Page 61 - e-CPG-SLE-8_5_24
P. 61

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


                                      44
   56   57   58   59   60   61   62   63   64   65   66