Shrestha Naveen, Samir K C, Baltussen Rob, Kafle Kumud K, Bishai David, Niessen Louis
Department of Community Medicine and Family Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
Trop Med Int Health. 2006 May;11(5):765-72. doi: 10.1111/j.1365-3156.2006.01599.x.
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.
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.
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.
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.
评估肺部健康实用方法（PAL）指南对哮喘、慢性阻塞性肺疾病和肺炎患者处方行为及处方总成本的影响。
在一项基层医疗设施整群随机试验中进行干预前后比较。尼泊尔的7个卫生站和33个下属卫生站按类型分层，随机分为干预组和对照组。来自干预设施的卫生工作者接受了为期5天的关于改编后的PAL指南及其使用的培训。为收集处方细节，两组均使用复写处方笺。为衡量PAL指南的影响，我们在多变量回归分析中使用了世界卫生组织的合理用药指标和药品成本指标。
PAL指南导致多种药物的处方减少，通用和基本药物的处方增多。除慢性阻塞性肺疾病外，该指南还降低了每种疾病的平均处方成本和浪费，尽管未达到统计学显著程度。同样，抗生素处方和对指南的遵循情况有所改善，尽管在统计学上不显著。
有证据表明，PAL指南的实施促进了某些呼吸道疾病的合理用药。在继续开展肺部健康培训之前，应将PAL指南预期的健康效果与其实施成本进行比较，并制定维持效果的策略。
