A Survey on the Access, Acceptability and Implementation of Dyslipidemia Guidelines among Physicians in Malang, Indonesia

Authors

  • Putu Arsana Brawijaya University – dr. Saiful Anwar General Hospital
  • Rulli Rulli Rosandi
  • Heri Sutanto
  • Achmad Rudijanto
  • Herman Trianto

Abstract

Objective. The implementation of guidelines in clinical practice is still facing a lot of obstacles. Although clinical recommendations of dyslipidemia are extant, little is known about how community physicians view guidelines and their implementation. The objective of this study is to assess the acceptance of guideline content and perceived implementation of dyslipidemia guidelines among physicians in Malang, Indonesia.

Methodology. Semi-structured validated questionnaires were given to 67 random physicians consisting of general practitioners (GP), internal medicine residents and internists. The questionnaire consisted of 19 questions evaluating four parts: information about access to dyslipidemia training, dyslipidemia guideline-perceived knowledge, level of understanding of dyslipidemia guidelines and application rate of guideline adopted. Evaluation results were scored ordinally and divided into 3 levels; less, enough and good for each part of the questionnaire.

Results. 89.2% of samples in the GP group lacked information about dyslipidemia training. The resident group had participated and were involved in dyslipidemia management training (98.3%), followed by the internist group (95.2%). In the GP group, 89.2% never or had less participation in dyslipidemia management training. The GP group (76.2%) also had had poor knowledge in understanding lipid guidelines, in which the least knowledge is known about targets of treatment, non-drug treatment and risk factors. Also, 40.3% of the GP group is still not capable of adopting dyslipidemia guidelines in daily practice. A major barrier was lack of understanding of guidelines (76.3%), followed by failure of adherence to the therapy of patients (12.1%). In the resident group, a major obstacle in the application of the guidelines is education level of the patient (45.5%). In all groups, HMG-CoA Reductase inhibitors are the most commonly used lipid-lowering drugs for treatment of dyslipidemia (98.1% in GP group, 96.3% in resident group, and 97.3% in internist group).

Conclusions. GPs, as physicians in primary health care system, had poor information and participation in dyslipidemia training, and poor knowledge of dyslipidemia guidelines (AACE, AHA, CCS), as well as understanding and application of the dyslipidemia guidelines (ATP III, PERKENI) to the population, whereas residents and internists had better perception and application of dyslipidemia guidelines. 

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References

Roger VL, Go AS, Lloyd-Jones DM, et al. American Heart Association Statistics Committee and Stroke Statistics Committee. Heart disease and stroke statis¬tics-2011 update: A report from the American Heart Association. (Errata in: Circulation. 2011;123:e240 and Circulation. 2011;124:e426). 2011;123:e18-e209.

Nicholls S, Lundman P. The emerging role of lipoproteins in atherogenesis: Beyond LDL cholesterol. Semin Vasc Med. 2004;4:187-195. http://dx.doi.org/10.1055/s-2004-835377.

Wild SH, Byrne CD, Tzoulaki I, et al. Metabolic syndrome, haemostatic and inflammatory markers, cerebrovascular and peripheral arterial disease: The Edinburgh Artery Study. Atherosclerosis. 2009;203:604-609. http://dx.doi.org/10.1016/ j.atherosclerosis.2008.07.028.

Rodriguez-Colon SM, Mo J, Duan Y, et al. Metabolic syndrome clusters and the risk of incident stroke: The ath¬erosclerosis risk in communities (ARIC) study. Stroke. 2009;40:200-205. http://dx.doi.org/10.1161/STROKEAHA.108.523035.

Cohen JD, Cziraky MJ, Cai Q, et al. 30-year trends in serum lipids among United States adults: Results from the National Health and Nutrition Examination Surveys II, III, and 1999-2006. (Erratum in: Am J Cardiol. 2010;106: 1826). Am J Cardiol. 2010;106:969-975. http://dx.doi.org/10.1016/j.amjcard.2010.05.030.

Jellinger PS, Dickey RA, et al. AACE Lipid Guidelines Committee; The American Association of Clinical Endocrinologists. AACE medical guidelines for clinical practice for the diagnosis and treatment of dyslipidemia and prevention of atherogenesis. (Erratum in: Endocr Pract. 2008;14:802-903). Endocr Pract. 2000;6:162-213.

Handelsman Y, Mechanick JI, Blonde L, et al. AACE Task Force for Developing Diabetes Comprehensive Care Plan. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for developing a diabetes mellitus comprehensive care plan. Endocr Pract. 2011;17(Suppl 2):1-53.

Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). JAMA. 1993;269:3015-3023.

http://dx.doi.org/10.1001/jama.1993.03500230097036.

Mechanick JI, Camacho PM, Cobin RH, et al. American Association of Clinical Endocrinologists Protocol for Standardized Production of Clinical Practice Guidelines--2010 update. Endocr Pract. 2010;16:270-283. http://dx.doi.org/10.4158/EP.16.2.270.

National Institutes of Health; National Heart Lung, and Blood Institute; 2002 National Cholesterol Education Program. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III): Final Report. NIH Publication No. 02-5215. September 2002.

Cromwell WC, Otvos JD, Keyes MJ, et al. LDL Particle number and risk of future cardiovascular disease in the Framingham offspring study - implications for LDL management. J Clin Lipidol. 2007;1:583-592. http://dx.doi.org/10.1016/j.jacl.2007.10.001.

Smith SC Jr, Allen J, Blair SN, et al. AHA/ACC; National Heart, Lung, and Blood Institute. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. (Erratum in: Circulation. 2006;113:e847.) Circulation. 2006;113:2363-2372.

Grundy SM, Cleeman JI, Merz CN, et al. National Heart, Lung, and Blood Institute; American College of Cardiology Foundation; American Heart Association. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004;110:227-239. http://dx.doi.org/10.1161/01.CIR.0000133317.49796.0E.

Lloyd-Jones DM, Wilson PW, Larson MG, et al. Framingham and risk score prediction of lifetime risk for coronary heart disease. Am J Cardiol. 2004;94:20-24. http://dx.doi.org/10.1016/j.amjcard.2004.03.023.

Cabana MD, Rand CS, Powe NR, et al. Why don't physicians follow clinical practice guidelines. JAMA. 1999; 282:1458-65.

http://dx.doi.org/10.1001/jama.282.15.1458.

Azwar A. Pengantar administrasi kesehatan. Jakarta: Bina Rupa Aksara. 1996.

Schers H, Braspenning J, Drijver R, Wensing M, Grol R. Low back pain in general practice: Reported management and reasons for not adhering to the guidelines in the Netherlands. Br J Gen Pract. 2000; 50:640-644.

Schnelle E. The metaplan method: Communication tools for planning and learning groups. Metaplan series No. 7, Hamburg, Quickborn 1979.

Wetzel D, Himmel W, Heidenreich R, et al. Participation in a quality of care study and consequences for generalizability of general practice research. Fam Pract. 2005; 22:458-64.

http://dx.doi.org/10.1093/fampra/cmi022.

Published

2014-11-29

How to Cite

Arsana, P., Rulli Rosandi, R., Sutanto, H., Rudijanto, A., & Trianto, H. (2014). A Survey on the Access, Acceptability and Implementation of Dyslipidemia Guidelines among Physicians in Malang, Indonesia. Journal of the ASEAN Federation of Endocrine Societies, 29(2), 124. Retrieved from https://www.asean-endocrinejournal.org/index.php/JAFES/article/view/139

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