Report an error   


Submitted: 18 February 2015 Modified: 10 March 2015
HERDIN Record #: NCR-JAFES-15021806593467

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

Endocrinology and Metabolic Disease Division, Internal Medicine Department - Brawijaya University - Saiful Anwar General Hospital

Abstract

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. 

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. 


 


 

1.
Publication Type:
Journal
Publication Sub Type:
Journal Article, Original
Title:
Journal of the ASEAN Federation of Endocrine Societies
Frequency:
Semi-Annual
Publication Date:
November 2014
Volume:
29
Issue:
2
Page(s):
124-128
Publisher:
ASEAN Federation of Endocrine Societies

Objectives

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. 


 


 

LocationCall NumberAvailable FormatAvailability
http://www.asean-endocrinejournal.org (632) 6373162 Fulltext External Link (View)
1. 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)" Circulation 123, e18-e209, 2011
2. Nicholls, S , Lundman, P . "The emerging role of lipoproteins in atherogenesis: Beyond LDL cholesterol" Semin Vasc Med 4(187-195): 2004 - [External Link]
3. Wild, SH , Byrne, CD , Tzoulaki, I , et al, . "Metabolic syn¬drome, haemostatic and inflammatory markers, cerebro¬vascular and peripheral arterial disease: The Edinburgh Artery Study" Atherosclerosis 203, 604-609, 2009 - [External Link]
4. 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 40, 200-205, 2009 - [External Link]
5. Cohen, JD , Cziraky, MJ , Cai, Q , et al, . "0-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 106, 969-975, 2010 - [External Link]
6. 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;14:802-9" Endocr Pract 6, 162-213, 2000
7. 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 17(Suppl 2): 1-53, 2011
8. "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 269, 3015-3023, 1993 - [External Link]
9. 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 16, 270-283, 2010 - [External Link]
10. National Institutes , . 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. 2002. (NIH Public)
11. 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 1, 583-592, 2007 - [External Link]
12. Smith Jr, SC , 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: Cir" Circulation 113, 2363-2372, 2006
13. 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 110, 227-239, 2004 - [External Link]
14. Lloyd-Jones, DM , Wilson, PW , Larson, MG , et al, . "Framingham and risk score prediction of lifetime risk for coronary heart disease" Am J Cardiol 94, 20-24, 2004 - [External Link]
15. Cabana, MD , Rand, CS , Powe, NR , et al, . "Why don" JAMA 282, 1458-65, 1999 - [External Link]
16. Azwar, A . Pengantar administrasi kesehatan. Jakarta: Bina Rupa Aksara, 1996.
17. 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 50, 650-644, 2000
18. Schnelle, E . The metaplan method: Communication tools for planning and learning groups. Hamburg, Quickborn: 1979. (Metaplan s)
19. 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 22, 458-64, 2005 - [External Link]