Mahmood Mohammad Afzal, Saniotis Arthur
Discipline of Public Health, School of Population Health & Clinical Practice, University of Adelaide, Australia.
J Pak Med Assoc. 2011 May;61(5):453-7.
Syndromic management is promoted as a measure to manage and control STIs in resource poor settings. This research was conducted to assess the diagnosis and prescription patterns using syndromic management algorithms as part of a community-based reproductive health programme.
The research was conducted in four squatter settlements of Karachi. Health care providers working for a reproductive health programme in these settlements received similar training on the use of algorithms. The people in these settlements had comparable socioeconomic and cultural backgrounds and access to health services. The medical records of 400 women who attended the centres for RTI/STIs were randomly selected. These records were reviewed for diagnosis and prescription patterns.
The diagnoses by and prescription practices of the health care providers differed greatly across the four clinics. As often there are more than one etiologic agents for most of the STI/RTI syndromes, algorithms allow multiple antibiotics use. However, this research pointed that despite diagnosing many patients as suffering from one particular infection, a large number of patients were prescribed more than one antibiotic.
It appeared that the health care providers had difficulties in using the algorithms, pointing to the need for ongoing support and training. The difficulty in correctly diagnosing STIs/RTIs could be the reason for over prescription. There is likelihood that the use of algorithms without sufficient support might contribute to the problems of drug resistance and prescription of drugs when they are contraindicated. Effective use of syndromic management algorithms requires training for effective communication, understanding about the locally prevalent STIs & RTIs, and periodic assessments of the quality of services.
推广症状管理作为在资源匮乏地区管理和控制性传播感染的一项措施。本研究旨在评估使用症状管理算法的诊断和处方模式，作为基于社区的生殖健康项目的一部分。
研究在卡拉奇的四个棚户区进行。在这些棚户区为生殖健康项目工作的医疗服务提供者接受了关于算法使用的类似培训。这些棚户区的居民具有可比的社会经济和文化背景，并能获得医疗服务。随机抽取了400名到性传播感染/生殖系统感染中心就诊的女性的病历。对这些病历的诊断和处方模式进行了审查。
四个诊所的医疗服务提供者的诊断和处方做法差异很大。由于大多数性传播感染/生殖系统感染综合征通常有多种病原体，算法允许使用多种抗生素。然而，本研究指出，尽管许多患者被诊断为患有某一种特定感染，但大量患者被开了不止一种抗生素。
医疗服务提供者在使用算法方面似乎存在困难，这表明需要持续的支持和培训。性传播感染/生殖系统感染诊断不准确可能是过度开药的原因。在没有足够支持的情况下使用算法可能会导致耐药性问题以及在禁忌时开药。有效使用症状管理算法需要进行有效沟通的培训、了解当地流行的性传播感染和生殖系统感染情况，以及定期评估服务质量。
