title: Practical approach to lung health in Nepal: better prescribing and reduction of cost.
abstract: OBJECTIVE
  To assess the impact of Practical Approach to Lung Health (PAL) guidelines on prescription behaviour and the total cost of prescription for patients with asthma, chronic obstructive pulmonary disease and pneumonia.
  
  
  METHODS
  Pre- and post-intervention comparison in a cluster randomized trial of primary care facilities. Seven health posts and 33 subhealth posts in Nepal were stratified by type and randomized into intervention and control groups. Health workers from the intervention facilities received 5 days training on the adapted PAL guidelines and their use. To collect prescription details, we used carbon-copy prescription pads in both groups. To measure the impact of PAL guidelines we used the World Health Organization's rational use of drug indicators and drug cost indicators, in a multivariate regression analysis.
  
  
  RESULTS
  The PAL guidelines led to fewer prescriptions of multiple drugs and to more prescriptions of generic and essential drugs. The guidelines also lowered average prescription cost and wastage by disease except for chronic obstructive pulmonary disease although not to a statistically significant degree. Similarly, the prescription of antibiotics and adherence to guidelines improved, albeit not statistically significant.
  
  
  CONCLUSIONS
  There is evidence that the implementation of PAL guidelines promotes rational use of drugs for some respiratory diseases. The expected health effects of PAL guidelines should be compared with their implementation costs before continuing training on lung health, and strategies put in place to sustain the effects.
authors.affiliation: Department of Community Medicine and Family Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors.forename: Naveen
authors.initials: N
authors.lastname: Shrestha
authors.forename: K C
authors.initials: KC
authors.lastname: Samir
authors.forename: Rob
authors.initials: R
authors.lastname: Baltussen
authors.forename: Kumud K
authors.initials: KK
authors.lastname: Kafle
authors.forename: David
authors.initials: D
authors.lastname: Bishai
authors.forename: Louis
authors.initials: L
authors.lastname: Niessen
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D011014:Pneumonia / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D011787:Quality of Health Care / Q000191:economics; D017678:Sex Distribution
chemical_list: D000900:Anti-Bacterial Agents