Kassab, Yaman Walid
(2013)
Utilization Of Evidence-Based Therapy For The Secondary
Prevention Of Coronary Artery Disease: Predictors And
Impact Of Pharmacist-Initiated Interventions.
PhD thesis, Universiti Sains Malaysia.
Abstract
Over the past decades, secondary prevention has played a more and more important
role in coronary artery disease management. Among the medications for long-term
secondary prevention, antiplatelets, β-blockers, angiotensin-converting enzyme
inhibitors (ACEIs), and statins were proven to be highly effective in reducing
morbidity and mortality in coronary patients. Malaysian guidelines emphasize the
continuous use of these evidence-based medications (EBMs) for long-term treatment
after an acute coronary event. Despite the guideline recommendations, studies have
reported an underuse of these EBMs in ACS patients. The main objectives of the
current study were to: (1) quantify the prescription of EBMs at discharge following an
acute coronary event and ongoing use in ambulatory care, (2) evaluate the impact of
pharmacist-initiated interventions on improving the prescribing trend of secondary
preventive therapies upon discharge, (3) evaluate patients’ adherence to EBMs at an
average of two years after discharge, and (4) investigate the relationship between
patients’ non-adherence and various predictors. This study adopted an interventional
comparative methodology with three phases: pre-intervention, intervention, and
follow-up phases. In the pre-intervention phase, a retrospective audit was conducted
and a random sample of medical records pertaining to ACS patients admitted to
Hospital Pulau Pinang during the period from January 2008 to January 2010 was
chosen as the control group.
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