Adherence to treatment guidelines in a university hospital: Exploration of facts and factors
DOI:
https://doi.org/10.3329/bjp.v9i2.18537Keywords:
Adherence, Treatment guidelineAbstract
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.
Downloads
343
174 Read
3
References
Arhinful DK, Das AM, Hadiyono JP, Heggenhougen K, Higginbotham N, Iyun FB, Quick J, Degnan DR. How to use applied qualitative methods to design drug use interventions. Massachusetts, USA, INRUD social scientist working group, 1996.
Bangabandhu Sheikh Mujib Medical University (BSMMU). Antibiotic guideline. Dhaka, 2005.
Bangabandhu Sheikh Mujib Medical University (BSMMU). Guideline for the treatment of genitourinary cancer. Dhaka, 2012.
Brook RH. Practice guidelines and practicing medicine: Are they compatible? JAMA. 1989; 262: 3027-30.
Brown EM. Guidelines for antibiotic uses in hospitals. J Antimicrob Chemo. 2002; 49: 587-92.
Chowdhury AK, Rahman MS, Faroque AB, Hasan GA, Raihan SZ. Excessive use of avoidable therapeutic injections in the upazilla health complexes of Bangladesh. Mym Med J. 2008; 17(2 Suppl): S59-64.
Christakis DA, Rivara FP. Pediatricians' awareness of and attitudes about four clinical practice guidelines. Pediatrics 1998; 101: 825-30.
Cohn JN. Monitoring adherence to guidelines. Circulation: Heart Failure 2008; 1: 87-88.
Das AK, Rahman MS. Prescribing vitamins at primary health care level: Exploration of facts, factors and solution. Bangladesh J Pharmacol. 2010; 5: 92-97.
Director General of Health Services (DGHS). Health Bulletin, 2012.
Directorate of Drug Administration (DDA). Bangladesh Medical Association (BMA), Bangladesh Pharmaceutical Society (BPS). Bangladesh National Formulary. 3rd ed. Dhaka, 2006.
Field MJ, Lohr KN, (eds). Clinical practice guidelines: Directions for a new program. Washington DC, National Academy Press, 1990.
Grill R, Margini N, Penna A. Practice guidelines developed by specialty societies: The need for a critical appraisal. Lancet 2000; 355: 103-06.
Grimshaw JM, Russell IT. Achieving health gain through clinical guidelines: Ensuring guidelines change medical practice. Qual Health Care. 1994; 3: 45-52.
Haque MM. ABC of research methodology and biostatistics. Department of Biochemistry, BSMMU, Dhaka, 2009.
Hogerzeil HV. Field tests for rational drug use in twelve developing countries. Lancet 1993; 342: 1408-10.
Hogerzeil HV. Promoting rational prescribing: An international perspective. Br J Clin Pharmacol. 1995; 39: 1-6.
Hysong SJ, Best RG, Pugh JA. Audit and feedback and clinical practice guideline adherence: Making feedback actionable. Impl Sci. 2006; 1: 9.
Islam MS, Rahman MS, Misbahuddin M. Impact of ‘Prescription audit & feedback’ on pattern of prophylactic antimicrobials in caesarean section: A cost reduction perspective. Bangladesh J Physiol Pharmacol. 2007; 23: 1-9.
Kafuko JM, Zirabumuzaale C, Bagenda D. Rational drug use in rural health units of Uganda: Effect of National Standard Treatment guidelines on rational drug use, 1994: (Unpublished report)
Lugtenberg M, Burgers JS, Besters CF, Han D, Westert GP. Perceived barriers to guideline adherence: A survey among general practitioners. BMC Fam Prac. 2011; 12: 98.
Mistiaen P, Bloemendal E, Weenink J, Harmsen M. Guideline adherence in the Netherlands: A systematic review, 2012;
Nabiswa AK, Makokha JD, Godfrey RC, Lore W. Management of malaria before and after introduction of a treatment protocol at the Eldoret District Hospital. East Afr Med J. 1994; 71: 9-13.
Naivalulevu L. Training for rational drug use. ARI News 1990; 18 November: 5.
Quick JD, Laing RO, Ross-Degnan DG. Intervention research to promote clinically effective and economically efficient use of pharmaceuticals: the International network for Rational Use of drugs. J Clin Epid. 1991; 44: 57-65.
Rahman MS, Akhter N, Haque MZ, Begum M, Chowdhury FA, Karim A, Khan IA. Prescribing pattern of Antimicrobials at different level of health care services and the impact of interventions (unpublished report).
Rahman MS, Begum M, Hoque MZ, Akhter N. Drug advertisements in medical journals: A commentary. Bangladesh J Physiol Pharmacol. 1999; 15: 31-36.
Rahman MS, Begum M, Khan IA, Chowdhury S, Islam AMZ, Sultana R, Hoque MZ, Akhter N. A baseline survey on the use of drugs at private practitioner level in Bangladesh. Bangladesh J Physiol Pharmacol. 1998; 14: 47-50.
Rahman MS. Changes required in pharmacotherapy teaching to ensure rational use of drugs. Bangladesh J Physiol Pharmacol. 1995; 11: 38-39.
Rastogi D, Shetty A, Neugebauer R, Harijith A. National Heart, Lung, and Blood Institute guidelines and asthma management practices among innercity pediatric primary care providers. Chest 2006; 129: 619-23.
Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Scott W. Evidence based medicine: What it is and what it isn't. Br Med J. 1996; 312: 71-72.
Sanders TR, Roberts CL, Gilbert GL. Compliance with a protocol for intrapartum antibiotic prophylaxis against neonatal group B streptococcal sepsis in women with clinical risk factors. Infect Dis Obs Gyn. 2002; 10: 223-29.
Siddika AN. Does antimicrobial prescribing of BSMMU Hospital comply to its’ antibiotic guideline? Thesis, (MPhill). Bangabandhu Sheikh Mujib Medical University, Dhaka, 2012.
World Health Organization (WHO). How to investigate drug use in health facilities: Selected drug use indicators. Geneva, World Health Organization, 1993.
Additional Files
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
