EVALUATION OF DOCTOR’S KNOWLEDGE, ATTITUDE, ADHERENCE TO CLINICAL PRACTICE GUIDELINE (GINA 2011) RECOMMENDATIONS AND COST ASSOCIATED WITH ASTHMA TREATMENT

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Date
2014-08
Authors
AFTAB, RAJA AHSAN
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Abstract
The existing literature suggests that doctors’ divergence from GINA guidelines is one of the major contributing factor for poor asthma control. The present study includes 27 doctors from the emergency department and 6 doctors from the respiratory department in study that was conducted at Hospital Pulau Pinang (HPP). Its aim was to evaluate doctors’ knowledge, attitude towards asthma clinical practice guideline (CPG), factors affecting asthma management, practices on GINA 2011 guideline and direct cost associated with asthma treatment at HPP. Doctor’s knowledge, attitude towards CPG (GINA 2011) and factors affecting asthma management were evaluated through a questionnaire. Prescriptions written by enrolled 27 emergency and 6 respiratory department doctors were noted. A total of 810 patients prescriptions from emergency and 180 patients prescription from respiratory department were noted (30 prescriptions per enrolled doctor).The noted prescriptions were classified either as “adhered” or “non-adhered” with CPG (GINA 2011). One hundred and eighty (180) patients in respiratory department were followed for second visit. Spirometry values (FEV1) noted on second visit were differentiated from spirometry values at first visit. SPSS 20 was used for data analysis. Where a p value of <0.05 was considered statistically significant. Twenty two (22) emergency department doctors (81.5%) and all 6 respiratory department doctors had adequate knowledge of CPG (GINA 2011). Twenty six (26) emergency and all 6 respiratory department doctors had positive attitude towards CPG (GINA 2011) with mean scores of 20.8 (SD ± 1.6) points and xxii 20.33 (SD ± 2.55) points respectively on a 25 point scale. A statistical insignificant correlation was observed between emergency doctors’ (0.13, p=0.49) and respiratory doctors’ (0.53, p=0.27) knowledge and practice scores. Six hundred and twenty eight (628) patients (77.5%) from emergency department and 143 patients (78.9%) from respiratory department received guideline adhered pharmacotherapy. Respiratory patients asthma control had a significant relation with gender (p=0.015). Spirometry values from patient second visit were statistically different from patients first visit (P <0.001). Cost of non adhered prescription for mild asthma patients (RM= 10.39) was higher than adhered mild asthma prescription (RM=9.18) at emergency department whereas the average cost of adhered prescription (RM=70.80) of respiratory department patients was higher than average non adhered prescription (RM=13.74). Of 180 asthma patients from respiratory department, 158 (87.7%) patient treatment outcome was successful. Among successfully treated patients, 124 (78.4%) patients received guideline adhered pharmacotherapy where as 34 (21.6%) patients did not receive guideline adhered pharmacotherapy. Doctor deviance from guideline based on personal experience and patient condition among successfully treated 34 (21.6%) asthma patients saved 4.51% of direct asthma cost at respiratory department. An overall good level of doctors’ knowledge and adherence with CPG (GINA 2011) was observed at HPP.
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EVALUATION OF DOCTOR’S KNOWLEDGE, ATTITUDE, ADHERENCE
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