Abstract
BackgroundThe standard treatment guidelines (STGs) and essential medicines list (EML) were a policy option recommended in the National Drug Policy for South Africa in 1996 to address the irrational and bloated medicines procurement list. STGs/EML serve as a tool to promote cost-effective use of medicines; rational prescribing; and improve accessibility to medicines for all citizens. The purpose of this study was to evaluate the use and implementation of the STGs/EML by prescribers at a public tertiary institution and its associated Primary Health Care (PHC) facilities in the uMhlathuze subdistrict of KwaZulu Natal. The study aimed to provide feedback and to make recommendations to policy makers to improve the use and implementation of the STGs/EML and to inform National Health Insurance (NHI) policy development.MethodAn observational quantitative descriptive research design was used. A retrospective audit of prescriptions was conducted, and questionnaires were utilized to collect data from prescribers and the facilities to evaluate the utilization of the STGs/EML and the rational use of medicines. All descriptive analyses were presented as counts with percentages, and Fisher’s exact test was used to compare results. The data was summarized, reduced, and analysed using SAS statistics software.Results107 medical doctors (97%) responded to the questionnaire at hospital level and 98 nurses (98%) responded to the questionnaire at the PHC level. Results revealed that the majority of doctors, 94.4%, had access to the latest STGs/EML compared with only 41.8% of nurses. 70.3% and 78.3% of doctor’s and nurse’s prescriptions, respectively, adhered to the guidelines. 94.9% of nurses requested training on the use of STGs/EML as most of them had not received formal training on its use.ConclusionThis study showed suboptimal adherence to STGs/EML by all prescribers, in contrast to previous research amongst nurses when hardcopies were available. Training on the use of the STGs/EML is needed at PHC level and improved monitoring of STGs/EML compliance is necessary. This study may be replicated for a wider population to paint a national picture and to periodically assess the extent of the implementation of the STGs/EML.
Highlights
The standard treatment guidelines (STGs) and essential medicines list (EML) were a policy option rec‐ ommended in the National Drug Policy for South Africa in 1996 to address the irrational and bloated medicines pro‐ curement list
Results revealed that the majority of doctors, 94.4%, had access to the latest Standard Treatment Guidelines (STGs)/EML compared with only 41.8% of nurses. 70.3% and 78.3% of doctor’s and nurse’s prescriptions, respectively, adhered to the guidelines. 94.9% of nurses requested training on the use of STGs/EML as most of them had not received formal training on its use
The South African National Department of Health (NDoH) has been proactive in strengthening the healthcare system for its citizens as evidenced by the introduction of the STGs/EML, which has ensured good availability of essential medicines in the public sector and has been successful at providing adequate treatment for the prevalent health conditions in SA, has made essential medicines more accessible to the population, this study found that more robust monitoring and improved protocols are necessary to address the gaps found in the implementation of the STGs/EML to create more succinct and quality guidelines, and improve the utilization of the guidelines, thereby ensuring that quality and sustainable healthcare is accessible to all
Summary
The standard treatment guidelines (STGs) and essential medicines list (EML) were a policy option rec‐ ommended in the National Drug Policy for South Africa in 1996 to address the irrational and bloated medicines pro‐ curement list. The study aimed to provide feedback and to make recommendations to policy makers to improve the use and implementation of the STGs/EML and to inform National Health Insurance (NHI) policy development. The NDoH provisioned the development and maintenance of the STGs/EML through the National Essential Medicines List Committee appointed by the Minister of Health, which is supported by the Affordable Medicines Directorate (AMD). The South African STGs/EML provide background information on each medical condition and recommended treatment regimens linked to the medicines listed in the EML, as well as non-pharmaceutical interventions, per level of care [2]
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