title: An assessment of adherence to asthma medication guidelines: findingsfrom a tertiary care center in the state of Penang, Malaysia.
abstract: OBJECTIVE
  Multiple asthma guidelines have been developed to reduce asthma mortality, morbidity, and cost associated with asthma worldwide. In Malaysia, within this context, it is relatively unknown to what extent doctors adhere to the asthma guidelines. This study aimed to assess guideline adherence and calculate the cost of adhered and nonadhered prescriptions by medical doctors in a public tertiary health care facility.
  
  
  METHODS
  A cross-sectional study was carried out at Hospital Pulau Pinang, Malaysia. One hundred and eighty patients, a total of 30 patients per doctor, were enrolled to assess guideline adherence. The patients were followed for a second visit to assess their lung function. The costs of adhered and nonadhered prescriptions were calculated.
  
  
  RESULTS
  One hundred and forty-three patients (79%) received guideline (Global Initiative for Asthma 2011)-adhering pharmacotherapy. In the majority of patients (n = 133, 73.9%) asthma control was classified as partially controlled. There was no significant association observed between patient asthma control and patient demographics; however, there was a significant difference (P < 0.001) between lung function values from the first and second visits. The cost of adhered prescription was higher (70.1 Malaysian ringgit) than that of nonadhered prescription (13.74 Malaysian ringgit).
  
  
  CONCLUSIONS
  Fair levels of guideline adherence were observed. Emphasis should be placed on identifying appropriate cost-effective medication regimens based on patient asthma control and constant feedback from patients.
authors.affiliation: Department of Clinical Pharmacy, School of Pharmaceutical Sciences Universiti Sains Malaysia, Penang, Malaysia.
authors.forename: Raja Ahsan
authors.initials: RA
authors.lastname: Aftab
authors.affiliation: Department of Clinical Pharmacy, School of Pharmaceutical Sciences Universiti Sains Malaysia, Penang, Malaysia.
authors.forename: Amer Hayat
authors.initials: AH
authors.lastname: Khan
authors.affiliation: Department of Clinical Pharmacy, School of Pharmaceutical Sciences Universiti Sains Malaysia, Penang, Malaysia.
authors.forename: Syed Azhar
authors.initials: SA
authors.lastname: SYed Sulaiman
authors.affiliation: Department of Respiratory Medicine, Penang General Hospital, Penang, Malaysia.
authors.forename: Irf
authors.initials: I
authors.lastname: Ali
authors.affiliation: Department of Clinical Pharmacy, School of Pharmaceutical Sciences Universiti Sains Malaysia, Penang, Malaysia.
authors.forename: Azmi
authors.initials: A
authors.lastname: Hassali
authors.affiliation: Department of Clinical Pharmacy, School of Pharmaceutical Sciences Universiti Sains Malaysia, Penang, Malaysia.
authors.forename: Fahad
authors.initials: F
authors.lastname: Saleem
mesh_terms: D001249:Asthma; D003430:Cross-Sectional Studies; D019983:Guideline Adherence; D006801:Humans; D008296:Malaysia; D062606:Tertiary Care Centers
keywords: Guideline adherence; cost-effectiveness; patient asthma control