Initial evaluation of the training programme for health care professionals on the use of Malaysian clinical practice guidelines for management of dementia

Introduction As in other developing countries, Malaysia is experiencing a rapid rise in the number of elderly persons in the population. Moreover, it is predicted that the proportion will continue to increase from the current 8% to 12% by the year 2030. (1, 2) Of concern is the prevalence of dementia in Malaysia. In 2005 the prevalence of dementia was estimated to be 0.063% with an annual incidence rate of 0.020%. Consequently, its prevalence is expected to increase to 0.126% in 2020 and 0. 454% in 2050. (3) Dementia has enormous health and financial consequences, not only for the affected individuals, but also specifically for their family caregivers as well as to society in general. (4) There have been initiatives to improve dementia care service delivery at the primary, secondary, and tertiary levels in Malaysia. The Clinical Practice Guidelines (CPG) for Management of Dementia developed by the Ministry of Health Malaysia (MOHM) were launched in 2010. (5) The key priorities they identified were prevention and risks, coordination and integration of care, memory clinic services, assessment and diagnosis, structural imaging, intervention strategies, challenging behaviours, and care of the caregivers. These can be achieved through education and training of the target population. (5) Hence, a quick reference for health care providers, patient information leaflets, and a teaching module was prepared at the same time. The guidelines also propose 2 clinical audit indicators, i. e. the number of people suspected with dementia referred from primary care to the memory/specialist clinics, as well as the percentage of antipsychotic drug use to control the behaviour and psychological symptoms of dementia. The first step involved the training of the health care providers, for which training modules were specifically developed by the CPG developmental committee. The modules were made up of 3 parts: 10 didactic lectures, (6) case vignettes, and pre- and post-evaluation questionnaires. To be more effective, the modules were developed to be as interactive as possible. Both the hard copy and soft copy versions of the manual was made available to the participants. The national-level training programme for the core trainers or 'champions' (a term defined by the MOHM as a group of leaders ensuring the continuation of the CPG training at their respective state level) was completed in September 2010, whereby 44 participants comprised psychiatrists, geriatricians, family medicine specialists, and hospital administrators who attended a 1.5-day workshop. A report by the Malaysian Health Technology Assessment Unit of the MOHM stated that all participants felt that this training had benefited them, and 97% said that they would recommend the training module to others. (6) The 'champions' were expected to initiate the second phase of training for other health care providers at the state level. By 2011, about 935 health care providers had been trained nationwide, of which about a third (n = 282) were medical professionals. (7) The second echelon of trainers was expected to train the health care providers in their respective districts and hospitals. As the training module was very comprehensive, allowance was given for the trainers to modify the module according to the category of the target population. The MOHM stipulated that echo training of the CPG should be made as one of the continuous programmes in hospitals and primary health care facilities in order to disseminate evidence-based recommendations made in the CPG. (6) In the State of Johor, initial echo training was carried out in January 2011 and involved both primary and secondary care specialists. The state was carved into northern (comprising the districts of Muar, Tangkak Segamat), central (Kluang, Mersing, Batu Pahat), and the southern (Johor Bahru, Kulai, Pontian, Kota Tinggi) zones. A leader was identified for each zone and was tasked to carry out further training and ensure that a large number of health care providers were trained. …