Investigating adherence of authorised prescribers to standerd treatment guidelines/essential medicine list when treating children presenting with respiratory conditions at primary health care level in the umkhanyakude health district, Kwazulu Nata

Abstract

Introduction: Primary Health Care (PHC) is regarded as the first level of contact with the National Health System with health care services provided mainly by nurses with varying competences. PHC is about interaction with people thus the quality of PHC depends extensively on the competence of the people who provide it. Therefore, the way health care personnel are trained and how capacity continues to be developed is of fundamental importance to PHC. Following the Alma-Ala Declaration, policies, such as the National Drug Policy (NDP) were developed in South Africa to guide health care services. The NDP resulted in the formulation of Standard Treatment Guidelines/Essential Medicine List (STGs/EML). Emphasis has been placed on all prescribers to strictly adhere to these guidelines when providing clinical patient care. Despite these developments reports still indicate that antibiotics are irrationally used when treating respiratory infections. It is therefore imperative that localised reasons for deviations from the STGs/EML when treating respiratory conditions are thoroughly investigated to facilitate relevant interventions. Objectives: The objectives of the study were to: (1) document the treatment prescribed to children up to 12 years of age for respiratory conditions, (2) assess adherence of the authorised prescribers to the 2008 PHC STGs/ EML and (3) determine factors impacting on deviations from the 2008 STGs/EML. Method: Twenty randomly selected PHC facilities in the district participated in the study. In each of the 20 selected PHC facilities, three prescribers were randomly selected for the structured interview and auditing of their prescription registers. Five prescriptions from each of the sampled prescription registers of the selected authorised prescribers, containing any of the children's respiratory conditions to be studied, were audited. A total of 15 prescriptions from each of the selected PHC facilities were audited. Descriptive statistics was used to xii analyse data and responses to categorical variables were summarised as frequency counts and percentages. Results were presented as tables, figures and graphs. Results: Pneumonia (39.7%) was found to be the most common respiratory condition seen at Umkhanyakude Health District followed by the common cold and influenza. Amoxicillin (52%) was the most often prescribed antibiotic for these respiratory conditions. Only 4% of prescribers showed full adherence to the 2008 PHC STGs/EML. While prescribers had a positive attitude towards the 2008 PHC STGs/EML, their sense of adherence, content understanding of these guidelines, as well as knowledge of medicine used for respiratory conditions, were exaggerated. Failure to accurately diagnose respiratory conditions and lack of implementation and monitoring strategies were also amongst the factors impacting on adherence. Conclusion: Adherence to the 2008 PHC STGs/EML for the treatment of respiratory conditions in children up to 12 years of age was found to be a challenge in Umkhanyakude PHC facilities with only four percent of prescribers adhering to these guidelines. The Umkhanyakude Health District Management team must consider employing multifaceted interventions from the recommendations of this study in order to improve adherence to the PHC STGs/EML. Recommendations: Strategies such as intensified monitoring and evaluation, improved supervision, targeted training and education together with compulsory in-service training are recommended to improve adherence to the STGs/EML in the Umkhanyakude Health District. Guideline implementation strategies with integrated approaches to guideline dissemination must also be strengthened.