Are Standard Therapeutic Guidelines (STGs) needed in Pakistan?

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Are Standard Therapeutic Guidelines (STGs) needed in Pakistan?

The use of Standard Therapeutic Guidelines (STGs) is a time-tested evidence-based system that works well and improves patients’ therapeutic outcome. Non-compliance with the STGs results in high morbidity and inflated cost. In the USA, non-compliance with STGs costs $100 billion every year. STGs are also called as clinical arrangements, treatment conventions, best-rehearse rules, and organized ways to deal with diagnosis and treatment.

The STGs provide multiple benefits to all stakeholders, which would help in controlling poly-pharmacy, unnecessary tests, irrational use of medicines, and unreasonable treatment selections. In fact, rational way to deal with therapeutics involves careful evaluation of the medical issues and choosing appropriate possibilities. Making a correct diagnosis and selecting correct treatment options are two major areas for adequate patient care. In view of the analysis, the stakeholders may select one of several treatment alternatives whereas the patient ought to adhere to the prescribed therapy. A healthcare provider may opt for pharmacological or non-pharmacological alternatives as per STGs. It is imperative to consider the aggregate cost of treatment in determining the medication in terms of efficacy, safety, and cost-effectiveness of the treatment.

In most of the countries, STGs are available for different diseases, which are usually developed by the key stakeholders e.g. clinicians, medical experts, pharmacists, social scientists and health researchers and are reviewed at regular intervals. These guidelines provide different methods of diagnosis, prognosis and therapeutic options on the basis of scientific evidence. The healthcare providers are also supposed to follow these guidelines. Such guidelines are available in Australia, Canada, UK, and USA to name a few. While the degree of compliance to STG by the healthcare providers varies from country to country. Despite several reports of high morbidity and mortality due to wrong treatment and prescription errors, the degree of compliance to STG, generally, is very low, particularly in the developing countries.  The magnitude of communication efforts for compliance to the STGs is highly inadequate. There seems a group of healthcare providers opines these guidelines would against the freedom and have a negative impact on innovative thinking.

In Pakistan, STGs for different diseases are neither available nor revised regularly. Moreover, international therapeutic guidelines are not followed. In a country, where the general physicians (GPs) contribute more than 90% of the prescriptions and continuous medical education (CME) is neither structurally in place nor is mandatory, the availability of STGs seems essential. If they do not comply with any standard guide, chances of prescription-related issues along with cost would multiply.

The report showed that 25% of doctors in Australia and 33% – 69% doctors in the USA did not comply with the STGs; hence, it is a universal problem. Interestingly, Irish National Adverse Events Study conducted in 2016 showed that adverse events rate was 10.3% in Ireland while amongst them, 72.5% events were considered as preventable if accurately dealt. However, these adverse events contributed to patients’ mortality rate of 6.7% adding 6.1 average days to patients’ stay at hospital. In addition, major consequences of non-adherence to STGs are a loss of productivity, patients’ personal satisfaction, and declining quality-of-life. Furthermore, Hameed et al. (2004) described that in Pakistan, 50% of participants could not define hypertension and 75% acknowledged prescribing anxiolytics as the first-line treatment option for high blood pressure.

On the brighter side of implementing and reviewing the STGs especially in developing countries, it has been identified that STGs helps to improve drug supplies and efficacy of medication, low probability of side-effects and reducing the cost of therapy. Furthermore, adherence to STGs can help healthcare providers to improve their treatment options and methodologies. STGs also ensure adequate medicine supply, accessibility to quality drugs and reducing the financial burden of treatment. From the perspective of health policy-makers, designing and implementing strategies to control costs related to drugs and assurance to an adequate supply of quality drugs to masses.