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gynecologist and primary care physicians in India
PW269 Modifying the Morisky Medication Adherence Scale by Adapting Two Items from the Brief Medication Questionnaire to Fit Assessing the Overall Adherence to Polypharmacy Regimen of Cardiac Patients
million women have GDM. However there is a huge shortage of trained physicians in India. Objectives: To address this need, a comprehensive high end training initiative in the form of Certificate Course in Gestational Diabetes Mellitus (CCGDM) is required for Physicians. Methods: An innovative and strategic partnership was established between Public Health Foundation of India (PHFI) and Dr. Mohan’s Diabetes Educational Academy (DMDEA), to train primary care physician, Obstetricians and Gynecologist on GDM by updated contents covering majority of salient aspects of GDM prevention, screening and management. Results: This uniquely designed program is aimed to train 1460 Primary Care Physicians, Obstetricians and Gynecologists of India in 55 Regional Centers, across India covering 16 states, 1 Union Territory and 39 cities with the backbone of 15 National Experts, 110 Regional Faculty and 25 Observers. The regional training centers serve as practice oriented skill enhancement centers and professional networking hubs. Sessions on GDM is conducted only on Sunday once a month for 4 consecutive months by regional faculty through use of standardized teaching material following standard operating procedures PAN India. Each center consist of dual expert i.e. Diabetologist/Endocrinologist and Gyn/Obst, each who act as Regional Faculty. National faculty empanelled across the country appraised the regional faculty on course curriculum and other modalities of the course. Educational material developed for program is latest, context specific, content and resource sensitive. Quality assurance of the educational program is ensured by necessary documentation, peer-reviews and by establishing alignment between module objectives, lectures material, case discussions, assignments & assessments. The educational grant for the program has been provided by Johnson & Johnson Medical India.
Ali Y. Nori*1, Muhamad S. A. K. Ali2, Baharudin Ibrahim1, Rahmat Awang3, M. Azmi Hassali1 School of Pharmaceutical Sciences, Universiti Sains Malaysia, 2Department of Cardiology, Hospital Pulau Penang, 3WHO Collaborative Center of Tobacco Control, Universiti Sains Malaysia, Penang Island, Malaysia
1
Introduction: Heart disease maintains being the leading cause of premature death in Malaysia. Careful follow up for cardiac patients is crucial to consistently optimize treatment and monitor the therapeutic plan. Although the term adherence is found in the Malaysian medical records, there is no standard method used in measuring compliance with the prescribed medications. However the Morisky Medication Adherence Scale (MMAS) is widely used in governmental hospitals, it is not accurately implemented when dealing with polypharmacy regimens. Objectives: This study aimed to evaluate the applicability and reliability of a modified version of MMAS after replacing two items of “medication discontinuation” and “medication missing” with a similar items adapted from the Brief Medication Questionnaire to establish a general measure of adherence to the multiple medications of cardiovascular disease (CVD). Methods: A pilot phase included 22 cardiac patients was run to demonstrate face validity for the modified MMAS as well as to improve the translation to the Malaysian language. Thereafter, 174 patients were surveyed where the original MMAS was administered before the modified extra two items along with other questions about demographics and barriers to adherence. The patients were categorized according to their diagnosis into: coronary heart disease, arrhythmias, heart failure, congenital heart disease, and valvular heart disease groups. Results: The mean age of the sample was 55 years (10.25), 80.6% were males, 46.9% were ethnically Chinese, monthly median income was z 330$ (1050 RM) and 81.1% were not current smokers. The mean number of daily CVD medications per patient was 5. Only 65.7% of the respondents had correctly taken the medications according to the prescribed instructions, whereas 73.7% had failed to name all their medications. 