Suboptimal Treatment in Chronic Diseases - Time to go Back to Basics
Abdul Rashid A.R., (2008) Suboptimal Treatment in Chronic Diseases - Time to go Back to Basics. Medical Journal of Malaysia, 63 (3). pp. 185-187. ISSN 0300-5283
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Cyberjaya University College of Medical Sciences. Dept. of Medicine.
As Malaysia progresses from a developing to a newly developed nation status by 2020 one thing is almost certain to happen; diseases associated with aging and urbanised lifestyle will be on the rise. The recently published Third National Health and Morbidity Survey of 2006 (NHMS 3) concurred with this gloom prediction; almost all risk factors which contributes to the most common chronic diseases in this country had increased in prevalence compared to the last survey of 1996. Hypertension in those age 30 years or more is now 43% (from 33%), diabetes mellitus 14.9% (from 8.3%) and overweight/obese Malaysians has increased in prevalence to 43% (from 27%). Not only is the increasing prevalence of these risk factors a concern, our collective failure to manage it optimally is also a concern. For example in the NHMS 3 only 26% of treated hypertensives were treated to target. This was exactly the figure seen 10 years earlier in the NHMS 2. Similar depressing findings of suboptimal management had been seen with other chronic diseases. In this issue of the Journal for example, Tan et al reported that only 26% of diabetics attending a major tertiary hospital in this country achieved a HbA1C of < 7%. What are the possible reasons for this widespread phenomenon? There are three main reasons why chronic diseases are poorly managed a). medication non-compliance b). prescriber’s attitude and c). disease complication which make optimal control difficult. This editorial will elaborate on the first two only, arguably two most important reasons.
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