UCG  and  EMHSLU  2016  

Appropriate Medicine Use unit

Pharmacy Department October 2017

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Changes  in    Guidelines  

New  epidemics  

New  treatment    policies  

NEW  TECHNOLOGIES  

New  drugs  

New  diagnosDc  tests  

Need  for  UCG  

             

     

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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

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History  of  UCG    

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1993   2003  

2010  

2012  

UCG  AND  EMHSLU  2016  

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Process  

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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

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NEW!  

WHAT  IS  NEW  ⇒ DETAILED TABLE OF CONTENTS

for easier consultation

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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  

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Example:  febrile  convulsions  

Example:  type  2  DM  

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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

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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”

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Annexes  

q Standard  Infec3on  Control  Precau3ons  q Pharmacovigilance  and  Adverse  Drug  reac3on  

q Essen3al  Medicine  List  2016  q Na3onal  Laboratory  Test  Menu    

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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?

 

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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?  

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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

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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

 

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