Suhadi, Rita

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11/6/2013 1 Presented by: Rita Suhadi (Author) Fac. of Pharmacy Sanata Dharma Univ. rita_suhadi@yahoo.com Outline: 11/6/2013 2 1. Background and Aims 2. Methods 3. Results and Discussion 4. Conclusion     Sanata Dharma University Indonesia Backgrounds  Hypertension: No.1 global health risk (WHO, 2009).  Good BP control reduced CVD events (Chobanian.2003).    BP control: not successful (Lewis. 2010; Setiati & Sutrisna, 2005; Wu  2009).   Doctor factor: barrier in BP control (Ogedegbe, 2008; Rose, 2009).  Feedback improved DR’s RX behavior (Ziemer, 2006) ,    the therapy intensification & BP control (Lűders, 2010).  The non-pharmacological intervention effect: heterogenic-inconsistent, and not predictably effective. The most effective intervention is unknown (Glynn, 2010; Doggrell 2010).  11/6/2013 3 Aims To assess the effect of the feedback intervention to physicians on the systolic blood pressure among hypertension subjects. 11/6/2013 4 Sanata Dharma University 11/6/2013 5 METHODS www.emedicine.net 11/6/2013 6 Characteristics Intervention (n=385) Non-intervention (n=271) Male (%)ǂ 41.6 44.2 Comorbid (%)ǂ* 78.7 91.5 Age (years) 64.1±10.1 64.2±8.8 Baseline SBP (mmHg)* 144.1±15.8 139.6±13.8 Baseline DBP (mmHg) 85.8±9.5 85.7±8.5 Mean SBP (mmHg) 141.6±12.2 142.0±12.9 Mean DBP (mmHg)* 84.6±6.7 85.8±7.1 Visit Frequency  4.8±1.4 4.6±1.4 * Significantly different between group;  ǂ chi-square test Table 1. Baseline/Period 1 Profiles of the Intervention and                 Non-Intervention Subjects RESULTS & DISCUSSION 11/6/2013 7 Characteristics Intervention (n=385) Non-intervention (n=271) Sig. Final SBP (mmHg) 138.2±17.2 140.6±15.4 0.07 Final DBP (mmHg) 83.0±9.5 84.2±8.9 0.09 Mean SBP (mmHg) 140.4±10.8 140.6±10.0 0.79 Mean DBP (mmHg)* 83.6±6.1 84.8±6.3 0.02 Final–Target SBP (mmHg)* -6.1±17.3 -9.6±15.5 <0.01 Mean–Target SBP (mmHg) -8.3±11.5 -9.7±10.4 0.12 Final–Baseline SBP (mmHg)* 5.9±20.3 -0.9±20.0 <0.01 Final– Mean SBP (mmHg)* 2.2±13.6 0.1±13. 0.79 * significantly different between groups  Table 2. Post-Intervention Profile and the Reduction of Blood Pressure between Intervention vs. Non-Intervention Subjects 11/6/2013 8 The monthly SBPs between groups were not different with repeated measurement Anova (p>0.05) Odds Ratio (OR) Controlled SBP of Intervention vs. Non-Intervention Subjects Final SBP:  OR 1.4(CI95%:1.0-1.9) Mean SBP: OR 1.6(CI95%:1.1-2.3) 11/6/2013 9 CONCLUSION BP feedback intervention to doctors improved SBP control based on : ∆final and baseline SBP, ∆final and target SBP, ∆final and mean SBP (p<0.05); and odds ratio mean SBP reached the target vs. non-intervention subjects. 11/6/2013 10 Ethical consideration The study protocol was approved by The Medical and Health Research Ethics Committee, Faculty of Medicine Gadjah Mada University.   Acknowledgement We are thankful to: 1. The Directors and staff for the kind permit and assistance during the study in the hospitals. 2. The Director General of Higher Education, Ministry of Education for  the research grant.   11/6/2013 11 www.emedicine.net 11/6/2013 12 REFERENCES  1. Chobanian AV, Bakris GL, Black HR, Cushman WC,  et al. The Seventh Report of the Joint               National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood                Pressure, the JNC7 Report in JAMA.2003;289;19; 2560-2572. 2. Doggrell SA. 2010. Adherence to Medicines in the Older-Aged wih Chronic Conditions, Does Intervention by an Allied Health Professional Help? Drugs Aging.27 (3):239-54. 3. Glynn LG; Murphy AW; Smith SM; Schroeder K; Fahey T. 2010. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD005182. DOI:10.1002/14651858.CD005182.pub4. 4. Lewis SJ, Robinson JG, Fox KM, Grandy S. 2010. Underutilisation of cardiovascular medications among at-risk individuals. Int J Clin Pract. 2010;64(5):604-10.  5. Lüders S, Schrader J, Schmieder RE, Smolka W, Wegscheider K, Bestehorn K. 2010. Improvement of hypertension management by structured physician education and feedback system: cluster randomized trial. Eur J Cardiovasc Prev Rehabil.17:271-9. Abstract. 6. Ogedegbe G. 2008. Barriers to Optimal Hypertension Control. J Clin Hypertens. 2008;10(8):644-6. 7. Rose AJ, Berlowitz DR, Manze M, Orner MB, Kressin NR .2009a. Intensifying Therapy for Hypertension Despite Suboptimal Adherence. Hypertension 2009;54;524-529.  8. Setiati S and Sutrisna B.  2005. Prevalence of Hypertension without Anti-hypertensive Medications and Its Association with Social Demographic Characteristics Among 40 Years and Above Adult Population in Indonesia. Ina Acta Medica 2005;37(1) 9. WHO. 2009. Global Health Risks, Mortality and burden of disease attributable to selected major risks, WHO Geneva.   10.Wu Y, Tai ES, Heng D, Tan CE, Low LP, Lee J. 2009. Risk factors associated with hypertension awareness, treatment, and control in a multi-ethnic Asian population. J Hypertens 2009;27:190-7.  11.Ziemer DC, Doyle JP, Barnes CS, Branch WT, Cook CB, El-Kebbi IM, Gallina DL, Kolm P, Rhee MK, Phillips LS. 2006. An Intervention to Overcome Clinical Inertia and Improve Diabetes Mellitus Control in a Primary Care Setting, Improving Primary Care of African Americans With Diabetes (IPCAAD) 8. Arch Intern Med. 166:507-13.  THANK YOU 11/6/2013 13 

The Effect of Feedback Intervention to Doctors on Systolic Blood Pressure Control of the Subjects in Indonesian Hospitals

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The Effect of Feedback Intervention to Doctors on Systolic Blood Pressure Control of the Subjects in Indonesian Hospitals

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