Conclusion Recommendations 0 CONCLUSION RECOMMENDATION

165 Improving Knowledge Of Type 2 Diabetes Mellitus Patients On Oral Hypoglycaemic Agents ABSTRACT Improving Knowledge Of Type 2 Diabetes Mellitus Patients On Oral Hypoglycaemic Agents Mohd Rohaizad Zamri 1 , Umi Hani Mohd Asmawi 1 , Mohd Fadhil Samsuri 2 , Liliwati Ismail 2 , Amar-Singh HSS 3,6 , Sondi Sararaks 4 , Ranjit Kaur Praim Singh 5 , Asmah Zainal Abidin 5 , Ruzzita Mustaffa 2 , Sabab Hashim 6 1 Hospital Teluk Intan 2 Hilir Perak Health Office 3 Clinical Research Centre Perak 4 Institute for Health Systems Research 5 Perak State Health Department 6 Hospital Raja Permaisuri Bainun Ipoh Introduction Healthcare providers nowadays are encountering a vast number of diabetic patients in Malaysia and the prevalence is increasing every year and so does the use and number of oral hypoglycaemic agents. The National Health and Morbidity Survey had shown an increase in the number of type 2 diabetic patients from 6.3 in 1986 to 8.3 in 1996 Malaysian Consensus Clinical Practice Guidelines 2004. The situation is similar in District of Hilir Perak, where in 2004 the number of diabetic patients was 4952 and has increased to 5063 in February 2005. In outpatient department of Hospital Teluk Intan itself, there is a total of 2967 diabetic patients registered up to June 2006 Daftar Diabetes 2005 2006. PKD Hilir Perak. Compliance towards medication is regarded as a major problem in healthcare. Better understanding of the problem is needed in order to improve the medication compliancy of patients Norehan Abdullah 2002. A study in Hospital Taiping revealed 25 of patients are non-compliant towards their medication due to poor knowledge Ng C.B., 2002 and another 46 in a similar study in Kedah. To improve knowledge among diabetic patients on oral hypoglycemic agent OHA in outpatient departments in Hilir Perak District by implementing intervention program. Methodology An interventional experimental study on type 2 diabetic patients on OHA treatment was conducted from November 2006 to August 2007 in outpatient department in District of Hilir Perak Hospital Teluk Intan and 3 health clinics. This study consists of three phases. Phase 1 was baseline data collection using a standard structured questionnaire, Phase 2 was development of an intervention package to educate patient. The package consists of standardized structured guidelines Buku Panduan OHA Untuk Pesakit Diabetes Mellitus Jenis 2 Appendix 1, OHA Chart Appendix 2, medication explanation checklist Appendix 3, reminder stickers for OHA envelopes Appendix 4 and pamphlets Appendix 5. Phase 166 Improving Knowledge Of Type 2 Diabetes Mellitus Patients On Oral Hypoglycaemic Agents 3 was implementation of the package done continuously everyday and followed by post- intervention study using the same questionnaire. Two post-intervention studies were done in May and August to evaluate effectiveness of the program. Results There was a significant difference between two different settings hospital and health clinics in baseline socio-demographic characteristics and clinical profile age and number of co-morbidities p-value = 0.003, ethnicity and duration of illness p value 0.001. The intervention produced significant improvement across all socio-demographic factors p-value 0.001, in both settings, more prominently in health clinics. In hospital setting, patients with socio-demographic factor of lower educational level showed significant improvement of knowledge after intervention, but in health clinics, solely diabetics showed improvement in knowledge after intervened. Conclusion Patients’ baseline knowledge regarding OHA is poor. The intervention module is effective showed by significant improvement in overall knowledge for both hospital and health clinics. However, improvement in health clinic is more than in hospital. Recommendations Continuation of this intervention package is highly recommended to a more extended scope regardless of socio-demographic background. The application of reminder sticker shall be continued and extended to all health centers because it provides complete and specific information on OHA. Intervention shall stress more in elderly age 60 years old in general and in specific, OHA names are stressed for those who cannot read with perhaps a different approach.

1.0 INTRODUCTION

1.1 Background and problem analysis

Diabetes Mellitus DM has been defined by World Health Organization WHO as a state of chronic hyperglycemia. The prevalence in the United States USA and European countries is approximately 6 www.diabetes.niddk.nih.govdm pubsstatistics. The clinical classification of DM syndromes follows the WHO recommendation; type 1, type 2, DM secondary to other diseases, gestational DM and impaired glucose tolerance. More than 95 of diabetics in Europe and USA fall into type 2 category. The disease affects people older than 40 years, especially the elderly. Diabetes is widely recognized as one of the leading causes of death and disability worldwide. It is associated with long term complications that affect almost 167 Improving Knowledge Of Type 2 Diabetes Mellitus Patients On Oral Hypoglycaemic Agents every part of the body. Total annual diabetes cost in the USA approximately USD135 billion. The goal of diabetes care is to manage the disease so that the patient can lead as near to normal life as possible. Healthcare providers nowadays are encountering a vast number of diabetic patients in Malaysia and the prevalence is increasing every year and so does the use and number of oral hypoglycaemic agents. The National Health and Morbidity Survey had shown an increase in the number of type 2 diabetic patients from 6.3 in 1986 to 8.3 in 1996 Malaysian Consensus Clinical Practice Guidelines 2004. The situation was similar in District of Hilir Perak, where in 2004 the number of diabetic patient was 4952 and has increased to 5063 in February 2005. In outpatient department Hospital Teluk Intan itself, there are a total of 2967 diabetic patients registered up to June 2006 Daftar Diabetes 2005 2006. PKD Hilir Perak. Compliance towards medication is regarded as a major problem in healthcare. Better understanding of the problem is needed in order to improve the medication compliancy of patients Norehan Abdullah 2002. It has been generally accepted that educational programs can be beneficial in the treatment of a number of chronic disease such as diabetes. The findings of one study has shown a positive short and long term impact of a structured educational intervention on the patient’s knowledge of issues related to hypertension Cuspidi C et al., 2000. One outcome study in Pakistan emphasizes the need for diabetes education at all levels, both for the patients as well as the health care providers to counter the pandemic of diabetes- related complication globally Jabbar A et al., 2001. Many studies have shown that diabetic patient education activities should be directed primarily at stimulating adherence to the drug dosage and awareness of side effect Timmer JW et al. 1999; Donnan et al. 2002 A study in Hospital Taiping revealed 25 of patients are non- compliant towards their medication due to poor knowledge Ng C. B., 2002 and another 46 in a similar study in Kedah. In additional, it was showed that among all medication used in Malaysia, sulphonylureas were the most widely used 21.157 DDD1000 population per day Malaysian Statistic of Medicine 2004.

1.2 Problem Statement

Patient’s knowledge regarding their medication is one of the crucial elements in ensuring compliance as part of knowledge on the disease itself. Most of the medical personnel are facing difficulties to implement effective measures to improve patient’s understanding towards their medication as it involves multiple limitations and obstacles with absence of a systematic and unified module for patient education. Apart from this reason, together with certain limitations, it would be appropriate for this study to further focus in educating patients on their medication in order