Effectiveness and prescription pattern of lipid-lowering therapy and its associated factors among patients with type 2 diabetes mellitus in Malaysian primary care settings

Background: Cardiovascular diseases (CVDs) are the main complication leading to morbidity and mortality among patients with type 2 diabetes mellitus (T2DM). There is a large amount of evidence to support the use of lipid-lowering therapy (LLT) for the prevention of CVD. This study aimed to assess the effectiveness and prescription quality of LLT among T2DM patients and to identify its associated factors. Methods: A multicenter cross-sectional study included 816 T2DM patients from four different primary care centers in Pahang, Malaysia. We involved LLT-eligible T2DM patients as per the national clinical practice guidelines (CPG). The assessment of therapy effectiveness focused on the attainment of target lipid measures stated in the CPG. Evaluation of the prescription quality was classified into appropriate, potentially inappropriate, and inappropriate, based on the compliance with guidelines and existence of potential safety concerns. Binomial logistic regression was employed to identify the predictors of LLT effectiveness and prescription quality. Results: The overall percentage of T2DM patients receiving statin therapy was 87.6% (715/816). Statin therapy was appropriately prescribed in 71.5% of the cases. About 17.5% of the LLT prescriptions have at least one significant drug interaction with co-prescribed medications. The achievement of the primary target of low-density lipoprotein cholesterol (LDL-C) levels was observed in only 37% of T2DM patients. The LLT indication and appropriateness of prescription were significantly associated with the attainment of LDL-C treatment goals. Primary prevention, Malay race, and hypertension were identified as predictors for appropriate prescribing of LLT among T2DM subjects. Conclusion: There is a need to enhance the quality of LLT prescribing in the primary care setting to cover all eligible high-risk patients and ensure patient safety. Strategies to improve the achievement of LDL-C goals among patients with T2DM, such as investigating the potential role of the combination therapy and high-intensity statin therapy, are required

Impact of educational outreach intervention on enhancing health care providers' knowledge about statin therapy prescribing in Malaysian patients with type 2 diabetes mellitus

Rationale Previous research reported underutilization of statin therapy among patients with type 2 diabetes mellitus. Improving health care providers' awareness and understanding of the benefits and risks of statin treatment could be of assistance in optimizing the statin prescribing process. Aims and Objectives This study aimed to assess health care providers' knowledge related to statin therapy and the impact of educational outreach intervention based on the perceived knowledge. Methods This was a cross‐sectional study based on educational outreach intervention targeting physicians and pharmacists in 1 major tertiary hospital in the state of Pahang, Malaysia. Participants responded to a 12‐item, validated questionnaire both prior to and after the outreach educational program. Two sessions were conducted separately for 2 cohorts of pharmacists and physicians. The knowledge scores prior to and after the educational intervention were calculated and compared using a paired‐samples t‐test. Results The response rate to both pre‐and post‐educational outreach questionnaires was 91% (40/44). Prior to the intervention, around 84% (n37) of the participants decided to initiate statin therapy for both pre‐assessment clinical case scenarios; however, only 27% (n12) could state the clinical benefits of statin therapy. Forty‐five percent (n20) could state the drug to drug interactions, and 52.3% (n23) could identify the statin therapy that can be given at any time day/evening. The educational outreach program increased participants' knowledge scores of 1.450 (95% CI, 0.918 to 1.982) point, P < .0005, which is statistically significant. Forty respondents (91%) were of the opinion that statin side effects are the most common cause of treatment discontinuation. Conclusion This work demonstrated the impact of an educational outreach intervention on improving health care providers' knowledge and beliefs about statin therapy. This type of intervention is considered effective for short‐term knowledge enhancement. Further research is needed to test the long‐term efficacy of such interventio

Patterns of statin therapy prescribing among hospitalized patients with type 2 diabetes mellitus in two Malaysian tertiary hospitals

