NTA Level 5 • Semester 1 • PST05105

Importance of (STG) and (EML) in Reducing Irrational Use of Medicines

Rational Use of Medicines • Source Session/Topic 10

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Session 10: Importance of (STG) and (EML) in Reducing Irrational Use of

Medicines

Total Session Time: 120 minutes

Prerequisites

• None

Students Learning Tasks

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

• Give overview of Tanzania STGs and EML

• Outline Importance of STGs

• Describe the Relation between STGs and EML

• Identify Advantages of Using Generic Names or INN in Medicine Use.

• List potential benefits of standard treatment guidelines

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

• Figure 10.1: Relationship between treatment guidelines and

essential medicine list

SESSION OVERVIEW

| | | |EML |

|8 | | | |

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (05 Minutes)

READ or ASK students to read the learning objectives and clarify

ASK students if they have any questions before continuing

STEP 2: Introduction to Tanzania STGs and EML (20 Minutes)

• The Standard Treatment Guidelines (STG) and the National Essential

Medicine List for Tanzania (NEMLIT) was first published in 1991, the

second edition was published in 1997.

• The third edition, published in 2013 incorporates the essential current

medical knowledge and new developments in medicines.

• It has incorporated major changes in the care and treatment of disease

conditions such as Tuberculosis and Leprosy, Malaria and HIV/AIDS due to

new scientific updates.

• Treatment guidelines (Standard treatment guidelines (STGs), treatment

protocols, clinical guidelines) are systematically developed statements

that assist prescribers in deciding on appropriate treatments for

specific clinical problems.

• These guidelines usually reflect the consensus on the optimal treatment

options within a health facility or health system.

• The information is disease centered, emphasizing the common diseases and

complaints and the various treatment alternatives.

• Information on medicines is usually limited to strength, dosage, and

duration. Most guidelines indicate a treatment of first choice. Some

include diagnostic criteria for starting the treatment or for choosing

among treatment alternatives.

• Standard clinical guidelines are an effective tool for assisting health

professionals to choose the most appropriate medicine for a given

condition. These should be developed and updated on a regular basis. It

is not sufficient to develop standard clinical guidelines without an

education and training program to encourage their use.

STEP 3: Importance of STG’s (20 Minutes)

|Activity: Buzzing (10 minutes) |

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

|minutes |

|What are the Importance of Standard Treatment Guidelines (STG’s) |

|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 following are the important of standard treatment guidelines (STG’s) in

the health management:

• Providing guidance to health professionals on the diagnosis and

treatment of specific clinical conditions

• Orienting new staff about accepted norms in treatment.

• Providing prescribers with justification for prescribing decisions

made in accordance with STGs

• Providing a reference point by which to judge the quality of

prescribing and dispensing

• Aiding efficient estimation of drug needs and setting priorities for

procuring and stocking drugs.

STEP 4: Relationship Between Treatment Guidelines and Essential Medicine

List (25 Minutes)

The subsequent are the relationship between Treatment guidelines and

Essential medicine list:

• The NEMLIT attached to the STG retains its purpose of identifying

medicines that are considered to be essential for the treatment of common

disease conditions in Tanzania.

• Treatment Guideline follows the principles and concepts of essential

medicines so as to simplify the management of medicines supply and

support a streamlined logistics system.

• Medicines in Treatment Guidelines are selected using the WHO Essential

medicines List (EM) as a model.

Choice of medicines in STG’s and EMLIT is based on:

• National health policy

o Free health care

o Subsidized health care

o Managed health care

• National medicine policy

o Free medicine policy

o Subsidized cost of medicines or cost recovery

o Cost sharing

• Patterns and prevalence of diseases

Quality and type of care provided at

o Primary health care institution

o Secondary health care institution

o Tertiary health care institution

• Available human resources

o Medical care (general MD and specialist care)

o Nursing care (nursing, midwifery, psychiatry)

o Pharmaceutical care (pharmacists, pharmacy technicians, Pharmaceutical

assistants)

• Financial resources.

• International Nonproprietary Names (INNs), also known as generic

names, are normally used in identifying selected medicines.

