UCG and EMHSLU 2016 Appropriate Medicine Use unit Pharmacy Department October 2017
UCG and EMHSLU 2016
Appropriate Medicine Use unit
Pharmacy Department October 2017
2
Changes in Guidelines
New epidemics
New treatment policies
NEW TECHNOLOGIES
New drugs
New diagnosDc tests
Need for UCG
3
InternaDonal guidelines
NaDonal guidelines
ScienDfic Evidence
Discussion Consensus
Cost effecDveness
Health system resources
Expert knowledge
Socio-‐cultural factors
How are UCG produced/reviewed
GOALS OF UCG
q OPTIMIZE PATIENTS’CARE
q COST EFFECTIVE AND EFFICIENT USE OF RESOURCES
4
History of UCG
5
1993 2003
2010
2012
UCG AND EMHSLU 2016
6
Process
7
2. STAKEHOLDERS’ WORKSHOP
1. EXPERTS’ REVIEW
4. QUALITY CONTROL (harmonizaDon, peer review, clarificaDons, re-‐consultaDon)
3. COMPILATION
5. EDITING/LAYOUT
WHAT IS NEW q CHAPTERS REORGANIZED
⇒ Emergencies: Common emergencies, trauma and injuries, poisoning
⇒ Infections, HIV and STDs ⇒ Medical chapters: cardiovascular, respiratory,
gastrointestinal and hepatic, renal and urinary, endocrino, mental, neurological and substance abuse, muscoloskeletal and joint, blood, oncology and palliative care
⇒ MCH chapters: gynaecology, family planning, obstetrics, childhood illnesses, immunization, nutrition
⇒ Specialist chapters: eye, ENT, skin, oro-dental, surgery, radiology and anaesthesia
8
NEW!
WHAT IS NEW ⇒ DETAILED TABLE OF CONTENTS
for easier consultation
9
WHAT IS NEW ⇒ Haemorrhagic fevers, yellow fever, chronic hepatitis
B, stroke, COPD, anaemia, sickle cell disease, atrial fibrillation, headache, Nodding disease, menopause, prostate diseases etc added
⇒ sections on non-communicable diseases expanded (diabetes, hypertension, asthma etc) and diagnostic criteria included
⇒ New IMCI and MCH guidelines – updated,
expanded ⇒ Management of side effects of FP methods and
vaccines added 10
WHAT IS NEW q Very prac3cal layout:
⇒ Tables for management, clearly demarcated ⇒ Non pharmacological to pharmacological
treatment ⇒ From first line to second line ⇒ From lower to higher level of care ⇒ Cross-‐references ⇒ NOTA BENE: Limited informa3on for higher levels
(RR and above)
q ICD10 classifica3on 11
12
Example: febrile convulsions
Example: type 2 DM
13
New guidelines included
MOH guidelines
q Palliative care guidelines 2014
q New HIV guidelines 2016 q New TB guidelines 2016 q Integrated Malaria
Management 2015 q Nutrition Guidelines 2016 q Management of chronic
hepatitis B 2016
WHO guidelines
q Integrated management of pregnancy and Childbirth 2015
q Integrated Management of Childhood Illnesses 2014
q Mental health GAP intervention guide 2010
q Other guidelines
14
AnDmicrobials in UCG q Input/Sources of informaDon
⇒ Guidance from microbiology expert (Dr. Najjuka) ⇒ Situation analysis/recommendations, 2015
by UNAS ⇒ MOH and WHO guidelines and publications ⇒ Experts’ opinion
q Challenges ⇒ Insufficient information on causes of diseases and
antimicrobial resistance patterns
q Principles ⇒ Access ⇒ Clinical effectiveness ⇒ “parsimony”
15
Annexes
q Standard Infec3on Control Precau3ons q Pharmacovigilance and Adverse Drug reac3on
q Essen3al Medicine List 2016 q Na3onal Laboratory Test Menu
16
UCG Pdf -‐ Xodo
What can I use it for? IN THE DIAGNOSTIC PROCESS q E.g. I think it could be typhoid fever: ⇒ are the symptoms and signs of my
patient consistent with what it is in the manual?
⇒ What are the differentials? ⇒ Which test should I do to confirm? ⇒ What are the diagnostic criteria?
18
What can I use it for? IN THE PRESCRIBING PROCESS q Which is the first line treatment? q Which dosages and route and dura3on of medicines?
q Which other measures are necessary besides medicines?
q At which level is this condi3on managed? Should I refer this pa3ent? And to which level?
q What is the second line treatment if the 1st line fails or is not available or is not tolerated?
19
EMHSLU 2016 q Reorganiza3on to align with WHO EML 2015 q Specialist medicines presented within each therapeu3c category
q Some changes ⇒ Amoxicillin 250 mg dispersible tablets
introduced ⇒ Ceftriaxone to HC3 (for MCH conditions) ⇒ Ergometrine and nalidixic acid removed ⇒ Atorvastatin introduced ⇒ Hydroxyurea introduced
20
Way forward q Capillary distribu3on copies through NMS/JMS q Dissemina3on
⇒ Ensure guidelines are available at prescribing points
⇒ Ensure HWs understand the rational and aims of UCG
⇒ Ensure HWs know how to use UCG ⇒ Monitor use and compliance with guidelines
21
22