The role of Standard Treatment Guidelines and Essential Medicines Lists to support rational prescribing

Below are the citation, abstract and key messages of a new paper in Health Policy and Planning, highly relevant to HIFA’s work on promoting the availability and use of reliable information for prescribers and users of medicines: http://www.hifa2015.org/prescribers-and-users-of-medicines/

It would be very interesting to hear from HIFA members in PNG and other countries about the role of Standard Treatment Guidelines, Essential Medicines Lists, and other resources to support rational prescribing.

The full text is freely available here:

http://heapol.oxfordjournals.org/content/early/2015/09/15/heapol.czv083.full?papetoc

CITATION: An evaluation of the Essential Medicines List, Standard Treatment Guidelines and prescribing restrictions, as an integrated strategy to enhance quality, efficacy and safety of and improve access to essential medicines in Papua New Guinea

Isaac B Joshu,   Phillip R Passmore and Bruce V Sunderland

Health Policy Plan. (2015)

doi: 10.1093/heapol/czv083

First published online: September 15, 2015

Corresponding author E-mail: i.joshua@postgrad.curtin.edu.au

ABSTRACT

The World Health Organization (WHO) has advocated the development and use of country specific Standard Treatment Guidelines (STGs) and Essential Medicines Lists (EML) as strategies to promote the rational use of medicines. When implemented effectively STGs offer many health advantages. Papua New Guinea (PNG) has official STGs and a Medical and Dental Catalogue (MDC) which serves as a national EML for use at different levels of health facilities. This study evaluated consistency between the PNG Adult STGs (2003 and 2012) and those for children (2005 and 2011) with respect to the MDCs (2002, 2012) for six chronic and/or acute diseases: asthma, arthritis, diabetes, hypertension, pneumonia and psychosis. Additionally, the potential impact of prescriber level restrictions on rational medicines use for patient’s living in rural areas, where no medical officer is present, was evaluated. Almost all drugs included in the STGs for each disease state evaluated were listed in the MDCs. However, significant discrepancies occurred between the recommended treatments in the STGs with the range of related medicines listed in the MDCs. Many medicines recommended in the STGs for chronic diseases had prescriber level restrictions hindering access for most of the PNG population who live in rural and remote areas. In addition many more medicines were listed in the MDCs which are commonly used to treat arthritis, high blood pressure and psychosis than were recommended in the STGs contributing to inappropriate prescribing. We recommend the public health and rational use of medicines deficiencies associated with these findings are addressed requiring: reviewing prescriber level restrictions; updating the STGs; aligning the MDC to reflect recommendations in the STGs; establishing the process where the MDC would automatically be updated based on any changes made to the STGs; and developing STGs for higher levels of care.

KEY MESSAGES

– Lack of integration of Essential Medicines Lists, Standard Treatment Guidelines and prescribing restrictions leads to potential inappropriate prescribing and restricted access to medicines.

– In Papua New Guinea (PNG) there is very limited public access to drugs for the management of chronic diseases.

– In PNG there are notable discrepancies between the Essential Medicines List and Standard Treatment Guidelines.

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

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