STRATEGY TO IMPROVE USE OF STGS IN PRESCRIBING PRACTICES AT PRIMARY HEALTH CARE OUTLETS IN NEPAL

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STRATEGY TO IMPROVE USE OF STGS IN PRESCRIBING
PRACTICES AT PRIMARY HEALTH CARE OUTLETS IN NEPAL

• Kafle KK, Shrestha AD, Shrestha N, Prasad RR,
  Bhuju GB, Karkee SB, Das PL, Pradhan YMS,Lee D,
  Ross-Degnan D
• INRUD, Nepal

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Introduction

• Prescribing is an important component in the
  health care delivery.
• Improving prescribing practices is a difficult
  task.
• Standard Treatment Guidelines (STGs) have been
  considered an important tool to improve
  prescribing practices. However, compliance with
  the guidelines is the major challenge.
• Identification of an effective strategy to
  implement STGs at health care outlets is needed.

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Objectives

• The overall objective was to test strategies for
  increasing the use of STGs to improve the
  prescribing practices of paramedics at primary
  health care facilities.

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Specific Objectives

• The specific objectives were to improve the
  prescribing practices of paramedics at primary
  health care facilities by
• increasing the use of ORS, decreasing the use of
  antidiarrhoeals and antimicrobials in acute
  watery diarrhoea in children below 5 years.
• increasing the use of cotrimoxazole or
  amoxycillin for pneumonia, decreasing the use of
  cotrimoxazole or amoxycillin or other antibiotics
  in no pneumonia in children below 5 years.

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• increasing the use of benzyl benzoate or gamma
  benzene hexachloride and decreasing the use of
  antibiotics in scabies.
• increasing the use of paracetamol or aspirin,
  decreasing the use of antibiotics or
  antimalarials in undiagnosed fever (Pyrexia of
  unknown origin) .

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Methodology

• The study was a pre-post comparison of two
  interventions randomly allocated to three
  different study groups.
•  The study was a three-way design consisting of
  small group training, small group training
  followed by peer-group discussion using
  self-assessment results and control.
•  It was conducted in randomly selected three
  regions of Nepal.
• The sample included randomly selected one hill
  and two terai (plains) districts from each
  region.

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• From each sampled district, all health posts were
  selected making 80 health posts, the study
  population.
•  The data were collected prospectively by using
  the carbon copy of prescriptions.
• The trainings were conducted one month after
  baseline. The first peer-group discussion was
  conducted one month after the training.
• The peer-group discussions were conducted by
  District Health Officers/District Public Health
  Officers at the district office. The peer-group
  discussion was held every month. There were five
  peer-group discussions in each district.

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• The discussions used Indicator Consolidation Form
  compiled by the incharges of health posts
  incorporating self-assessment findings of all
  prescribers of the health post.
•  A Self-assessment Indicator Encounter Form was
  used to obtain self-assessment results.
•  The first follow-up assessment was carried out
  one month after second peer-group discussion.
  Similarly, the second follow- up assessment was
  carried out one month after fifth peer group
  discussion.
• All carbon copy prescriptions for four selected
  health problems were analysed. The prescriptions
  with single diagnosis only were included in the
  study.

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Results
Two months Assessment
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Six months Assessment
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Conclusion

• The peer-group discussion is a more effective
  and convenient strategy post-training than
  supervision/monitoring by the district for
  improving prescribing practices.