Evaluation of educational intervention impact on lipid-lowering therapy prescribing for patients with type 2 diabetes in Pahang, Malaysia

Abstract

Hyperlipidemia is a major contributor to the evolution of cardiovascular disease (CVD) among patients with type 2 diabetes mellitus (T2DM). This study aimed to describe the lipid-lowering therapy (LLT) prescribing pattern among patients with T2DM, evaluate the appropriateness of LLT prescribing, assess the attainment of the primary target (LDL-C) for diabetic dyslipidemia treatment. and evaluate the impact of academic detailing program on enhancing healthcare providers’ knowledge and the overall appropriate LLT prescribing among Malaysian patients with T2DM. The study followed a quasi-experimental design with a control group and pre-tests to assess the impact of educational intervention on the rational statin therapy prescribing among the inpatient and outpatients with T2DM. The impact of educational intervention on knowledge of health care providers concerning statin therapy prescribing was assessed by comparing the achieved knowledge scores before and after the intervention using the same study questionnaire. The evaluation of the appropriateness of statin therapy prescribing was mainly based on the 2015 Malaysian CPG for treatment of patients with T2DM that recommended statin therapy for all patients between 40 and 75 years. The output of the evaluation process was classified into three main classifications, which were appropriate, inappropriate, or potentially inappropriate. A total of 782 hospital records and 816 primary care records were reviewed. Majority of patients were of Malay ethnicity. The prevalence of statins prescribing was about 69% (n=537) and 87% (n=715) in the hospital and primary care setting, respectively. The most commonly prescribed LLT in all settings was moderate intensity simvastatin-based regimens. Prevalence of potential drug interactions were 33% in hospital and 17% in primary care setting. Approximately, 63% of the study subjects were not able to achieve target LDL-C values in primary care. Only 37.5% (hospital) and 71.5% (primary care) of study subjects were receiving appropriate LLT. Regarding the knowledge assessment, healthcare providers’ mean score after the educational session was (6.73 ± 1.37 points) as opposed to the pre-session scores (5.28 ± 1.71 points). The educational outreach program elicited a statistically significant difference in providers’ knowledge scores of 1.450 point (95% CI, 0.918 to 1.982), p < .0005, d = 0.87. The prescribing assessment of educational intervention impact showed a statistically significant difference ?2 (2) =18.390, p <0.001. In the post-intervention phase, the proportion of appropriate LLT prescribing was (n = 246, 61.7%) compared to pre-intervention phase (n = 188, 47.1%), p < 0.0166. Moreover, there was a statistically significant difference in the proportion of inappropriate LLT prescribing between the post-intervention phases compared to pre-intervention phase (n = 81, 20.3% versus n = 125, 31.3%), p < 0.0166. By contrast, there was no statistically significant difference between the two proportions of LLT prescribing in the control group ?2 (2) =3.031, p = 0.220. There was a need to improve the management of diabetic dyslipidemia in different practice settings. Still, a significant portion of T2DM subjects was not able to attain LDL-C treatment targets. Prescribing-improvements interventions focused on healthcare providers could potentially have a positive impact on the providers’ knowledge and their prescribing of CVD prophylaxis medications among patients with T2DM.