TNMSC Times Bulletin on Essential Drug Therapy

Standard Treatment Guidelines

Dr.S.Gopalakrishnan. MD, DPH
Introduction

The Standard Treatment Guidelines are prepared as a tool to assist and guide doctors,
pharmacists, dispensers, and other healthcare staff who prescribe at primary care facilities in
providing quality care to patients. The guidelines list the preferred treatments for common
health problems experienced by people in the health system. The guidelines are designed to be
used as a guide to treatment choices and as a reference book to help in the overall
management of patients and are meant for use at all levels within the health system, both
public and private. [WHO]

Standard Treatment Guideline has been defined as a systematically developed statement

designed to assist practitioners and patients in making decisions about appropriate health care
for specific clinical circumstances. Standard treatment guidelines offer a number of potential
advantages for the patients, health providers, supply managers and health policy makers. The
potential benefits of introducing standard treatments include the following.

For Patients:
Consistency among prescribers reduced confusion and increased compliance.
Most effective treatments prescribed
Improved supply of drugs, if drugs are prescribed only when needed.
For Providers
Gives expert consensus on most effective, economical treatment for a specific setting
Provider can concentrate on correct diagnosis.
Provide a standard to assess quality of care.
Provide a simple basis for monitoring and supervision.
For Supply Management Staff:
Performance standard for drug supply, there should be sufficient quantities of drugs
available for the most commonly treated problems at the different levels of the health
system
Facilitates pre-packaging of course of-therapy quantities of commonly prescribed items
for common conditions
Drug demand more predictable, so forecasting more reliable.
For Health Policy makers
Provide a method to control costs by using drug funds more efficiently.
Serve as a basis to assess and compare quality of care.
Development and implementation of a single set of standard treatments can be a vehicle
for integrating special programmes, at the primary health care facilities.
E.g. Diarrheal diseases control, ARI control, tuberculosis control, malaria control etc.

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TNMSC Times Bulletin on Essential Drug Therapy

Standard treatments focus the thinking on critical aspects of the therapeutic process like the:
Careful identification of signs and symptoms
Correct diagnosis
Effective patient counseling on proper use of drugs or non-drug treatments that will truly
benefit the patient.

Key features of Standard Treatment Guidelines:

Standard treatment exists for common illnesses of children, common illness of adults and
obstetrics and gynecology. The existence of these treatments has reportedly had a major
impact on the consistency, effectiveness and economy of prescribing.

Key features of the standard treatments include:

Simplicity:
The number of health problems is limited. For each health problem, a few key clinical
diagnostic criteria are listed. Finally, drugs and dosage information is clear and concise.
Credibility
The treatments are initially developed for patients by the most eminent clinicians. Revisions
based on actual experience will further add to the credibility.

Same standard for all levels

The first choice of treatment of a patient depends on the patients' diagnosis and condition. The
referral criteria may differ. Doctors and other health care providers can use the same standard
treatment. If a patient attends a primary level or secondary level or tertiary level hospital, with
a common condition the treatment will be exactly the same.

Drug Supply based on Standards

The standard treatment guidelines are coordinated with the supply of drugs.

Pre-service Training
Standard treatment manuals are introduced and distributed during pre-service training and
their use becomes habit.

Regular Updates:
A change or alteration in the therapeutic preferences are incorporated and updated, the
standards should be revised to reflect current recommendations

Pocket manuals
The standard treatments are published as small, durable pocket manuals, which makes them
convenient to carry and use.

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TNMSC Times Bulletin on Essential Drug Therapy

Development of Standard Treatment Guidelines

The following important considerations to be taken into account in the development of

standard treatment.

Target priority conditions

Based on local disease factors
Coordination with special programmes
Use fewest drugs necessary
Choose cost effective treatments
Use essential drug list drugs only
Invoke eminent clinicians
Consider patient perspective.

In the interest of therapeutic and economic efficiency, standard treatments should target those
conditions which contribute the most in terms of morbidity and mortality patterns. In terms of
selection of Health problems, standard treatments fall into one of the three categories.

1. Individual

A standard treatment is prepared for only one problem or set of problems, (e.g. only diarrheal
diseases, only ARI or only Malaria)

2. Selective

Standard treatments are prepared for a small number of high priority problems, for example a
package of treatment for diarrheal diseases, ARI, ante natal care, malaria, tuberculosis etc.

3. Comprehensive

Standard treatment Guidelines are prepared for 50-100 or even more common health
problems. When published, such standard treatment for the common health problems will be
comprehensive and easy to practice and will be useful in terms of efficiency and in considerable
reduction in the cost of treatment as well.

The standard treatment guideline together with the essential drug list and the drug formulary
will help to rationalize medical practice. There is an urgent need to protect the population from
irrational and hazardous therapy. Often unnecessary drugs and injections are given to patients
merely to satisfy a wrong perception of health and health care. Educating people and health
professionals about the hazards of irrational curative care is another necessity of our times.
Rationalizing clinical health care also reduces costs for the public health system and makes the
system more effective for the same level of expenditure.

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