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E-DRUG: Re: Lack of Impact from Undergraduate Prescibing Training

Dear E-druggers,

Lack of impact from training is an issue that the Decentralized Health
Services Project (Proyecto de Servicios Decentralizados -- PSSD) in
Nicaragua has begun to address.

We developed a training methodology which has been used for rational
antibiotic prescription with ARI's.  This training methodology begins with
the participants' active assessment of their own treatment and diagnosis
parterns through review of their own case files and daily registers.  This
information is compared with the treatment algorithms developed by WHO and
PAHO.  Goals are made regarding correct treatment.  Participants later meet
to report on their progress and a systematic review of treatment is
conducted.  A key component of this training is physicians' on-going self
audit which facilitates a new attitute in the application of correct norms.
Antibiotic use has been demonstrated to decline.  This, in turn, increase
availability.

In various training sessions conducted we found that although adequate and
thorough training had been provided, it did result in a change in treatment
patterns.  A crucial component was a simple and easy way to allow physicians
to monitor their own patterns and that on-going monitoring and evaluation at
the individual and facility level is institutionalized.  
--------------------------------------------------------------------------
Catherine Dormitzer
Mary Luz Dussan 
Management Sciences for Health
Projecto de Servicios de Salud Descentralizados (PSSD)
MINSA - Complejo "Dra Concepcion Palacios"
Apartado 4636 - Managua, Nicaragua
Telf:   505- 289-4801  505-289-0401
FAX:    505-289-0369
e-mail: mshnic@ibw.com.ni 

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