Posted by Duncan Maru
One of Nyaya Health’s main objectives is to develop a model of evidence-based rural healthcare delivery. For a clinic providing free medicines, it is important to carefully define the scope of pharmaceuticals that are offered. This is necessary for efficient management of patients, but also because local community members, foreign donors, and governments want to know that their investments are used in a cost-effective manner. To ensure this, prescribing practices should be data-driven.
Over the last several months, we have been experimenting with different strategies for rapid input, analysis, and presentation of pharmaceutical data. These data already are helping to drive the type and quality of the clinical care that we provide. You can read more about these data on our wiki by clicking the link below:
Screen shot of our pharmaceutical tracking map
We have used these data to refine our clinical practice. One example is in the prescription of symptomatic therapies. Medicine as practiced in Nepal and throughout much of the world is focused largely on symptomatic treatment. Many of the medicines prescribed in rural Nepal do not alter diseases. Some common examples are acetaminophen/paracetamol (e.g. Tylenol), non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, PPIs/H2 blockers for gastric reflux, and anti-histamines for cold symptoms. Rural “quack” practitioners often earn a hefty income, since they provide services to both diagnose the patient and prescribe these treatments.
Patients eventually come to expect such treatments. Even well-intentioned providers will prescribe these symptomatic treatments because patients often travel several hours for care and clinicians feel a need to provide them with something, even if the therapy does not alter the disease course. However, doling out analgesics for anyone with vague, non-specific pains is not an effective and sustainable public health strategy.
Infant who received four antibiotics (metronidazole, cefixime, cephalexin, cefpodoxime) for cough and fever from a private pharmacist before coming to our clinic
During our ongoing evaluation of our operations, we noted our clinic spent 23,000 Nepali Rupees in August on NSAIDs alone. In order to streamline our prescribing procedures and more efficiently manage patients, we subsequently instituted protocols to manage syndromes such as lower back pain. By November, our monthly NSAIDs costs had plummeted to 2,200 Nepali Rupees.
Our long-term goal is an integrated primary care system that rigorously addresses the wide array of syndromes for which patients seek our care. Such a comprehensive system requires rigorous protocols, extensive follow-up, as well as on-site physical therapy and counseling services. In the short term, we are focusing our efforts on more treatable conditions with measurable public health outcomes, such as malnutrition, tuberculosis, pregnancy, abscess, and pneumonia. But in parallel, we are starting to build a strong organizational foundation required to efficiently build the long-term comprehensive system needed for adequate health care in this area.
Nyaya Pharmacist Tara Man entering data
G’day
What a fantastic blog and information on Wiki pages.
Have not seen such openness from a remote health service anywhere.
Keep up the great work, blog and wiki.
Robbo