25.1% had a history of medication discontinue without doctor’s order. The internal consistency (Cronbach’s alpha reliability) of the original and modified MMAS were 0.583 and 0.588 a respectively. Significant Item-total correlation (P <0.01) and between both versions (0.898; P <0.01) manifests concurrent validity for the newly modified MMAS in addition to the retaining of the dimensional structure of a single-factor scale confirmed by factor analysis. Conclusion: Although the psychometric properties of both scales are similar, it is advised to use the modified MMAS to assess adherence to multiple drug therapy (polypharmacy) and get a clear picture about medication discontinuation behaviour. Disclosure of Interest: None Declared PW271 Implementation of educational training program in Gestational Diabetes Mellitus Management for obstetricians / gynecologist and primary care physicians in India Sourabh K. Sinha*1, Sandeep Bhalla1, V. Mohan2, Ranjit Unnikrishnan3, Pratibha Karnad4, K. S. Reddy5, D. Prabhakaran6 1 Training, Public Health Foundation of India, New Delhi, 2Chairman, 3Vice Chairman, Dr Mohans Diabetes Education Academy, Chennai, 4Education, Johnson & Johnson Medical India, Mumbai, 5Administration, Public health foundation of India, 6Executive Director, Centre for Chronic Disease Control, New Delhi, India Introduction: Given the global scenario around 366 million people suffering from diabetes in 2011, which is expected to rise to a total of 552 million by 2030. India alone has 62.4 million people with diabetes and 77.2 million people with pre-diabetes as of year 2011. GDM affects up to 15% of pregnant women worldwide and in India estimated 4
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
Conclusion: GDM program is an effort to build capacity among primary care physicians, gynecologist & obstetricians in Gestational Diabetes Mellitus Management. This unique and sustainable initiative hopefully serve as a trend setter in the field of diabetes education and help improve maternal and child health indices in India. Disclosure of Interest: None Declared
PW272 Role of nursing staffs as primary care givers in Management of Non Communicable Diseases with focus in Diabetes Mellitus in Rural India Utplakshi Kaushik*1, Sourabh K. Sinha2 1 Sneh, Family Health International, 2Training, Public Health Foundation of India, New Delhi, India
e313
POSTER ABSTRACTS
process of literature review and consensus (May-Aug 2013) led to establishment of agreed goals and key messages. An Advisory Council for individual input was also formed and the Australian Federal Government and policy-makers were successfully engaged. Communication is via teleconference, face-to-face workshops and electronic means. Results: The Secondary Prevention Alliance (Australia) was established (May 2013) with representatives from 19 national organisations. These include government and non-government stakeholders, professional organisations, consumers and the Heart Foundation. The Advisory Council consists of 149 individuals and experts from Australia, New Zealand, Europe and Canada with a variety of expertise in clinical roles (43%), education/ research (31%), health management (19%) and government (7%). The Alliance has already facilitated increased awareness of secondary prevention and has engaged media and government relations. The alliance also allows consensus on national models of care and indicators. Conclusion: The National Secondary Prevention Alliance has united stakeholders with the common goal of raising the profile of the need for improved health care services in Australia. The process provides an example of how national unity and common messages facilitates advocacy. Disclosure of Interest: J. Redfern Grant/research support from: AZ Educational Grant, K. Gall Grant/research support from: AZ Educational Grant, C. Chow Grant/research support from: AZ Educational Grant
million women have GDM. However there is a huge shortage of trained physicians in India. Objectives: To address this need, a comprehensive high end training initiative in the form of Certificate Course in Gestational Diabetes Mellitus (CCGDM) is required for Physicians. Methods: An innovative and strategic partnership was established between Public Health Foundation of India (PHFI) and Dr. Mohan’s Diabetes Educational Academy (DMDEA), to train primary care physician, Obstetricians and Gynecologist on GDM by updated contents covering majority of salient aspects of GDM prevention, screening and management. Results: This uniquely designed program is aimed to train 1460 Primary Care Physicians, Obstetricians and Gynecologists of India in 55 Regional Centers, across India covering 16 states, 1 Union Territory and 39 cities with the backbone of 15 National Experts, 110 Regional Faculty and 25 Observers. The regional training centers serve as practice oriented skill enhancement centers and professional networking hubs. Sessions on GDM is conducted only on Sunday once a month for 4 consecutive months by regional faculty through use of standardized teaching material following standard operating procedures PAN India. Each center consist of dual expert i.e. Diabetologist/Endocrinologist and Gyn/Obst, each who act as Regional Faculty. National faculty empanelled across the country appraised the regional faculty on course curriculum and other modalities of the course. Educational material developed for program is latest, context specific, content and resource sensitive. Quality assurance of the educational program is ensured by necessary documentation, peer-reviews and by establishing alignment between module objectives, lectures material, case discussions, assignments & assessments. The educational grant for the program has been provided by Johnson & Johnson Medical India.
