Producing National Drug and Therapeutic Information - The Malawi Approach to Developing Standard Treatment Guidelines
(1994; 49 pages) View the PDF document
Table of Contents
View the documentAcknowledgements
Open this folder and view contentsIntroduction
Open this folder and view contentsMSTG 1 (First edition)
Open this folder and view contentsMSTG 2 (Second edition)
Close this folderAppendices
View the documentAppendix 1 - Background publications used in preparation of the guidelines
View the documentAppendix 2 - Sample page of MSTG 1 (December 1988) first draft
View the documentAppendix 3 - Sample page of MSTG 1 (May 1989) second draft
View the documentAppendix 4 - Sample page of MSTG 1 (July 1989) third draft
View the documentAppendix 5 - Sample page of MSTG 1 (November 1990) final version
View the documentAppendix 6 - Technical notes on MSTG 1
View the documentAppendix 7 - Cover page of MSTG 1
View the documentAppendix 8 - Modification form for MSTG 1
View the documentAppendix 9 - Sample page of MSTG 2 (July 1993) final version
View the documentAppendix 10 - Technical notes on MSTG 2
View the documentAppendix 11 - Cover page of MSTG 2
View the documentAppendix 12 - Comparison table for MSTG 1 and MSTG 2
View the documentAppendix 13 - District training workshops to introduce MSTG 2 and MPC
 

Appendix 13 - District training workshops to introduce MSTG 2 and MPC

1. Description of activities

At each workshop a pre-intervention test was performed with participants being asked to answer, using the books, five short questions on treatments and patient management (see 3). For each answer, the book(s) used and the method of locating the relevant information (i.e. using the index(es), table(s) of contents, or other) was to be indicated together with details of the page and section numbers.

This was followed by an introduction to the structure, presentation of information and advice on the correct use of the books.

After being split into smaller working groups of five to six persons, participants at each workshop were then asked to complete a further series of 10 short questions (two questions being allocated to each group) using the books (see 4). The answers were presented to a plenary session and followed by discussions on the answers and the method of finding the information.

The workshop continued with a role play performed by the facilitators to introduce the subjects of drug management (dispensing) and patient management, including communication with the patient, history taking, patient examination, diagnosis, prescribing and couselling.

The first play showed an example of incorrect patient management (e.g. lack of privacy, poor attitude of the prescriber, poor communication with the patient with resultant lack of input from the latter, inadequate history taking, little or no patient examination, poor diagnosis, incorrect prescribing, insufficient patient counselling, etc.). After a plenary discussion of the principles of correct patient management, the role play was repeated showing an example of how these principles should be applied in daily clinical practice.

A second role play focusing on the dispensing process, illustrated the incorrect way of performing this final step in patient management (e.g. poor communication with the patient, poor attitude of the dispenser, lack of proper dispensing containers, little or no advice on dose regimes, inadequate counselling, etc.). Following a plenary discussion during which the rules of good dispensing were identified, the role play was repeated showing how these principles could be applied in practice.

Working groups were then each allocated five longer questions, one question to each group, in the form of “paper patients” or case studies (see 5) in order to discuss the diagnosis and management of the patients using the information available in the books. Each of these cases was then presented, making reference to the relevant sections of the books, at a plenary session for further discussion of the recommendations of each group for management of their “patient” and the method of locating the information.

A post-intervention test, using the same five short questions as in the pre-test conducted at the start of the workshop, was then completed by each participant. The scores obtained in the two tests were quickly averaged and compared and the results discussed. Results showed a marked increase from an approximate average of 25% to 85% indicating greatly improved use of the books and location of the required information.

Finally, a workshop evaluation form (see 6), distributed earlier in the day, was filled in by the participants and collected. Participants were also asked for any suggestions about how the workshop might be improved.

In general participants found the workshops to be very useful and enjoyable. They considered that the correct use of the two books would enable them to greatly improve their drug and patient management skills. However, many participants suggested that such workshops would need to be repeated every two years or so to refresh existing prescribers and orientate new prescribers coming into the health system.

2. Typical district workshop programme

08.00 - 08.15

Welcome and personal introductions by facilitators and participants.


Opening address by the District Health Officer (DHO).



08.15 - 08.30

Pre-intervention test (five short questions) using the MSTG and MPC.



