Two cheers or three for treatment guidelines? Nudging prescribers in right directions

Evaluating the implementation of the standard treatment guidelines (STGs) and essential medicines list (EML) at a public South African tertiary institution and its associated primary health care (PHC) facilities

“…Nurses scored marginally better than doctors in both adherence to guidelines and the stating of diagnoses. The lack of adherence to guidelines can be affected by the complexity of both the diagnosis and the guidelines itself—where nurses see simpler, primary health care conditions for which treatment guidelines are straight-forward and the more complex health conditions (which may include multiple diagnoses) are referred to hospital to be seen by doctors and may have more complex diagnoses [ 25 ]. It is unknown whether the lack of recorded diagnoses was due to uncertainty of the diagnosis or simply the lack of recording it.…”

“…Two non-EML medicines were prescribed which required a buy-out utilizing applications for the use of non-EML medicines on a “named patient” basis, which indicated that the majority of the prevalent health conditions of the population were provisioned for by the treatment guidelines but that some exceptions to care exist in rare instances. STGs/EML provide recommendations based on the best clinical evidence available but are there to serve as a guide and cannot replace sound clinical judgement [ 25 ].…”