Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia.
School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia.
BMC Health Serv Res. 2024 Aug 6;24(1):897. doi: 10.1186/s12913-024-11341-0.
The management of non-communicable diseases (NCDs) has benefited from telehealth services. As these services which include teleconsultation services and e-prescriptions are relatively new in Malaysia, the data generated provide an unprecedented opportunity to study medication use patterns for the management of NCDs in the country. We analyze e-prescriptions from a local telehealth service to identify medication use patterns and potential areas to optimize medication use in relation to clinical practice guidelines.
A cross sectional observational study was conducted by retrieving e-prescription records retrospectively from a telehealth service. 739,482 records from January 2019 to December 2021 were extracted using a designated data collection form. Data cleaning, standardization and data analysis were performed using Python version 3.11. The diagnoses were classified according to the International Classification of Disease 10 (ICD-10), while medications were classified using the Anatomical Therapeutic Chemical (ATC) system. Diagnoses, frequency of use for medication classes and individual medications were analyzed and compared to clinical practice guidelines.
The top five NCD diagnoses utilized by the service were hypertension (37.7%), diabetes mellitus (25.1%), ischemic heart disease (24.3%), asthma (14.4%), and dyslipidemia (11.7%). Medications were prescribed mostly in accordance with guideline recommendations. However, angiotensin receptor blockers (ARBs) were significantly more frequently prescribed compared to angiotensin converting enzyme inhibitors (ACEIs). Several medication classes appeared underutilized, including ACEIs in hypertensive patients with diabetes or ischemic heart disease, sodium glucose cotransporter 2 inhibitors in diabetic patients with ischemic heart disease, and metformin in patients with diabetes.
Telehealth services are currently being utilized for the management of NCDs. Medication use for the management of NCDs through these services are mostly in accordance with guideline recommendations, but there exist areas that would warrant further investigation to ensure optimal clinical and economic outcomes are achieved.
远程医疗服务使非传染性疾病（NCD）的管理受益。由于这些服务包括远程咨询服务和电子处方，在马来西亚相对较新，所产生的数据提供了一个前所未有的机会来研究该国 NCD 管理中的药物使用模式。我们分析了当地远程医疗服务的电子处方，以确定药物使用模式和与临床实践指南相关的潜在优化药物使用领域。
通过从远程医疗服务中回顾性检索电子处方记录，进行了一项横断面观察性研究。使用指定的数据收集表从 2019 年 1 月至 2021 年 12 月提取了 739,482 份记录。使用 Python 版本 3.11 进行数据清理、标准化和数据分析。根据国际疾病分类第 10 版（ICD-10）对诊断进行分类，而药物则使用解剖治疗化学（ATC）系统进行分类。分析了诊断、药物类别使用频率和个别药物，并与临床实践指南进行了比较。
该服务使用的前五种 NCD 诊断是高血压（37.7%）、糖尿病（25.1%）、缺血性心脏病（24.3%）、哮喘（14.4%）和血脂异常（11.7%）。药物的开具大多符合指南建议。然而，血管紧张素受体阻滞剂（ARBs）的使用频率明显高于血管紧张素转换酶抑制剂（ACEIs）。一些药物类别似乎使用不足，包括患有糖尿病或缺血性心脏病的高血压患者中的 ACEIs、患有缺血性心脏病的糖尿病患者中的钠葡萄糖共转运蛋白 2 抑制剂以及糖尿病患者中的二甲双胍。
远程医疗服务目前正被用于 NCD 的管理。通过这些服务管理 NCD 的药物使用大多符合指南建议，但存在需要进一步调查的领域，以确保实现最佳的临床和经济结果。