08.30 - 09.00

Introduction to the structure, presentation of information and correct use of the MSTG and MPC.



09.00 - 09.30

Divide into working groups to answer ten short questions using the books (two questions per group).



09.30 - 10.00

Plenary session to discuss answers and method of finding the information.



10.00 - 10.15

Tea/coffee break.



10.15 - 12.00

Role play by facilitators illustrating incorrect patient management.


Plenary discussion of the role play and the principles of good patient management.


Presentation of summary baseline survey data on prescribing practices.


Role play demonstrating correct patient management.




Role play by facilitators illustrating poor dispensing technique.


Plenary discussion on the role play and on the principles of good dispensing practices.


Presentation of summary baseline data on dispensing practices.


Role play demonstrating correct dispensing and patient counselling.



12.00 - 13.30

Lunch break.



13.30 - 15.15

Group work on five longer questions (case studies) using the books (one case study per group) - 45 minutes.


Presentations by groups (max. 15 minutes each) to plenary session for comment and discussion.



15.15 - 15.30

Tea/coffee break.



15.30 - 15.45

Post-intervention test (five questions).



15.45 - 16.30

Distribution and completion of workshop evaluation form.


Discussion of pre- and post-intervention test results.


Suggestions for improvements to the workshop.



16.30

Closing comments on workshop by the DHO.

3. Pre- and post-intervention test questions

1. What is an essential drug?
2. What are the four steps of the planning cycle?
3. What are the signs and symptoms of kwashiorkor?
4. What are the signs of impetigo? Where is the treatment described?
5. What are the clinical signs of hookworm mostly caused by?

4. Example of 10 short questions used in district workshops

1. What does drug supply management involve?
2. What is the problem solving approach to making a diagnosis?
3. What are the signs and symptoms of marasmus?
4. Describe the management of mastitis
5. Which group of patients are at special risk from malaria infection?
6. What are the signs and symptoms of dehydration?
7. Describe the management of dental abscess
8. List the available methods of family planning
9. When should an abscess be incised?
10. What is the other name for threadworm?

5. Example of five long questions (case studies) used in district workshops

Using the MSTG and MPC answer the following questions:

1. Mphatso Chintengo, 18 months old, has just been admitted to the paediatric ward for severe malnutrition.

a) What are the possible signs and symptoms she may present with?
b) Describe the correct management of this child
c) How may malnutrition be prevented?
d) List the complications of malnutrition

2. Mary, aged 23, unmarried, normal monthly periods, comes to the clinic with a complaint of lower abdominal pains and offensive vaginal discharge. Has not been to any clinic for treatment.

O/E mild fever,
lower bilateral abdominal tenderness on palpation,
V/E offensive discharge, cervix tender on motion

a) What is the diagnosis? How did you make it?
b) Describe the correct management of this patient
c) What are the possible complications?

3.

a) What is the difference between AIDS and HIV?

b) How can you diagnose AIDS in adults?

c) A patient complains of weight loss, chronic diarrhoea, prolonged intermittent or constant fever and persistent cough (all for over one month). What pre-test counselling would you give this patient?

d) What safety precautions must be carefully observed by health workers?

4. Mrs Chipha brings her 13 year old daughter, who has been complaining of fever, joint pains, headache and vomiting for the past two days, to the out-patient department. On examination the girl seems to be shivering and her temperature is 39C.

a) What is the most likely diagnosis?
b) What investigation(s) would assist in making the diagnosis?
c) Describe the correct management of this patient

5. Mrs Mphango came to the hospital presenting with severe diarrhoea with rice water stools and moderate vomiting for two hours. On examination she has no fever, very sunken eyes, rapid pulse, her skin feels cold and clammy, and she has a very dry tongue. On pinching the skin goes back slowly.

a) What is the likely diagnosis?
b) How would you assess the degree of dehydration?
c) Describe the correct management of this patient
d) What are the control measures required for this condition?

6. Evaluation questions for the district workshops

1. How useful was the workshop for learning how to use the Malawi Prescriber’s Companion?

Very useful

Useful

Not very useful

2. How useful was the workshop for learning how to use the Malawi Standard Treatment Guidelines?

Very useful

Useful

Not very useful

3. How did you rate the organization of the workshop?

Very useful

Useful

Not very useful

4. Please give suggestions for improving the workshop.

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