Purpose: To assess the patterns of statin therapy prescribing among hospitalized patients with type 2 diabetes mellitus (T2DM) in two Malaysian tertiary healthcare institutions and to determine compliance with Malaysian treatment guidelines. Methods: A cross-sectional study was conducted from September to December 2016. The study involved hospitalized T2DM patients aged between 40 to 75 years recruited from the medical wards of two tertiary hospitals in the state of Pahang, Malaysia. Evaluation of statin prescribing was classified as appropriate (statin therapy was prescribed with no concurrent drug interactions) or inappropriate (not receiving any statins, although no contraindications), or potentially inappropriate (drug interactions detected or renal dose adjustment needed). Results: Among the 393 medical records screened, 65 % had a statin therapy prescription. The evaluation of statins prescribing showed that approximately 35 % of patients were not prescribed statins, contrary to national treatment guidelines. Twenty-six percent of the study cases were given drugs that interacted with statins. Renal dose adjustment of the given statin was needed in 5 % of patients. Finally, only one-third of the patients were prescribed appropriate statin doses. Conclusion: A significant portion of T2DM hospitalized patients did not receive their recommended statin therapy for cardiovascular disease prophylaxis. Closer monitoring and further dose adjustments are warranted to optimize statin therapy prescribing. Further interventions to improve statin prescribing should be considered

Prevalence and risk factors for menstrual irregularities among systemic lupus erythematosus in rural Malaysia

Objectives: The aim of this study was to determine the prevalence and the types of menstrual irregularities among patients with SLE, and to identify factors that influence their development. Methodology: Sixty-one patients with SLE were enrolled into a cross-sectional, observational study. at medical clinics, University Science Malaysia Hospital (Hospital Universiti Sains Malaysia). A total of 120 healthy women were selected randomly to act as the control group. A menstrual questionnaires were administered, vital signs were recorded, and blood was evaluated. A review of past medical records were also undertaken. Results: The mean age (SD) for the study group 33.23 +/- 10.96 years, the majority being ethnic Malay, 75% had severe SLEDAI score on initial presentation and 59 percent were on cyclophosphamide. 49% of study population had menstrual irregularities in which 60% had sustained amenorrhea. 9 patients with sustained amenorrhea had hormonal assay which confirmed diagnosis of premature menopause. Conclusions: This study showed that SLE patients had a higher risk of developing menstrual irregularities to normal /healthy population. The risk was higher in older age group (>30 years old), and those on cyclophosphamide therapy; especially those with a cumulative dose of more than 10 gram. Sustained amenorrhea was the commonest menstrual irregularity and majority of them had confirmed premature menopause. Keywords: Systemic lupus erythematosus, menstrual irregularity, premature menopaus

Impact of educational outreach intervention on enhancing health care providers' knowledge about statin therapy prescribing in Malaysian patients with type 2 diabetes mellitus

Rationale: Previous research reported underutilization of statin therapy among patients with type 2 diabetes mellitus. Improving health care providers' awareness and understanding of the benefits and risks of statin treatment could be of assistance in optimizing the statin prescribing process. Aims and Objectives: This study aimed to assess health care providers' knowledge related to statin therapy and the impact of educational outreach intervention based on the perceived knowledge. Methods: This was a cross-sectional study based on educational outreach intervention targeting physicians and pharmacists in 1 major tertiary hospital in the state of Pahang, Malaysia. Participants responded to a 12-item, validated questionnaire both prior to and after the outreach educational program. Two sessions were conducted separately for 2 cohorts of pharmacists and physicians. The knowledge scores prior to and after the educational intervention were calculated and compared using a paired-samples t-test. Results: The response rate to both pre-and post-educational outreach questionnaires was 91% (40/44). Prior to the intervention, around 84% (n37) of the participants decided to initiate statin therapy for both pre-assessment clinical case scenarios; however, only 27% (n12) could state the clinical benefits of statin therapy. Forty-five percent (n20) could state the drug to drug interactions, and 52.3% (n23) could identify the statin therapy that can be given at any time day/evening. The educational outreach program increased participants' knowledge scores of 1.450 (95% CI, 0.918 to 1.982) point, P <.0005, which is statistically significant. Forty respondents (91%) were of the opinion that statin side effects are the most common cause of treatment discontinuation. Conclusion: This work demonstrated the impact of an educational outreach intervention on improving health care providers' knowledge and beliefs about statin therapy. This type of intervention is considered effective for short-term knowledge enhancement. Further research is needed to test the long-term efficacy of such intervention

