Skip to main content

Free Content Practical Approach to Lung Health in Nepal: better prescribing and reduction of cost

Download Article:

You have access to the full text article on a website external to Ingenta Connect.

Please click here to view this article on Wiley Online Library.

You may be required to register and activate access on Wiley Online Library before you can obtain the full text. If you have any queries please visit Wiley Online Library

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.
No References
No Citations
No Supplementary Data
No Article Media
No Metrics

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

Document Type: Research Article

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

  • Access Key
  • Free content
  • Partial Free content
  • New content
  • Open access content
  • Partial Open access content
  • Subscribed content
  • Partial Subscribed content
  • Free trial content
Cookie Policy
Cookie Policy
Ingenta Connect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more