Abstract
Quantification of prescribers’ adherence to evidence-based guidelines can be used as an outcome measure to assess the impact of services on the quality of medication use. Additionally, it can help in reducing inappropriate interventions and ensure that high-quality care is provided to patients. This study aimed to evaluate prescribing practices for secondary prevention of coronary heart disease (CHD) in post-acute coronary syndromes (ST-elevation myocardial infarction [STEMI] or non-ST elevation acute coronary syndrome [NSTEACS]) patients using two medication assessment tools (MATs) at secondary and tertiary health-care settings in Kuwait. Both MATs were developed and validated based on the relevant guidelines issued by the European Society of Cardiology and the American College of Cardiology/American Heart Association. A quantitative cross-sectional multicenter study was conducted on 460 patients’ medical records collected randomly from six health-care facilities in Kuwait. Application of MATSTEMI on 232 patients’ medication records (with 85.9% applicability) resulted in intermediate overall adherence (69.8%; 95% CI: 67.6–72.0). Application of MATNSTEACS on 228 patients’ medication records (with applicability 83.2%) resulted in intermediate overall adherence (73.3%; 95% CI: 70.5–76.0). There was no significant difference between the percentages of overall adherence among patients managed post-NSTEACS compared to those managed post-STEMI (p = 0.05). Multivariable logistic regression analysis revealed that the overall adherence to the MATSTEMI criteria was significantly higher among the specialized cardiac centers than among the general hospitals (OR: 1.6; 95% CI: 1.1–2.3; p = 0.02). The overall adherence to the MATNSTEACS criteria was found to be significantly lower among non-Kuwaitis than among Kuwaitis (OR: 0.6; 95% CI: 0.5–0.9; p = 0.01) and patients with a serum LDL ≥1.8 mmol/L than those with a serum LDL-C < 1.8 mmol/L (OR: 0.5; 95% CI: 0.4–0.7; p < 0.001). The present findings revealed that both MATs were useful tools in identifying the standard of clinical performances and highlighting areas for improvement regarding secondary prevention of CHD in post-acute coronary syndrome patients.
Highlights
The prevention and management of chronic cardiovascular disorders have been reported as a global health priority since cardiovascular diseases (CVDs) are proven to be the leading cause of mortality worldwide (WHO, 2018)
Males and non-Kuwaitis were significantly more among patients with prior STEMI than those with prior NSTEACS (p 0.009 and p 0.01, respectively)
Female individuals and Kuwaitis were significantly more among patients with prior NSTEACS than those with prior STEMI (p 0.009)
Summary
The prevention and management of chronic cardiovascular disorders have been reported as a global health priority since cardiovascular diseases (CVDs) are proven to be the leading cause of mortality worldwide (WHO, 2018). CPGs are designed to synthesize and disseminate the best available evidence to guide clinical practice (Ryan, 2017). They have proven to be of value in standardizing care to patients as they allow practitioners to provide systematic care to their patients that is evidence-based (Woolf et al, 1999). Quantification of prescribers’ adherence to CPGs serves as an outcome measure to evaluate the influence of services on the quality of medication use. It can help in reducing inappropriate interventions and ensure that high-quality care is provided to patients. Evidence has shown positive effects of adherence to CPGs on patients’ health-care outcomes (Lugtenberg et al, 2009; Arabi et al, 2010) and cost-effectiveness (Davis and Taylor-Vaisey, 1997; Klazinga, 2003), studies have shown that many barriers exist that prevent prescribers from adhering to CPGs
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