E-DRUG: Information on clinical guidelines (3)
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In developing countries the rationale for clinical guidelines applies as described by Mary Hemming. In addition standard clinical or treatment guidelines based on a national essential medicines list are crucial to address issues associated wih safety, affordability, access and necessity.
To prepare clinical or treatment guidelines
- disease patterns are analysed
- consideration is given to how the common conditions should be treated in your setting
- essential medicines are aimed at the best treatment for most of the people
Ideally, treatment guidelines should be prepared first and the medicines needed will be determined during the process. It is possible to work through the process of disease management from the base level of the health services, through the various referral levels. Treatment guidelines and lists of drugs can be designed for different levels of programs resulting in uniform or complementary treatment by doctors, health workers and nurses.
- The use of guidlines associated with a basic list is not only the most efficient way to use the money that is available, it also provides safe and reliable treatment, and appropriate drugs will always be available;
- It is a guarantee that products are excluded which haven't been properly evaluated, or are known to be quite dangerous, or which have nothing to do with the needs of the population; it also excludes inappropriate drugs that could be made available by donation;
- Apart from helping to stop the waste of money on unnecessary drugs or on drugs that are more expensive than equally effective ones, it also makes the recording, storage and distribution much easier.
Beverley Snell
Centre for International Health
Macfarlane Burnet Institute for Medical Research and Public Health
P O Box 2284 Melbourne 8001, Australia
Telephone 61 3 9282 2115
Fax 61 3 9282 2144
email <bev@burnet.edu.au>
Site address: 85 Commercial Road, Melbourne, 3004
E-DRUG: Information on clinical guidelines (4)
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In the last decade a number of educational programmes have been
developed to improve the teaching of rational pharmacotherapy,
standard clinical or treatment guidelines but no serious efforts are
done for any rational approach to diagnose with minimal
investigations. As a part of clinical guidelines, criteria for
selection of most appropriate investigation/s for diagnosis should
also be designed.
Structured training in rational approach for clinical investigations
is relatively uncommon. In many medical schools teaching is
characterized by the transfer of knowledge about diagnosis and drugs,
rather than by the skill to treat patients. Medical students should
develop, at some time in the course of their studies or early in their
career, a set of P-Investigations (like the concept of P-Drugs) which
they will use regularly from then on. Usually, the choice of
investigations is made on irrational grounds, e.g. by copying
the prescribing behaviour of clinical teachers or peers without
considering alternatives or knowing how to choose between them.
Doctors are subject to many influences on their prescribing or
ordering of investigations including scientific publications in favour
of a particular investigation, commercial information and patient
pressures.
Logical structure to guide teachers and students through the process
of rational approach of diagnosis particularly in selection of
specific investigation from the long list of investigations is
probably beneficial in itself. Medical students need to be trained in
additional, skills necessary to apply the method successfully in
rational choice of investigations.
There is a need of teaching based on rational approach to clinical
investigations, which is possible within the structure of a
traditional (non problem-based) curriculum. We must have most logic
based flowcharts or algorithm in all investigations for diagnosis. But
at the same time there is a need to update all available
investigational algorithms periodically.
Syed Ziaur Rahman
Department of Pharmacology
Jawaharlal Nehru Medical College
AMU, Aligarh 202002, India
Telephone: +91-9358259740