The Standard Treatment Guidelines

Session 14: The Standard Treatment Guidelines

Total Session Time: 120 minutes

Prerequisites

None

Learning Tasks

By the end of this session students are expected to be able to:

Describe the Standard Treatment Guidelines

List Steps which involved during establishment of Standard Treatment Guidelines

Outline Uses of Standard Treatment Guidelines

Mention Advantages of Standard Treatment Guidelines

Mention Disadvantages of Standard Treatment Guidelines

Resources Needed:

Flip charts, marker pens, and masking tape

Black/white board and chalk/whiteboard markers

SESSION OVERVIEW

Step

Time

Activity/

Method

Content

1

5 minutes

Presentation

Introduction, Learning Tasks

2

15 minutes

Presentation Buzzing

Introduction to Standard Treatment Guidelines

3

15 minutes

Presentation

Steps which Involved During Establishment of Standard Treatment Guidelines.

4

15 minutes

Presentation

Uses of Standard Treatment Guidelines.

5

30 minutes

Buzzing

Presentation

Advantages of Standard Treatment Guidelines.

6

30 minutes

Brainstorming

Presentation

Disadvantages of Standard Treatment Guidelines.

7

5 minutes

Presentation

Key Points

8

5 minutes

Presentation

Evaluation

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning Tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Introduction to Standard Treatment Guidelines (15 minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

What is standard treatment guideline?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Definition of STG: A systematically developed statement designed to assist practitioners and patients in making decisions about appropriate health care for specific clinical circumstances

STGs—also known as standard treatment schedules, standard treatment protocols, therapeutic guidelines, list the preferred pharmaceutical and non-pharmaceutical treatments for common health problems experienced by people in a specific health system.

STGs have existed for as long as the art of healing has existed. Traditional healers developed their standard sets of cures and passed them from generation to generation

In modern medicine, however, the concept arose that more than one treatment modality may available for many medical conditions. This concept leads to confusion and, in many cases, incorrect treatment

Doctors, nurses, pharmacists, community health workers, and other health care providers learn about all of the treatments that could be used, instead of focusing on the best treatment that should be used.

Casual observation, as well as more systematic study of prescribing practices, frequently reveals a pattern of tremendous diversity among prescribers in the treatment of even the most common conditions

Polypharmacy is one problem; for example, three, four, five, six, and sometimes more medicines may be prescribed for acute viral gastroenteritis, for which only oral rehydration therapy is effective in reducing morbidity and mortality. Other common problems are making incorrect medicine choices, overdosing, under dosing, and choosing a more expensive medicine when less expensive ones would be equally or more effective.

STEP 3: Steps which Involved During Establishment of Standard Treatment Guidelines. (15 minutes)

STGs establishment involves the following Eight steps:

Establish a committee to address the development of the guidelines

Develop an overall plan for guidelines.

Identify the diseases that the STGs will cover.

Determine appropriate treatment options

Determine what information should be included in the STG; For example the following elements are suggestions for comprehensive STGs.

Clinical condition

Diagnostic criteria and exclusions

Treatment Tasks (e.g., elimination of plasmodium parasites from a blood smear)

Non-pharmaceutical treatment

Medicines of choice (and alternatives) for the medical condition

Important prescribing information— dose, duration, contra indications, side effects, warnings, medicine interactions

Referral criteria

Patient education information

What to do when clinical response is poor

Draft the STGs for comments and pilot testing

Publish and disseminate

Revise and update

STEP 4: Uses of Standard Treatment Guidelines. (15 minutes)

Standard treatments are used at different points of the therapeutic process they may be used to;

Diagnose,

Decide on treatment and pharmaceutical supply, and

Assist with adherence to the prescribed treatment. This use will more likely lead to the desired clinical outcome.

STEP 5: Advantages of Standard Treatment Guidelines. (30 minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

What are the advantages of standard treatment guideline?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

The use of STGs can benefit health care providers, health care officials, supply management personnel, and patients in the following ways.

Health care providers

Provides standardized guidance to practitioners

Encourages high quality care by directing practitioners to the most appropriate medicines for specific conditions

Encourages the best quality of care since patients are receiving optimal therapy.

Utilizes only formulary or essential medicines, so the health care system needs to provide only the medicines in the STGs

Provides valuable assistance to all practitioners, especially to those with lower level skills

Enables providers to concentrate on making the correct diagnosis because treatment options will be provided for them.

Health care officials

Provides a basis for evaluating quality of care provided by the health care professionals

Provides the most effective therapy in terms of quality

Provides a system for controlling cost by using funds more efficiently

Provides information for practitioners to give to patients concerning the institution’s standards of care

Can be a vehicle for integrating special programs (e.g., diarrhea disease control, acute respiratory infection (ARI), tuberculosis control, malaria) at the primary health care facilities using a single set of guidelines

Supply management

Utilizes only formulary or essential medicines, therefore the health care system needs to provide only medicines in the STGs

Provides information for forecasting and ordering (because medicines and quantities for common diseases will be known)

Provides information for purchase of pre-packaged medicines.

Patients

Patients receive optimal pharmaceutical therapy

Enables consistent and predictable treatment from all levels of providers and at all locations within the health care system

Allows for improved availability of medicines because of more consistent use and ordering

Helps provide improved outcomes because patients are receiving the best treatment regimens available

Lowers cost

STEP 6: Disadvantages of Standard Treatment Guidelines (30 minutes)

Activity: Brainstorming (10 minutes)

ASK students to brainstorm on the following question:

What are the disadvantages of Standard Treatment Guidelines?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMERIZE by using the content bellow

Disadvantages of treatment guidelines do exist, but seldom are they proven to have any serious effects on overall patient outcomes.

Inaccurate or incomplete guidelines will provide the wrong information for providers and therefore do more harm than good. Guidelines may not be based on the most reliable information

Updating guidelines is difficult and time-consuming and must be done on a regular schedule or they will become obsolete very quickly

Guidelines have been referred to as “cook book” medicine. They provide information to treat the population, but not necessarily the individual patient

Guidelines provide a false sense of security, i.e. many providers will limit their evaluation of a particular patient as soon as it fits into a particular standard treatment.

STEP 7: Key Points (5 minutes)

STG: A systematically developed statement designed to assist practitioners and patients in making decisions about appropriate health care for specific clinical circumstances

Standard treatments are used to diagnose, decide on treatment, pharmaceutical supply, and assist with adherence to the prescribed treatment.

STEP 8: Evaluation (5 minutes)

What is Standard Treatment Guideline?

What are the advantages of STGs?

What are the uses of STGs?

References

MSH and WHO (2012). Managing Access to Medicines and Health Technology, (3rd Edition). Kumarian Press

MoHSW (2003). Tanzania, Food, Drugs and Cosmetics Act, Government Printers Dar es Salaam

MoHSW (2011). Pharmacy Act, Government Printers Dar es Salaam

United Republic of Tanzania (1971). the drugs and prevention of illicit traffic in drugs act, Government Printers Dar es Salaam

United Republic of Tanzania (2011). Public Procurement Act, Dar es Salaam

MoHSW (2003). The National Health Policy, Government Printers Dar es Salaam

MoHSW (1991). The National Drug Policy, Government Printers Dar es Salaam

United Republic of Tanzania (1993).Medical Stores Department Act, Government Printers Dar es Salaam

Figure 2f from: Irimia R, Gottschling M (2016) Taxonomic revision of Rochefortia Sw. (Ehretiaceae, Boraginales). Biodiversity Data Journal 4: E7720. https://doi.org/10.3897/BDJ.4.e7720. (n.d.). doi:10.3897/bdj.4.e7720.figure2f

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