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Management of Systemic Lupus Erythematosus

12. IMPLEMENTING THE GUIDELINES

Implementation of this CPG is important as it helps in providing quality
healthcare services based on the best and most recent available
evidence applied to local scenario and expertise. Various factors and
resource implications should be considered for the success of the
uptake in the CPG recommendations.

12.1 Facilitating and Limiting Factors

The facilitating factors in implementing the CPG are:
i) availability of CPG to healthcare providers (hardcopies and
softcopies)
ii) conferences and updates on management of SLE including
those involving professional bodies (e.g. Malaysian Society of
Rheumatology)
iii) Key Performance Indicator on Rheumatology Services monitored
by MoH (i.e. number of newly presented SLE patients prescribed
HCQ in the Rheumatology Outpatient Clinic)
iv) public awareness campaigns on SLE (e.g. World Lupus Day in
collaboration with Malaysian SLE Association)

Limiting factors in the CPG implementation include:
i) different levels of care and wide variation in practice due to
expertise, facilities and financial constraints
ii) limited awareness and knowledge in management of SLE among
healthcare providers
iii) lack of awareness of the disease and its management by the public
iv) no local SLE registry

12.2 Potential Resource Implications

Early diagnosis of SLE may be difficult to establish as the presentations
are non-specific and it is even more challenging with the presence of
SLE mimickers. Besides that, the supporting relevant investigations
may not be easily accessible in the public primary care especially in
remote areas. The confirmation of the diagnosis and its assessment
requires the specialists’ expert opinion especially the rheumatologists,
where the service is limited nationwide. Thus, this CPG serves as a
guide for early disease recognition and referral. There is a compelling
need to increase awareness and knowledge on the evidence-based
management of SLE by ensuring widespread distribution of the CPG
and reinforcing related training to the healthcare providers.

Treatment of SLE can be a daunting task particularly in patients with
severe disease and co-morbidities. The assessment of disease severity

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