E-DRUG: Standard Treatment Guidelines (2)
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Dear Colleagues,
This is just a reminder. While we have Standard
Treatment Guidelines in various countries, it appears
to me that some Clinicians do not utilise them (or
even feel their presence or importance). This makes
the task of eradicating diseases using the minimum
resources we have (particularly in East Africa) very
tough.
We shouldn't have different prescriptions for same
cases reported, unless there is a real need to do
so...(using a team of medical experts in a particular
hospital/set-up).
Our challenge is to countinue pouring in the heads of
Clinicians (wherever they are), the concept of having
Standard Treatment Guidelines in a particular country
or set-up.
If every Clinician will treat a patient his own way,
then definitely we are heading nowhere!
If for example a country has decided that SP should be
a first-line treatment for treating uncomplicated
malaria...let it be so! Any other choice, should be
done with great caution!
However, we who are working on the ground we are
seeing a different picture!
regards
Frank Komakoma
? profession
? affiliation
fkoma@yahoo.com
E-DRUG: Standard Treatment Guidelines (3)
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Dear Frank,
What you express reflect my same experience working in developing countries.
I try to understand what physicians think and do when are asked to use a
STG. As a physician myself, we are trained to think and act with arrogance
and we feel threatened when receiving directives from policy makers who most of the time formulate them and expect prescribers to adhere with submission.
Often times, our anecdotal experience from the field prevails and not matter what it is being told, physicians continue to be on their own.
We have tried for years to have doctors in Latin America countries, to
review, adapt and implement a PAHO STG for infectious diseases, but guess
what.....it some countries it has come down to be a territorial issue
heavily influenced by the same arrogance and non sense. Let's solve the
problem by engaging doctors in a behavioral process.....so they (we) will
feel they (we) are in control!
E-DRUG: Standard Treatment Guidelines (4)
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dear E-druggers,
Frank Komakoma's experience and observation is very
prevalent in Africa. It is borne out of the dictum
that "the physician knows best about his patient".
This is not necessarily a wise saying, however, it has
eaten deep into the fabric of the African prescriber
.... who often feels that 5 years in a medical school
is synonymous with unfaltered knowledge, understanding
and wisdom!
My personal counsel and what I have said over the
years is that there are three ways of eliminating
this:
1. Educational Intervention: that is organize training
sessions for prescribers on the use, importance and
advantages of STGs;
2. Managerial Intervention: Get the health authorities
to intervene, especially highlighting the unnecessary
financial waste that can occur when STGs are ignored.
This may be followed by sanction! Healthcare
professionals should recognize that money is not
free-flowing and someone must pay for their ignorance
or arrogance!!
3. Regulatory Intervention: Regulatory agencies should
be prepared to enforce the various laws and
regulations. This can be done jointly with the various
bodies, such as Medical Council, Food & Drug Agencies
and Pharmacists Council.
May be with all these, both prescibers and dispensers
will rise up to their expected compliance with laid
down rules and regulations.
regards
Professor Fola Tayo
Dept. of Clinical Pharmacy & Biopharmacy, Faculty of
Pharmacy, University of Lagos Nigeria,
<folatayo2001@yahoo.com>
E-DRUG: Standard Treatment Guidelines (5)
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dear e-druggers,
It is interesting that so far none of the respondents appear to see
patient education and empowerment as part of the solution. Do we continue
to support the paradigm of a 'patient' patient, who is only expected to
say 'ya, doc'?
I think considerable progress has been made in this regard among people
living with HIV. Treatment literacy has taught us to learn about
guidelines, and ask questions when they are 'violated'. Yes, I know we are
still in a minority, and I know the health care providers HATE empowered
patients, but it CAN be done.
Of relevance perhaps are the two twin documents recently released by WHO
et. al. on TB treatment. These are the International Standards of TB Care
and the Patient Charter for TB Care. Both refer to each other, and both
are aimed at TB Care, rather than 'Control'. Empowering patients through
the Charter is already putting pressure on the profession to become aware
of the Standards, and to start to implement and adhere to them.
regards
Chris
--
Chris W. Green (wartaaids@gmail.com)
AIDS Treatment Educator, Spiritia Foundation
Jakarta, Indonesia
Tel: +62 (21) 422-5163 Fax: +62 (21) 4287 1866
Web site: <http://www.spiritia.or.id>
E-DRUG: Standard Treatment Guidelines (6)
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Dear E-druggers,
In our country, we have several guidelines for must prevalent clinical
problems, but these guidelines were prepared with general physicians for primary care and also with another level.
I know that the compliance of the guide is difficult, but this is the
challenge, and it´s part of the Educational Intervention, and also
Managerial Intervention, and in Cuba it´s an important aspect of the drug rational use program.
My personal counsel is to work with professionls that want to do it, in
spite of their ignorance or arrogance position, because always w´ll be
better for the patient do something.
best regards,
Dra. Miriam Cires Pujol
Therapeutic Consultation Services
Pharmacoepidemiology Development Center- Cuba
miriam@mcdf.sld.cu; www.cdf.sld.cu.
E-DRUG: Standard Treatment Guidelines (7)
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Dear Chris,
Thank you for bringing up "the patient side" to our attention. You are absolutely right!!
As a former AIDS Health Care Provider, we did what we did thanks to the patient who became an educated consumer not only in their medical issues, but also in their rights and responsibilities. This means, that we have same responsibility with our consumers in Africa, Asia and LAC.
We must work together!
Anibal Sosa, MD
Alliance for the Prudent Use of Antibiotics
75 Kneeland Street
Boston, MA 02111, USA
www.apua.org
E-DRUG: Standard Treatment Guidelines (8)
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Dear Chris,
Treatment guidelines that I have been involved with have not been all
didactic. A lot of other things as well as which medicines to use
are written into them. The guidelines include recognition of the
role and perceptions of the patient, which will vary in different
settings. Patients' perceptions and whole needs have to be addressed
and TGs can suggest appropriate strategies for your setting. Of
course, non-drug recommendations are always included too.
'Treatment ' includes partnerships with patients. As you say,
empowering the patients is an enormous part of the 'treatment'. It
must be at least ten years since we started to recognise and document
that treatment includes communication.
At the same time a guide for the appropriate use of medicines is
extremely helpful, not only to encourage appropriate use of medicine:
adherence to treatment guidelines helps maintain a reliable supply of
the medicines by making prediction of quantities much more efficient.
Best wishes
Beverley
Beverley Snell
Senior Fellow
Centre for International Health
Macfarlane Burnet Institute for Medical Research & Public Health
GPO Box 2284, Melbourne 3001 Australia http://www.burnet.internationalhealth.edu.au
Telephone 613 9282 2115 / 9282 2275
Fax 61 3 9282 2144 or 9282 2100
Time zone: 10 hours ahead of GMT.
email <bev@burnet.edu.au>