USING  UCG  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  diagnosCc  tests  

Need  for  UCG  

             

     

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InternaConal  guidelines  

NaConal    guidelines  

ScienCfic  Evidence  

Discussion  Consensus  

Cost    effecCveness  

Health  system    resources  

Expert    knowledge  

Socio-­‐cultural    factors  

SUMMARY  OF  REVIEW  PROCESS  

Principles  

q Priority  condi-ons  q Scien-fic  evidence  q Cost  effec-veness  q Implementability  

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GOALS OF UCG

q OPTIMIZE PATIENTS’CARE

q COST EFFECTIVE AND EFFICIENT USE OF RESOURCES

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EXERCISE  q Answer  2  to  4  clinical  scenarios  or  ques-on  in  small  groups  (2-­‐4  people,  one  clinician  in  each  group  if  possible)  using  UCG  

q Dedicate  not  more  than  10  minutes  to  each  ques-on/scenario  

q Note  down  the  sec-on  you  consulted    

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Clinical  scenario  1  q A  child  is  brought  to  your  clinic  because  he  was  biPen  in  the  morning  by  a  stray  dog.  The  bite  is  superficial  and  small  and  the  mother  washed  it  with  water.  ⇒ What do you do? -  Wound mgt -  Prescribed Rx -  Vaccines

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Clinical  scenario  2  q 50-­‐year  old  obese  lady  diagnosed  diabetes,  on  meTormin  500  mg  BD.  Her  fas-ng  blood  sugar  is  270  mg/dL  and  her  BP  is  150/110.    

What  do  you  do?  -  Diabetes treatment -  Hypertension diagnosis/treatment -  Complication screening -  Lifestyle advice

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Clinical  scenario  3  q Child  2-­‐year  old,  cough  fever  2  days,  a  bit  of  runny  nose.  What  do  you  do?  ⇒ Which questions do you ask? ⇒ Which signs do you look for? ⇒ Which tests do you carry out? ⇒ How do you manage if no DOB, no danger

signs and RR 30?

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QuesCon  1  q A  young  woman  comes  asking  for  “the  test  for  cancer”…  what  do  you  answer?  

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QuesCon  2  q An  intern  asks  you  for  advice:  his  pa-ent  (female  30-­‐year  old)  has  leucocytes  in  the  urine  but  no  symptoms  (no  pain,  no  frequency)  ⇒ What do you do? ⇒ Which question should you ask?

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Clinical  scenario  4  q Young  women  with  burning  in  passing  urine.  What  do  you  do?  ⇒ Which questions? ⇒ What differential diagnosis? ⇒ Which treatment if history and signs/symptoms

confirm likely diagnosis of UTI?  

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QuesCon  3  q Dosage  of  magnesium  sulphate  for  pre-­‐eclampsia    

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Clinical  scenario  5  q Woman  22  years  got  depo  8  weeks  before,  has  heavy  prolonged  bleeding.  What  do  you  do?  

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QuesCon  4    q What  do  you  assess  in  a  woman  who  came  for  a  post  natal  care  visit?  

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QuesCon  5    q How  do  you  diagnose  typhoid  fever?  

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Clinical  scenario  6    q   A  young  man  comes  with  a  posi-ve  HBsAg  test.  What  do  you  do?  

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QuesCon  6  malaria    q Differen-al  diagnosis  of  fever  with  nega-ve  RDT  

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Clinical  scenario  7  q You  have  a  case  of  a  child  who  got  burned  on  the  lec  forearm  with  hot  water  and  has  blisters.  How  do  you  classify  and  treat  the  burn?  

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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 22  

WHAT  IS  NEW  q Very  prac-cal  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  informa-on  for  higher  levels  

(RR  and  above)  

q ICD10  classifica-on  23  

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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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AnCmicrobials  in  UCG  q Input/Sources  of  informaCon  

⇒  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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 Thanks  and  enjoying  using  UCG  

                 

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