Ali Y. Nori*1, Muhamad S. A. K. Ali2, Baharudin Ibrahim1, Rahmat Awang3, M. Azmi Hassali1 School of Pharmaceutical Sciences, Universiti Sains Malaysia, 2Department of Cardiology, Hospital Pulau Penang, 3WHO Collaborative Center of Tobacco Control, Universiti Sains Malaysia, Penang Island, Malaysia
1
Introduction: Heart disease maintains being the leading cause of premature death in Malaysia. Careful follow up for cardiac patients is crucial to consistently optimize treatment and monitor the therapeutic plan. Although the term adherence is found in the Malaysian medical records, there is no standard method used in measuring compliance with the prescribed medications. However the Morisky Medication Adherence Scale (MMAS) is widely used in governmental hospitals, it is not accurately implemented when dealing with polypharmacy regimens. Objectives: This study aimed to evaluate the applicability and reliability of a modified version of MMAS after replacing two items of “medication discontinuation” and “medication missing” with a similar items adapted from the Brief Medication Questionnaire to establish a general measure of adherence to the multiple medications of cardiovascular disease (CVD). Methods: A pilot phase included 22 cardiac patients was run to demonstrate face validity for the modified MMAS as well as to improve the translation to the Malaysian language. Thereafter, 174 patients were surveyed where the original MMAS was administered before the modified extra two items along with other questions about demographics and barriers to adherence. The patients were categorized according to their diagnosis into: coronary heart disease, arrhythmias, heart failure, congenital heart disease, and valvular heart disease groups. Results: The mean age of the sample was 55 years (10.25), 80.6% were males, 46.9% were ethnically Chinese, monthly median income was z 330$ (1050 RM) and 81.1% were not current smokers. The mean number of daily CVD medications per patient was 5. Only 65.7% of the respondents had correctly taken the medications according to the prescribed instructions, whereas 73.7% had failed to name all their medications. 25.1% had a history of medication discontinue without doctor’s order. The internal consistency (Cronbach’s alpha reliability) of the original and modified MMAS were 0.583 and 0.588 a respectively. Significant Item-total correlation (P <0.01) and between both versions (0.898; P <0.01) manifests concurrent validity for the newly modified MMAS in addition to the retaining of the dimensional structure of a single-factor scale confirmed by factor analysis. Conclusion: Although the psychometric properties of both scales are similar, it is advised to use the modified MMAS to assess adherence to multiple drug therapy (polypharmacy) and get a clear picture about medication discontinuation behaviour. Disclosure of Interest: None Declared PW271 Implementation of educational training program in Gestational Diabetes Mellitus Management for obstetricians / gynecologist and primary care physicians in India Sourabh K. Sinha*1, Sandeep Bhalla1, V. Mohan2, Ranjit Unnikrishnan3, Pratibha Karnad4, K. S. Reddy5, D. Prabhakaran6 1 Training, Public Health Foundation of India, New Delhi, 2Chairman, 3Vice Chairman, Dr Mohans Diabetes Education Academy, Chennai, 4Education, Johnson & Johnson Medical India, Mumbai, 5Administration, Public health foundation of India, 6Executive Director, Centre for Chronic Disease Control, New Delhi, India Introduction: Given the global scenario around 366 million people suffering from diabetes in 2011, which is expected to rise to a total of 552 million by 2030. India alone has 62.4 million people with diabetes and 77.2 million people with pre-diabetes as of year 2011. GDM affects up to 15% of pregnant women worldwide and in India estimated 4
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
Conclusion: GDM program is an effort to build capacity among primary care physicians, gynecologist & obstetricians in Gestational Diabetes Mellitus Management. This unique and sustainable initiative hopefully serve as a trend setter in the field of diabetes education and help improve maternal and child health indices in India. Disclosure of Interest: None Declared
PW272 Role of nursing staffs as primary care givers in Management of Non Communicable Diseases with focus in Diabetes Mellitus in Rural India Utplakshi Kaushik*1, Sourabh K. Sinha2 1 Sneh, Family Health International, 2Training, Public Health Foundation of India, New Delhi, India
e313
POSTER ABSTRACTS
process of literature review and consensus (May-Aug 2013) led to establishment of agreed goals and key messages. An Advisory Council for individual input was also formed and the Australian Federal Government and policy-makers were successfully engaged. Communication is via teleconference, face-to-face workshops and electronic means. Results: The Secondary Prevention Alliance (Australia) was established (May 2013) with representatives from 19 national organisations. These include government and non-government stakeholders, professional organisations, consumers and the Heart Foundation. The Advisory Council consists of 149 individuals and experts from Australia, New Zealand, Europe and Canada with a variety of expertise in clinical roles (43%), education/ research (31%), health management (19%) and government (7%). The Alliance has already facilitated increased awareness of secondary prevention and has engaged media and government relations. The alliance also allows consensus on national models of care and indicators. Conclusion: The National Secondary Prevention Alliance has united stakeholders with the common goal of raising the profile of the need for improved health care services in Australia. The process provides an example of how national unity and common messages facilitates advocacy. Disclosure of Interest: J. Redfern Grant/research support from: AZ Educational Grant, K. Gall Grant/research support from: AZ Educational Grant, C. Chow Grant/research support from: AZ Educational Grant