title: An evaluation of the Essential Medicines List, Standard Treatment Guidelines and prescribing restrictions, as an integrated strategy to enhance quality, efficacy and safety of and improve access to essential medicines in Papua New Guinea.
abstract: The World Health Organization (WHO) has advocated the development and use of country specific Standard Treatment Guidelines (STGs) and Essential Medicines Lists (EML) as strategies to promote the rational use of medicines. When implemented effectively STGs offer many health advantages. Papua New Guinea (PNG) has official STGs and a Medical and Dental Catalogue (MDC) which serves as a national EML for use at different levels of health facilities. This study evaluated consistency between the PNG Adult STGs (2003 and 2012) and those for children (2005 and 2011) with respect to the MDCs (2002, 2012) for six chronic and/or acute diseases: asthma, arthritis, diabetes, hypertension, pneumonia and psychosis. Additionally, the potential impact of prescriber level restrictions on rational medicines use for patient's living in rural areas, where no medical officer is present, was evaluated. Almost all drugs included in the STGs for each disease state evaluated were listed in the MDCs. However, significant discrepancies occurred between the recommended treatments in the STGs with the range of related medicines listed in the MDCs. Many medicines recommended in the STGs for chronic diseases had prescriber level restrictions hindering access for most of the PNG population who live in rural and remote areas. In addition many more medicines were listed in the MDCs which are commonly used to treat arthritis, high blood pressure and psychosis than were recommended in the STGs contributing to inappropriate prescribing. We recommend the public health and rational use of medicines deficiencies associated with these findings are addressed requiring: reviewing prescriber level restrictions; updating the STGs; aligning the MDC to reflect recommendations in the STGs; establishing the process where the MDC would automatically be updated based on any changes made to the STGs; and developing STGs for higher levels of care.
authors.affiliation: School of Pharmacy, Faculty of Health Sciences, Curtin University, Perth, Western Australia and Discipline of Pharmacy, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea i.joshua@postgrad.curtin.edu.au.
authors.forename: Isaac B
authors.initials: IB
authors.lastname: Joshua
authors.affiliation: School of Pharmacy, Faculty of Health Sciences, Curtin University, Perth, Western Australia and.
authors.forename: Phillip R
authors.initials: PR
authors.lastname: Passmore
authors.affiliation: School of Pharmacy, Faculty of Health Sciences, Curtin University, Perth, Western Australia and.
authors.forename: Bruce V
authors.initials: BV
authors.lastname: Sunderland
mesh_terms: D000328:Adult; D002648:Child; D011307:Drug Prescriptions / Q000592:standards; D004358:Drug Therapy / Q000592:standards; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control; D018954:Drugs, Essential / Q000592:standards / Q000600:supply & distribution* / Q000627:therapeutic use; D006297:Health Services Accessibility; D006801:Humans; D010219:Papua New Guinea; D017410:Practice Guidelines as Topic
chemical_list: D018954:Drugs, Essential
keywords: Essential Medicines Lists; prescribing restrictions; standard treatment guidelines