DISCUSSION If you did not seek treatment for your illness,
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3. There was also movement of staff during the study period, this also affect our study.
One of the doctors had move from intervention clinic to control clinic, the other doctor transferred to the hospital and one resign from governments. One of the
medical assistant from the intervention clinic were promoted and transferred.
4. The trained staffed in the intervention are not always available during clinic days.
These maybe due to their taking leave or going for courses and being relieved by untrained staff.
5. We are not doing card auditing so we cannot assess weather staffs involved actually
practiced all the interventions. Same also to the patients. As far as we know, this is the first study that attempt to look into the effectiveness of
intervention in the management of patients with essential hypertension involving three districts in Perak, namely Perak Tengah, Manjung and Kerian. Knowledge of patients
regarding hypertension was good. Majority of them knew why they should take medication, the need for lifelong treatment and their complication. Only 50 of the patients know
what are normal blood pressure and their current status. So, at majority of our patients knows about hypertension but did not aware of their target blood pressure.
From focus group discussion we found that Clinical Practice Guidelines and protocols are available but their usages are limited hence the knowledge. Paramedic had limited
knowledge regarding the range of anti hypertensive that is available whereas the medical officers having problem with List A drugs. Majority of the staff also said that they are over
worked.
In phase 3, there were significant differences between the percentages of pre interventions blood pressure control as compare to post interventions in the intervention group. When
compared between the post interventions the percentage of controlled blood pressure, it did not show significant difference. There were improvements initially but not sustained
over the time. These might be due to relocation of staff causing loss of trained staff. By minimized the movements of staff and reinforced on the used of interventional package.
In the control group, we found that there were significant improvement in controlled blood pressure in May and Jun but there were dropped in July and dropped further in
August.
Perak Tengah had shown a continuous good improvement in controlled blood pressure in the intervention clinic. In districts of Manjung, the percentage of controlled blood
pressure had increased for the first month but deteriorate after that. The change of doctors and medical assistant in Klinik Kesihatan Pulau Pangkor might had contributed to
this deterioration. In Klinik Kesihatan Pantai Remis, the medical officer went for maternity leave for two month. Relocation of staff had a great impact on the management of
patient as the officer that replaces might not familiar with the intervention that had been implemented and there were also no proper handlings over of task before leaving the
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clinic. For Kerian, the percentage of controlled blood pressure were increased for May and Jun but dropped later, however the dropped were not significant. It dropped a bit
in July as one medical officer from the intervention clinic from Tanjung Piandang had left the government service leaving the clinic without resident medical officers.
In controlled group the percentage of controlled blood pressure shown an improvement in districts of Perak Tengah for the first two month and dropped after that.
In the intervention group, most of the increment in blood pressure control between pre- intervention and post-intervention were due to increments in the controlled of blood
pressure among female patients. So the intervention has more impact on female patients refer to Figure 6. From previous study, we noted that women are more concern about
health and willing to change their behaviors as needed. Further analysis had shown that the intervention that had been implemented had shown marked improvements in the
percentage of control blood pressure in woman in the districts of Perak Tengah. Women in all the districts had shown significant improvement after the intervention, but women
in the district of Perak Tengah shown significant improvement from June onwards.
Figure 6. Percentage of controlled blood pressure in three districts in between gender
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