• INNs are intended for use in pharmacopoeias, labeling,

production information, advertising and other promotional

material, pharmaceutical regulation, and as a basis for generic

product names

• The choice of medicines by generic names requires the existence

of an effective Drug Regulatory Authority (i.e. TFDA) to ensure

the availability of good-quality, safe, effective and affordable

drugs

Figure 10.1: Relationship between treatment guidelines and essential

medicine list

[pic]

STEP 5: Advantages of Using Generic Names or INN in Medicines (20Minutes)

|Activity: Small Group Discussion ( 15minutes) |

|DIVIDE students into small manageable groups |

|ASK students to discuss on the following question |

|What are the advantages of Using Generic Names or INN in Medicines? |

|ALLOW students to discuss for 10 minutes |

|ALLOW few groups to present and the rest to add points not mentioned |

|CLARIFY and SUMMARIZE by using the contents below |

The medicines on the essential medicines list are referred to by their INN

or generic names. The generic name is used in writing prescriptions as well

as in purchasing medicines. The use of the generic name for these purposes

has certain advantages

• There is easy recognition of the type of medicines, especially where many

selected drugs exist in that class (e.g. all benzodiazepines have INNs

ending with “-zepam”).

• Generic names are more informative than brand names and facilitate the

purchase from multiple sources, thus giving the advantage of buying at a

competitive price.

• Generic prescribing facilitates product substitution where

bioavailability presents a clinical problem.

• The confusion associated with the use of brand names can be avoided.

• Generic products are often cheaper than products sold by brand name.

• The use of generic names for pharmaceutical purchasing as well as

prescribing carries considerations of clarity, price and quality, With

regard to clarity, the generic name helps identify the class of

medication.

Examples of generic names and brand names

|Generic names (INNs) |Brand Names |

|Acetyl Salicylic Acid |Aspirin®,Aspro® |

|Albendazole |Zentel® |

|Ampicillin |Penbritin® |

|Cimetidine |Tagamet® |

|Diazepam |Valium® |

|Paracetamol |Panadol® |

|Metronidazole |flagyl |

|Brufen + paracetamol |Ibuprofen |

|Amoxacilline + |Flucamox |

|flucloxacin | |

STEP 6: Potential Benefits of Standard Treatment Guidelines (20 Minutes)

The following are potential benefits of standard treatment guidelines

For Health officials:

• Permits identification of cost-effective treatments for common health

problems

• Provides basis for assessing and comparing quality of care

• Identifies most effective therapy in terms of quality and combats

antimicrobial resistance

• Provides information for practitioners to give to patients concerning the

institution’s standards of care

• Is a vehicle for integrating special programs (control of diarrheal

disease, acute respiratory infection, tuberculosis, malaria and so on) at

the point of the primary health care provider

For supply management staff

• Identifies which medicines should be available for the most commonly

treated problems.

• Facilitates prepackaging of course-of-therapy quantities of commonly

prescribed items

• Makes medicine demand more predictable, so forecasting is more reliable.

For health care providers

• Provides expert consensus on most effective, economical treatment for a

specific setting.

• Gives providers the opportunity to concentrate on correct diagnosis

• Sets a quality-of-care standard

• Provides a basis for monitoring and supervision

For Patients

• Encourages adherence to treatment through consistency among prescribers

at all locations within the health care system

• Ensures most cost-effective treatments are provided

• Improves availability of medicines

• Improves treatment and outcomes

STEP 7: Key Points (05 Minutes)

Patients can be better informed about the effective use of medicines when

the number of medicines they are confronted with is limited

Establishing and using a limited list of carefully selected essential

medicines is perhaps the single most cost-effective action that any health

care system or health care provider can take to promote regular supply and

rational use of medicines.

Treatment guidelines (Standard treatment guidelines (STGs), treatment

protocols, clinical guidelines) are systematically developed statements

that assist prescribers in deciding on appropriate treatment for specific

clinical problems.

STEP 8: Evaluation (05 Minutes)

• What are the advantages of using generic names or INN in medicines

• What is the importance of STG’s

• What are the relationship between Standard Treatment Guide and Essential

Medicine List?

References:

GoT (1998). Tanzania National Formulary (1st ed.). Dar es salaam, Tanzania:

MOHSW.

GoT (2013). Standard Treatment Guidelines& National Essential Medicines

List Tanzania MainLand ( 4th ed). Dar-es-salaam, Tanzania: MOHSW.

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