PHYSICIANS’ PERCEPTION AND ADHERENCE TO CLINICAL GUIDELINES FOR THE MANAGEMENT OF ACUTE CORONARY SYNDROME IN VIETNAMESE HOSPITALS

Abstract

Introduction: Understanding guideline acceptance related factors and barriers to guideline adoption may help improve guideline implementation. We aimed to investigate physicians’ perception and adherence to ACS guidelines in Vietnamese hospitals. Methods: This was a cross-sectional study. Physicians’ perception was collected through interviews, using a validated questionnaire. Physicians’ adherence to ACS guidelines was determined through medical records of ACS patients treated by interviewed doctors, using prescribing indicators. Data were analyzed using SPSS 20.0, with significant level of p < 0.05. Results: There were 33 cardiologists completed the interview (mean age 36.4, male 57.6%). Majority of physicians perceived that ACS guidelines were useful, reliable, and available. They definitely understood, would keep updating, and implementing those guidelines. About a third of physicians supposed that guideline adherence did not save treatment costs. Major barrier was lack of health insurance coverage. A total of 342 medical records of ACS patients (mean age 65.3, male 59.1%) was reviewed for physicians’ adherence. Patients with unstable angina/non-ST-elevation myocardial infarction accounted for the largest proportion. Statins were predominantly indicated (in 96.4% of patients), followed by aspirin (89.9%), ACEIs/ARBs (86.3%), P2Y12 inhibitors (84.7%), and beta-blockers (59.5%). Ultimately, 52.2% of patients were prescribed all four recommended medications. No differences in physicians’ characteristics, perception and barriers to guideline between high- and low-adherence doctors were found. Conclusions: Majority of physicians had positive perception towards ACS guidelines, but there were still certain barriers. Physicians’ prescribing practice was highly consistent with the guidelines, but the indication of beta-blockers and all four recommended medications were limited.