Authors: Shrestha, Naveen; Samir, K. C.; Baltussen, Rob¹; Kafle, Kumud K.²; Bishai, David³; Niessen, Louis¹

Source: Tropical Medicine & International Health, Volume 11, Number 5, May 2006 , pp. 765-772(8)

Publisher: Wiley-Blackwell

Abstract:

Summary Objectives 

To assess the impact of Practical Approach to Lung Health (PAL) guidelines on prescription behaviour and the total cost of prescription for patients with asthma, chronic obstructive pulmonary disease and pneumonia. Methods 

Pre- and post-intervention comparison in a cluster randomized trial of primary care facilities. Seven health posts and 33 subhealth posts in Nepal were stratified by type and randomized into intervention and control groups. Health workers from the intervention facilities received 5 days training on the adapted PAL guidelines and their use. To collect prescription details, we used carbon-copy prescription pads in both groups. To measure the impact of PAL guidelines we used the World Health Organization's rational use of drug indicators and drug cost indicators, in a multivariate regression analysis. Results 

The PAL guidelines led to fewer prescriptions of multiple drugs and to more prescriptions of generic and essential drugs. The guidelines also lowered average prescription cost and wastage by disease except for chronic obstructive pulmonary disease although not to a statistically significant degree. Similarly, the prescription of antibiotics and adherence to guidelines improved, albeit not statistically significant. Conclusion 

There is evidence that the implementation of PAL guidelines promotes rational use of drugs for some respiratory diseases. The expected health effects of PAL guidelines should be compared with their implementation costs before continuing training on lung health, and strategies put in place to sustain the effects.

Keywords: respiratory care guidelines; rational prescribing; quality of care; health worker education; prescription costs; Nepal

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1365-3156.2006.01599.x

Affiliations: 1:  Institute of Health Policy & Management, Erasmus Medical Centre, Erasmus University, Erasmus, Rotterdam, the Netherlands 2:  Department of Clinical Pharmacology, Institute of Medicine Tribhuvan University, Kathmandu, Nepal 3:  Department of Population and Family Health Sciences, John Hopkins School of Public Health, Baltimore, MD, USA

Publication date: 2006-05-01

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