UCG and EMHSLU Appropriate Medicine Use unit Pharmacy Department October 2017
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1 UCG and EMHSLU 2016 Appropriate Medicine Use unit Pharmacy Department October 2017
2 Need for UCG New epidemics Changes in Guidelines New drugs NEW TECHNOLOGIES New treatment policies New diagnosdc tests 2
3 How are UCG produced/reviewed ScienDfic Evidence Socio- cultural factors InternaDonal guidelines Expert Health system knowledge resources NaDonal guidelines Cost effecdveness Discussion Consensus 3
4 GOALS OF UCG q OPTIMIZE PATIENTS CARE q COST EFFECTIVE AND EFFICIENT USE OF RESOURCES 4
5 History of UCG
6 UCG AND EMHSLU
7 1. EXPERTS REVIEW Process 3. COMPILATION 2. STAKEHOLDERS WORKSHOP 4. QUALITY CONTROL (harmonizadon, peer review, clarificadons, re- consultadon) 5. EDITING/LAYOUT 7
8 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 NEW! 8
9 WHAT IS NEW DETAILED TABLE OF CONTENTS for easier consultation 9
10 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
11 q Very prac3cal layout: WHAT IS NEW 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 12
13 Example: type 2 DM 13
14 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
15 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
16 Annexes q Standard Infec3on Control Precau3ons q Pharmacovigilance and Adverse Drug reac3on q Essen3al Medicine List 2016 q Na3onal Laboratory Test Menu 16
17 UCG Pdf - Xodo
18 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
19 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 1 st line fails or is not available or is not tolerated? 19
20 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
21 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 22
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