Informed consent: a socio-legal study

Introduction: Informed consent [IC] is a recognized socio-legal obligation for the medical profession. The doctrine of IC involves the law, which aims to ensure the lawfulness of health assistance and tends to reflect the concept of autonomy of the person requiring and requesting medical and/or surgical treatment. Recent changes in the health care delivery system and the complex sociological settings, in which it is practiced, have resulted in an increase in judicial activity and medical negligence lawsuits for physicians. While IC is a well-established practice, it often fails to meet its stated purpose. In the common law, the standard of medical care to disclose risks has been laid down by the Bolam test- a familiar concept to most physicians, but it has been challenged recently in many jurisdictions. This paper aims to discuss some important judgments in cases of alleged medical negligence so as to familiarize doctors regarding their socio-legal obligations. We also propose to discuss some factors that influence the quality of IC in clinical practice. Methods: Literature review. Results: The law of medical consent has been undergoing changes in recent years. Case law appears to be evolving towards a more patient centered standard of disclosure. Patient’s expectations are higher and they are aware of the power of exercising their rights. Failure to obtain IC is one of the common allegations in medical malpractice suits. Conclusion: The medical professionals need to change their mindset and avoid claims of negligence by providing information that is “reasonable” in the eyes of the court. Key Words: Informed consent, medical negligence, Medical ethics, Investigation, Bolam tes

Attitudes toward euthanasia and related issues among physicians and patients in a multi-cultural society of Malaysia

Introduction: Due to globalization and changes in the health care delivery system, there has been a gradual change in the attitude of the medical community as well as the lay public toward greater acceptance of euthanasia as an option for terminally ill and dying patients. Physicians in developing countries come across situations where such issues are raised with increasing frequency. As euthanasia has gained world‑wide prominence, the objectives of our study therefore were to explore the attitude of physicians and chronically ill patients toward euthanasia and related issues. Concomitantly, we wanted to ascertain the frequency of requests for assistance in active euthanasia. Materials and Methods: Questionnaire based survey among consenting patients and physicians. Results: The majority of our physicians and patients did not support active euthanasia or physician‑assisted suicide (EAS), no matter what the circumstances may be P < 0.001. Both opposed to its legalization P < 0.001. Just 15% of physicians reported that they were asked by patients for assistance in dying. Both physicians 29.2% and patients 61.5% were in favor of withdrawing or withholding life‑sustaining treatment to a patient with no chances of survival. Among patients no significant differences were observed for age, marital status, or underlying health status. Conclusions: A significant percentage of surveyed respondents were against EAS or its legalization. Patient views were primarily determined by religious beliefs rather than the disease severity. More debates on the matter are crucial in the ever‑evolving world of clinical medicine

Attitudes toward euthanasia and related issues among physicians and patients in a multi‑cultural society of Malaysia

Introduction: Due to globalization and changes in the health care delivery system, there has been a gradual change in the attitude of the medical community as well as the lay public toward greater acceptance of euthanasia as an option for terminally ill and dying patients. Physicians in developing countries come across situations where such issues are raised with increasing frequency. As euthanasia has gained world‑wide prominence, the objectives of our study therefore were to explore the attitude of physicians and chronically ill patients toward euthanasia and related issues. Concomitantly, we wanted to ascertain the frequency of requests for assistance in active euthanasia. Materials and Methods: Questionnaire based survey among consenting patients and physicians. Results: The majority of our physicians and patients did not support active euthanasia or physician‑assisted suicide (EAS), no matter what the circumstances may be P < 0.001. Both opposed to its legalization P < 0.001. Just 15% of physicians reported that they were asked by patients for assistance in dying. Both physicians 29.2% and patients 61.5% were in favor of withdrawing or withholding life‑sustaining treatment to a patient with no chances of survival. Among patients no significant differences were observed for age, marital status, or underlying health status. Conclusions: A significant percentage of surveyed respondents were against EAS or its legalization. Patient views were primarily determined by religious beliefs rather than the disease severity. More debates on the matter are crucial in the ever‑evolving world of clinical medicine. Keywords: Attitude, euthanasia, legalization, multi‑cultural, physician‑assisted suicid