ObjectivesThe aim of this study was to provide a comprehensive overview of the evolution of health technology assessment (HTA) in Malaysia over the past decade.MethodsWe described the evolution of HTA program in Malaysia based on review of administrative data, publicly available information and quantitative description of impact evaluation.ResultsHealth Technology Assessment HTA was formalized in Malaysia in 1995 as a central structure within the Ministry of Health, Malaysia in 1995. Expansion of activities demonstrated over the years including Horizon Scanning of health technologies and implementation of evidence-based Clinical Practice Guidelines. Improvement on the processes in terms of types of report, quality, monitoring, and impact evaluation as well as accessibility was also carried out. Examples of impact/influence of the reports have also been demonstrated.ConclusionsHTA program in Malaysia has evolved over the past decades. Its role in policy formulation and decision making of health technologies has become more significant over the years and is foreseen to be bigger in the future. As a trusted source of evidence, HTA in Malaysia will continue to strengthen the health system by advocating informed decision making and value-based medicine. As other countries in this region is trying to establish their own HTA processes and procedures, this review on the evolution of the HTA program in Malaysia might give some insights on developing a sustainable HTA program.
Clinical Practice Guideline (CPG) provides evidence-based guidance for the management of Dengue Infection in adult patients. A cross sectional study was conducted to evaluate awareness and utilization of CPG among doctors in public or private hospitals and clinics in Malaysia. Doctors practicing only at hospital Medical and Emergency Departments were included, while private specialist clinics were excluded in this study. A multistage proportionate random sampling according to region (Central, Northern, Southern, Eastern, Sabah and Sarawak) was performed to select study participants. The overall response rate was 74% (84% for public hospitals, 82% for private hospitals, 70% for public clinics, and 64% for private clinics). The CPG Awareness and Utilization Feedback Form were used to determine the percentage in the study. The total numbers of respondent were 634 with response rate of 74%. The mean lengths of service of the respondent were 13.98 (11.55).A higher percentages of doctors from public facilities (99%) were aware of the CPG compared to those in private facilities (84%). The percentage of doctors utilising the CPG were also higher (98%) in public facilities compared to private facilities (86%). The percentage of Medical Officer in private facilities that utilizing the CPG were 84% compares to Medical Officer in public facilities 98%. The high percentage of doctors using the CPG in both public (97%) and private (94%) hospitals were also observed. However, only 69% of doctors in private clinics utilised the CPG compared to doctors in public clinics (98%). Doctors in both public and private facilities were aware of the dengue CPG. However, most doctors in private clinic were less likely to utilise the CPG. Therefore, there is a need to increase the level of CPG utilisation especially in private clinics.
The Malaysian Dengue Clinical Practice Guidelines (CPG) have been developed to provide evidence-based guidance in the management of dengue infections. The use of these guidelines is essential to ensure its recommendations are being practiced. However, the adherence to the guidelines for management of dengue (revised 2nd edition) by healthcare providers still remains unknown. Therefore, the aim of this study was to evaluate the proportion among healthcare providers that adhere to this Dengue CPG. A retrospective cohort study of dengue cases registered from 1 January 2014 to 1 June 2015 was conducted in public hospitals and health clinics in Selangor, Putrajaya and Kuala Lumpur. Adherence to the CPG recommendations were recorded by reviewing patients’ case notes. Overall proportion of adherence in clinical components of the recommendation were (7.1 to 100.0% versus 7.7 to 73.8%) in history taking, (6.7 to 100.0% versus 12.3 to 60.0%) in physical examinations, (18.4 to 100.0% versus 23.1 to 83.2%) in assessment of warning signs, (0.6 to 100.0% versus 12.3 to 87.7%) in assessment of haemodynamic status, (60.0 to 100.0% versus 27.7 to 40.0%) in diagnosis, (46.6 to 80.0% versus 52.3%) in case notifications, (73.2 to 100.0% versus 89.2 to 96.9%) in performing specific laboratory investigations and (7.9 to 100.0% versus 21.5%) in monitoring, for outpatient versus inpatient, respectively. Adherence trends were demonstrated to be higher in hospital settings compared to outpatient settings. Adherence to this Dengue CPG varies widely with overall good clinical outcomes observed.
Grading BACKGROUND (INTRODUCTION):At the 2009 conference it was reported that the Scottish Intercollegiate Guidelines Network is to adopt the GRADE approach to developing guideline recommendations. The progress that has been made since the decision was made to proceed is reported, and lessons learned so far are identified. LEARNING OBJECTIVES (TRAINING GOALS):1. Highlight the key areas where existing methodology has to adapt to GRADE. 2. Identify the main stakeholder groups that need to be involved in major methodological changes. 3. Understand how implementing grading changes is as much about change management as methodology. 4. Consider ways of preparing guideline users for a major change in guideline presentation. METHODS: The approach taken to overcoming a number of methodological and organizational barriers is described. The new methodology has been integrated into the existing one through a process of iterative discussions, and new tools developed as necessary. A system of progressive training for guideline development group members has been introduced to ensure full understanding and uptake of the new system. RESULTS: The first groups to use the new approach started work in spring 2010, and will not complete it until 2011 at the earliest. Progress with involving staff and GDG members will be described. Steps taken to start preparing users for changes in the presentation of guideline recommendations and to explain the implications in terms of reliability of evidence and guidelines will be outlined. DISCUSSION (CONCLUSION): Changing the grading system involves a complete change of culture for an established organization such as SIGN. GRADE is a difficult system to explain in the abstract. Getting existing staff to accept the need for change and the potential benefits has proved challenging, but is an essential first step in getting the changes embedded in the guideline development process. Many of the lessons learned during this work will be applicable to guideline developers elsewhere in the world. TARGET AUDIENCE(S):1. Guideline developer 2. Guideline implementer 3. Developer of guideline-based products 4. Quality improvement manager/facilitator 5. Consumers' and patients' representatives S22-Using and adapting GRADE methodology in an area of low-quality evidence: An example from a national guideline on ablative therapies for the treatment of Barrett's esophagus Tarang Sharma, MPH (Presenter)
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