Abstract
The present study was conducted to evaluate the adherence to treatment guidelines in Bangabandhu Sheikh Mujib Medical University. The study assessed the awareness of prescribers, adherence to treatment guidelines and reasons for non-adherence. A questionnaire survey was conducted followed by a retrospective medical review and in-depth interview. The study revealed that 60.9% of key prescribers are aware of Treatment Guidelines. In pediatric patients, adherence was highest in neonatal sepsis (71.7%) and lowest in bronchial asthma (3.3%) and pneumonia (3.3%). In adult patients, adherence was highest in rheumatoid arthritis (100%) and lowest in bronchial asthma (13.3%). Adherence was 29.5% and 52.7% in pediatric and adult patients respectively and difference was highly significant (p<0.001). The adherence was highest with International Guideline (100%), followed by institutional Guideline (71.7%) and National Guideline (22.5%). There is significant variation in extent of adherence in different age group of patients, diseases and categories of guidelines.
Highlights
Prescribing has become extremely complex because of innovation of abundant medicines and rationality of prescribing has been increasingly questioned
60.9% (28/46) of the key prescribers of Bangabandhu Sheikh Mujib Medical University (BSMMU) hospital are aware of treatment guidelines
Key prescribers from 39 departments have mentioned 73 diseases/clinical conditions treated in their departments, of which International Guidelines (33/73), National Guideline (4/73), institutional guideline (12/73) and textbooks/journal/own experience (24/73) are followed as their guiding principles
Summary
Prescribing has become extremely complex because of innovation of abundant medicines and rationality of prescribing has been increasingly questioned. Series of studies were conducted in Bangladesh using those indicators, which generated evidences of varieties of irrationalities at different level of medical care and facilities (Rahman et al, 1998; Rahman et al, 1999; Rahman et al, 2001; Islam et al, 2007). Efforts have been increased to improve medicine use in developing countries (Arhinful et al, 1996). Different intervention strategies have been proven to improve medicine use, namely educational, managerial, financial and regulatory intervention (Quick et al, 1991; Islam et al, 2007; Chowdhury et al, 2008). Medical institutes of developed countries follow either their national guideline or institutional guideline. Among few institutional guidelines published in Bangladesh, BSMMU antibiotic guideline (BSMMU, 2005) and Guideline for the treatment of genitourinary cancer (BSMMU, 2012) are mentionable
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