Knowledge assessment regarding secondary prevention of coronary heart disease- a multi centre survey

BMC Medical Education

Ruvan Ekanayaka²  Niroshan C Lokunarangoda²  Anne Thushara Matthias¹ 

[1] University Medical Unit, Colombo South Teaching Hospital, Colombo, Sri Lanka;Institute of Cardiology, National Hospital of Sri Lanka, Colombo, Sri Lanka

关键词: Continuous medical education;    Sri Lanka;    Secondary prevention;    Coronary heart disease;    Cardiovascular disease prevention;   

Others  :  866695
DOI  :  10.1186/1472-6920-14-113

 received in 2013-10-24, accepted in 2014-06-02,  发布年份 2014

【 摘 要 】

Background

Cardiovascular Disease (CVD) is a major cause of mortality worldwide. Control and reduction of cardiovascular risk factors such as elevated blood pressure, high cholesterol levels, excess of body weight, smoking and lack of exercise can contribute to a reduction of CVD mortality.

Methods

A standardized questionnaire was administered to all medical officers willing to participate in the study, who were working in the Cardiology Units all over Sri Lanka to assess the source of continuous medical education, attitudes on secondary prevention, barriers to secondary prevention and knowledge assessment of secondary prevention of cardiovascular diseases. Chi square was used to compare groups and p < 0.05 was considered significant.

Results

132 participants with equal numbers of males and female doctors participated. While 56 doctors have had no training in cardiology, 75 doctors have had some training in a cardiology unit. The barriers for secondary prevention were, poor knowledge/understanding of patients 3.82 (1.06), too many drugs 3.74 (0.98), presence of co-morbid conditions 3.68(0.97), cost of medications 3.69 (0.97) and poor adherence to prevention strategies by patients 3.44 (1.15). Routine clinic visits 85 (65%) and public awareness day seminars 30 (22.2%) were the most effective methods of secondary prevention. Guidelines were the most popular method of continuous medical education. Those who have had some training in cardiology did not differ in their knowledge from those who have never had training in cardiology. Knowledge about prevention with regard to diet was inadequate and exercise and lipids were adequate but not good. Rates of knowledge on smoking cessation were much higher than for other CVD risk factors.

Conclusion

There needs to be more adherences to clinical guidelines and attention paid to CVD prevention, in particular, the importance of dietary modifications, adequate exercise, and lipid control.

