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
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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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Keywords
EVALUATION OF DOCTOR’S KNOWLEDGE, ATTITUDE, ADHERENCE