S-25-5: ASSESSING THE LEVEL OF PRACTICE AMONG PRIMARY CARE PHYSICIANS REGARDING HYPERTENSIVE DISEASE OF PREGNANCY(HDP): A CROSS-SECTIONAL NATIONAL SURVEY IN MALAYSIA

Abstract

Objectives: Hypertensive disorders in pregnancy are one of the leading causes of maternal and neonatal morbidity and mortality worldwide. In Malaysia, The percentage of maternal death due to HDP rose from 15.2% (1997) to 18.1% (2007), resulting from the inaccessibility of healthcare services, lack of knowledge of complications by patients, and inadequately trained staff handle the difficulties. This study aimed to determine and evaluate the level of good practice for HDP among primary care physicians and the factors that influenced good knowledge regarding the management of HDP. Design and method: This cross sectional study recruited PCP practising in government or private clinics from Malaysia. It employed universal sampling through social networking, which was carried out using a validated self administered questionnaire through an online google form. The questionnaire consisted of 4 sections; social demography of the respondents, knowledge, attitude and practices involving HDP patients. Multivariate logistic regression was used to determine factors associated with poor practice on HPD. Results: A total of 176 participants were recruited for this study with a response rate of 46%, with a median age of 35 years (SD 7.28 years, 29 to 73.years). Most of the respondents were female (70.5% and practised in urban areas (55.7%) or the suburbs (31.8%). Most were in a group practice (75.6%), and only half the respondents had attended courses on HDP (53.5%). The following factors were found to correlate with good clinical practice: (1) age (p = 0.01), (2) practice location(p = 0.101) (3) average number of HDP patients seen in a week(p = 0.08) (4) availability of CPG in the clinic(p = 0.125) (5) duration since highest qualification (p = 0.04), (6) duration in primary care practice (p = 0.03) (7) Total of HDP attitude score(p = 0.04). In multiple logistic regression, duration since highest qualification(p = 0.02, OR 0.96, 95 %CI 0.886 to 1.040) and the average number of HDP patients seen per week(p = 0.025, OR 1.957, 95 %CI 1.038 to 1.731) were found to be predictors for good clinical practice. Conclusion: There is a low level of good practice among senior physicians and those who do not manage many HDP patients per week. Greater priority towards delivering more continuous medical education on HDP is required; to augment the clinical knowledge and skills, especially among senior physicians. Our study also revealed that physicians who worked with more HDP patients ensured their practice was up to date by the greater availability of the CPG in their clinic.