STANDARD TREATMENTS

Standard treatments offer a number of potential advantages for the patients, health providers, supply managers and health policy makers. The Potential benefits of introducing standard treatment includes the following.

For Patients:

* Consistency among prescribers, reduced confusion and increased compliance.

* most effective treatments prescribed

* Improved supply of drugs, if drugs are prescribed only when needed.

For Providers

* Gives expert consensus on most effective, economical treatment for a specific setting

* Provider can concentrate on correct diagnosis.

* Provide a standard to assess quality of care.

* Provide a simple basis for monitoring and supervision.

For Supply Management Staff:

* Performance standard for drug supply, there should be sufficient quantities of drugs available for the most commonly treated problems at the different levels of the health system.

* Facilitates pre-packaging of course-of-therapy quantities of commonly prescribed items for common conditions.

* Drug demand more predictable, so forecasting more reliable.

For Health Policy makers

* Provide a method to control costs by using drug funds more efficiently.

* Serve as a basis to assess and compare quality of care.

* Development and implementation of a single set of standard treatments can be a vehicle for integrating special programmes, at the primary health care facilities.

Eg. diarrhoeal diseases control, ARI control, tuberculosis control, malaria control etc.

Standard treatments focus the thinking on critical aspects of the therapeutic process like the

* Careful identification of signs and symptoms

* Correct diagnosis

* Effective patient counselling on proper use of drugs or non-drug treatments that will truly benefit the patient.

Key features of Standard Treatments:

Standard Treatments have been in use in many countries for many years. Standard treatment exists for common illnesses of children, common illness of adults and obstetrics and gynaecology. The existence of these treatments has reportedly had a major impact on the consistency, effectiveness and economy of prescribing. Key features of the standard treatments include.

Simplicity:

The number of health problems is limited. For each health problem, a few key clinical diagnostic criteria are listed. Finally, drugs and dosage information is clear and concise.

Credibility:

The treatments are initially developed for patients by the most eminent clinicians. Revisions based on actual experience will further add to the credibility.

Same standard for all levels:

The first choice of treatment of a patient depends on the patients' diagnosis and condition. The referral criteria may differ. Doctors and other health care providers can use the same standard treatment. If a patient attends a primary level or secondary level or tertiary level hospital, with a common condition the treatment will be exactly the same.

Drug Supply based on Standards:

The standard treatments are coordinated with the supply of drugs.

Pre-service Training:

Standard treatment manuals are introduced and distributed during pre-service training and their use becomes habit.

Regular Updates:

A change or alteration in the therapeutic preferences are incorporated and updated, the standards should be revised to reflect current recommendations.

Pocket manuals:

The standard treatments are published as small, durable pocket manuals, which makes them convenient to carry and use.

Development of Standard Treatment

The following important considerations to be taken into account in the development of standard treatment.

* Target priority conditions

* Based on local disease factors

* Coordination with special programmes

* Use fewest drugs necessary

* Choose cost effective treatments

* Use essential drug list drugs only

* Invoke eminent clinicians

* Consider patient perspective.

In the interest of therapeutic and economic efficiency, standard treatments should target those conditions which contribute the most in terms of morbidity and mortality patterns.

In terms of selection of Health problems, standard treatments fall into one of the three categories.

1. Individual:

A standard treatment is prepared for only one problem or set of problems. (eg. only diarrhoeal diseases, only ARI or only Malaria)

2. Selective

Standard treatments are prepared for a small number of high priority problems, for Example a package of treatment for diarrhoeal diseases, ARI, Ante natal care, Malaria, tuberculosis etc.

3. Comprehensive

Standard treatments are prepared for 50-100 or even more common health problems. When published, such standard treatment for the common health problems will be comprehensive and easy to practice and will be useful in terms of efficiency and in considerable reduction in the cost of treatment as well.