【 授权许可】

   
2014 Matthias et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Institute of Medicine (US) Committee on Preventing the Global Epidemic of Cardiovascular Disease: Meeting the Challenges in Developing Countries. In Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health. Edited by Fuster VKB. Washington (DC): National Academies Press (US); 2010. 2, Epidemiology of Cardiovascular Disease. Available from: http://www.ncbi.nlm.nih.gov/books/NBK45688/ webcite
• [2]Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, De Bacquer D, Ducimetiere P, Jousilahti P, Keil U, Njolstad I, Oganov RG, Thomsen T, Tunstall-Pedoe H, Tverdal A, Wedel H, Whincup P, Wilhelmsen L, Graham IM: Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003, 24:987-1003.
• [3]D'Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB: General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008, 117:743-753.
• [4]Woodward M, Brindle P, Tunstall-Pedoe H: Adding social deprivation and family history to cardiovascular risk assessment: the ASSIGN score from the Scottish Heart Health Extended Cohort (SHHEC). Heart 2007, 93:172-176.
• [5]Lloyd-Jones DM: Cardiovascular risk prediction: basic concepts, current status, and future directions. Circulation 2010, 121:1768-1777.
• [6]Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren WM, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvanne M, Scholte Op Reimer WJ, Vrints C, Wood D, Zamorano JL, Zannad F: European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Atherosclerosis 2012, 223:1-68.
• [7]Smith SC Jr, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, Gibbons RJ, Grundy SM, Hiratzka LF, Jones DW, Lloyd-Jones DM, Minissian M, Mosca L, Peterson ED, Sacco RL, Spertus J, Stein JH, Taubert KA: AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol 2011, 58:2432-2446.
• [8]Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003, 289(19):2560-2572.
• [9]National Cholesterol Education Program (NCEP) Expert Panel on Detection E, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002, 106(25):3143-3421.
• [10]Filippi A, Buda S, Brignoli O, Cricelli C, Degli Espositi E: Global cardiovascular risk evaluation in Italy: a cross-sectional survey in general practice. Ital Heart J Suppl 2004, 5:223-227.
• [11]Hyman DJ, Pavlik VN: Self-reported hypertension treatment practices among primary care physicians: blood pressure thresholds, drug choices, and the role of guidelines and evidence-based medicine. Arch Intern Med 2000, 160:2281-2286.
• [12]Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR: Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999, 282:1458-1465.
• [13]Peck C, McCall M, McLaren B, Rotem T: Continuing medical education and continuing professional development: international comparisons. Bmj 2000, 320:432-435.
• [14]Mendis LABV, Adhikari RK, Muzaherul Huq M, Qureshi AF: Postgraduate medical education in South Asia: Time to move on from the postcolonial era. BMJ 2004, 328(7443):779.
• [15]Epa SS: Revalidation of Sri Lankan doctors. Ceylon Med J 2003, 48:65-67.
• [16]Heidrich J, Behrens T, Raspe F, Keil U: Knowledge and perception of guidelines and secondary prevention of coronary heart disease among general practitioners and internists. Results from a physician survey in Germany. Eur J Cardiovasc Prev Rehabil 2005, 12:521-529.
• [17]Willett WC, Stampfer MJ: Rebuilding the food pyramid. Sci Am 2003, 288:64-71.
• [18]Mosca L, Linfante AH, Benjamin EJ, Berra K, Hayes SN, Walsh BW, Fabunmi RP, Kwan J, Mills T, Simpson SL: National study of physician awareness and adherence to cardiovascular disease prevention guidelines. Circulation 2005, 111:499-510.
• [19]Law MR, Morris JK, Wald NJ: Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009, 338:b1665.
• [20]Doroodchi H, Abdolrasulnia M, Foster JA, Foster E, Turakhia MP, Skelding KA, Sagar K, Casebeer LL: Knowledge and attitudes of primary care physicians in the management of patients at risk for cardiovascular events. BMC Family Practice 2008, 9:42. BioMed Central Full Text
• [21]Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK: Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001, 345:494-502.
• [22]Reinharth D: Clinical inertia. Ann Intern Med 2002, 137:547-548. author reply 547–548
• [23]Hobbs FD, Erhardt L: Acceptance of guideline recommendations and perceived implementation of coronary heart disease prevention among primary care physicians in five European countries: the Reassessing European Attitudes about Cardiovascular Treatment (REACT) survey. Fam Pract 2002, 19:596-604.
• [24]Wood D: Guidelines and global risk: a European perspective. Eur Heart J 2002, 4:F12-F18.
• [25]Kiessling A: Participatory learning: a Swedish perspective. Heart 2004, 90(1):113-116.
• [26]Timmerman MK, Rensing KL, Giral P, Cramer MJ, Bruckert E, Twickler TB: Lessons from france: the cardiovascular prevention clinic in the la pitie-salpetriere hospital in paris. Neth Heart J 2007, 15:22-26.
• [27]2014: Therapeutic Patient Education, Continuing Education Programmes for Health Care Providers in the Field of Prevention of Chronic Diseases, Report of a WHO Working Group, 1998. http://www.euro.who.int/__data/assets/pdf_file/0007/145294/E63674.pdf webcite. Last accessed on 3rd of June 2014
• [28]Pinidiyapathirage MJ, Wickremasinghe AR, Mendis S: The Role of a Cardiac Rehabilitation Programme on Risk Modification in Patients with Established Coronary Heart Disease Department of Public Health, Faculty ofMedicine, University ofKelaniya, Institute of Cardiology, National Hospital of Sri Lanka, Colombo 10. University of Kelaniya: Proceedings of the Annual Research Symposium 2007- Faculty of Graduate Studies; http://www.kln.ac.lk/uokr/ARS2007/5.1.pdf webcite. Last accessed on 3rd of June 2014
• [29]Doroodchi H, Abdolrasulnia M, Foster JA, Foster E, Turakhia MP, Skelding KA, Sagar K, Casebeer LL: Knowledge and attitudes of primary care physicians in the management of patients at risk for cardiovascular events. BMC Fam Pract 2008, 9:42. BioMed Central Full Text
• [30]Ferrante D, Konfino J, Linetzky B, Tambussi A, Laspiur S: Barriers to prevention of cardiovascular disease in primary care settings in Argentina. Rev Panam Salud Publica 2013, 33:259-266.
• [31]Grant A, Niyonsenga T, Isabelle D, Elisabeth D, Marianne X, Roch B: Physician attitudes toward prevention and treatment. Canadian Family Physician 1998, 44:780-788.
• [32]O'Keefe CE, Hahn DF, Betts NM: Physicians' perspectives on cholesterol and heart disease. J Am Diet Assoc 1991, 91:189-192.