.org/10.3329/icpj.v3i8.19405 International Current Pharmaceutical Journal, July 2014, 3(8): 309-312

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Section: Discussionsupporting

confidence: 86%

Guideline adherence and control of diabetes mellitus with or without co-morbidities in various wards of a tertiary hospital in Malaysia

et al. 2014

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“…Different studies have found different levels of compliance to treatment guidelines for hypertension in various contexts. Like this study, a study conducted in Malaysia observed that doctors poorly adhered to Malaysian Clinical Practice guidelines [ 30 ]. In another study in Malaysia as well, 85.3% of prescriptions at a Cardiac clinic were in accordance with guidelines [ 31 ].…”

Section: Discussionmentioning

confidence: 89%

“…In such a scenario of severe undiagnosed hypertension in Zimbabwean population the relevance of monotherapy as observed in our study with 38% of patients being on monotherapy becomes questionable since it may not provide adequate control [ 25 , 27 ]. Indeed, in a study by Al-Drabah et al in which the majority of subjects were prescribed monotherapy, the researchers observed that target BP control was not achieved in most patients [ 29 ] which implies that monotherapy may not be sufficient for achieving adequate BP control in majority of patients [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

To what extent do prescribing practices for hypertension in the private sector in Zimbabwe follow the national treatment guidelines? An analysis of insurance medical claims

Basopo

Mujasi

2017

J of Pharm Policy and Pract

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BackgroundHypertension is the most prevalent cardiovascular disease in Zimbabwe. The prevalence of Hypertension in the country is above 30% regardless of the cut off used. Currently, majority of patients in Zimbabwe seek health care from the private sector due to limited government funding for the public health sector. However, Standard treatment guidelines for hypertension are only available in the public sector and are optional in the private sector. This study assesses compliance of private sector prescribing to Standard Treatment guidelines for hypertension.MethodsWe reviewed hypertension prescription claims to a private health insurance company in Zimbabwe for the period Jan 1-Dec 31 2015. We used the last prescription claimed in the year on the assumption that it represented the patient’s current treatment. Prescription data was analyzed by comparing medicines prescribed to those recommended in the Zimbabwe 7th Essential Medicines List and Standard Treatment Guidelines 2015. We used Microsoft Excel© 2010 to conduct the analysis.ResultsA total of 1019 prescriptions were reviewed. Most patients were either on mono or dual therapy (76%). The mostly prescribed class of antihypertensive as first line were Angiotensin Converting Enzyme Inhibitors /Angiotensin Receptor Blockers. Regardless of whether they were being used as first, second or third line this class of antihypertensives emerged as the most prescribed (639 times). Only 358 (35%) prescriptions were compliant with standard treatment guidelines; the rest (661) did not meet several criteria. Areas of non-compliance included use of second line medicines as first line, failure to consider patient characteristics when prescribing, use of contraindicated medicines for certain patients, clinically significant interactions among prescribed medicines and illogical combinations that predispose patients to toxicity.ConclusionThe poor compliance to standard treatment guidelines observed in our study indicates need to improve prescription practices for Hypertension in the private sector in Zimbabwe for its cost-effective management among the covered patients. However, further investigation is needed to understand the drivers of the prescribing habits and the non-compliance to the Essential Medicines List and Standard Treatment guidelines observed. This will enable design of appropriate educational, managerial and economic interventions to improve compliance.

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“…On the contrary, a study conducted in Malaysia, observed that doctors poorly adhered to Malaysian Clinical Practice Guideline (CPG) in hypertensive patients with diabetes and left ventricular hypertrophy. A better hypertension control was seen with ACEIs and guidelines-adherent therapy [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

A review on prescribing patterns of antihypertensive drugs

Rao²,

et al. 2015

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Hypertension continues to be an important public health concern because of its associated morbidity, mortality and economic impact on the society. It is a significant risk factor for cardiovascular, cerebrovascular and renal complications. It has been estimated that by 2025, 1.56 billion individuals will have hypertension. The increasing prevalence of hypertension and the continually increasing expense of its treatment influence the prescribing patterns among physicians and compliance to the treatment by the patients. A number of national and international guidelines for the management of hypertension have been published. Since many years ago, diuretics were considered as the first-line drugs for treatment of hypertension therapy; however, the recent guidelines by the Joint National Commission (JNC8 guidelines) recommend both calcium channel blockers as well as angiotensin-converting enzyme inhibitors as first-line drugs, in addition to diuretics. Antihypertensive drug combinations are generally used for effective long-term management and to treat comorbid conditions. This review focuses on the antihypertensive medication utilization, their cost factors, adherence to treatment by patients, and physicians’ adherence to guidelines in prescribing medications in different settings including Indian scenario. The antihypertensive medication prescribing pattern studies help in monitoring, evaluation and necessary modifications to the prescribing habits to achieve rational and cost-effective treatment. Additionally, periodic updating of recommended guidelines and innovative drug formulations, and prescription monitoring studies help in rational use of antihypertensive drugs, which can be tailored to suit the patients' requirements, including those in the developing countries.

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Guidelines Adherence and Hypertension Control in an Outpatient Cardiology Clinic in Malaysia

Abstract: Purpose: To evaluate doctors' adherence to Malaysian Clinical Practice Guideline (CPG) (Ф = 0.195, p < 0.01), p = 0.017), p = 0.017) and monotherapy (Ф = -0.168, p < 0.01

Cited by 12 publications

References 15 publications

Guideline adherence and control of diabetes mellitus with or without co-morbidities in various wards of a tertiary hospital in Malaysia

Guideline adherence and control of diabetes mellitus with or without co-morbidities in various wards of a tertiary hospital in Malaysia

To what extent do prescribing practices for hypertension in the private sector in Zimbabwe follow the national treatment guidelines? An analysis of insurance medical claims

A review on prescribing patterns of antihypertensive drugs

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