Practical approach to lung health in Nepal: better prescribing and reduction of cost

Tropical Medicine & International Health : TM & IH
Naveen ShresthaLouis Niessen

Abstract

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. 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. 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. There i...Continue Reading

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Citations

Feb 7, 2008·Chest·Wan C Tan, Tze P Ng
Feb 19, 2009·Tropical Medicine & International Health : TM & IH·Kamran Siddiqi, Andrew Chee Keng Lee
Nov 24, 2012·The Journal of Continuing Education in the Health Professions·Jennifer PearceJonathan I Bisson
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Oct 8, 2014·The Cochrane Database of Systematic Reviews·Susan M PattersonCarmel Hughes
Sep 4, 2018·The Cochrane Database of Systematic Reviews·Audrey RankinCarmel Hughes
Jan 11, 2017·International Journal of Mental Health Systems·Mary DochertyGraham Thornicroft

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