Introduction
This is a project proposal designed
to improve the health of people living in the
Vanni region of North-East Sri Lanka through the
development of clinical practice guidelines and
treatment algorithms for common medical problems.
Potential topics include, but are not limited
to diabetes, asthma, hypertension, and how/when
to prescribe antibiotics for outpatients. These
guidelines and treatment algorithms would help
in a number of ways to improve health at the population
level, as well as improve the efficiency of the
healthcare system:
-
simplifying
decision-making for local healthcare practitioners,
especially those whose training is not as extensive
as the average MBBS doctor
-
standardization
of medical care, whether provided by local doctors
or visiting expatriate doctors
-
simplifying
the process of continuing medical education
-
seamless implementation
of the latest evidence-based treatment strategies
-
minimizing
expenditures through selection of the most cost-effective
treatment strategies
Development of Guidelines
The clinical practice guidelines
and algorithms should be created and decided upon
by a committee medical doctors from Tamil Diaspora
health organizations. Ideally, the committee should
include some participation from medical doctors
living in all countries (Australia, Canada, Malaysia,
Norway, UK, USA, etc.) who volunteer their time
in Vanni. Evidence-based and cost-effective approaches
should be given priority. Recent formularies of
healthcare centres in Vanni are available for
consultation.
Thileepan Primary Healthcare Centre
Formulary
(March 2004)
Kilinochchi District Hospital Formulary
(March 2004)
Implementation
Once guidelines have been developed,
healthcare providers in Vanni should be educated
in their use. It is important to create educational
materials and guidelines in Tamil, because the
English knowledge of providers is variable.
Clinical practice guidelines can
be introduced to Vanni healthcare providers in
a number of ways:
-
lectures by
visiting expatriates who are familiar with the
guidelines
-
written material
created by expatriates and sent to Vanni
-
videotaped
lectures created by expatriates and sent to
Vanni
Questions about the guidelines
can be communicated to expatriate medical doctors
through e-mail.
Vanni healthcare providers can
undergo refresher training or be notified when
the clinical practice guidelines are updated or
revised.
The Example of Hypertension
Guidelines
An example of the latest high
blood pressure guidelines (JNC 7) for healthcare
providers in the United States is available at
the following links:
Teaching, Training, and Implementation
Currently, doctors take the vast
majority of blood pressure readings. Nurses can
also be trained in how to measure blood pressure.
Both doctors and nurses should
be taught the importance of treating high blood
pressure as a public health strategy to reduce
cardiovascular morbidity and mortality. Teaching
should also include the importance of accuracy
in blood pressure measurement such as using the
correct cuff size and being patient when listening
for Koratkoff sounds to appear and disappear.
Testing can be conducted in a
standardized manner. 10-15 volunteers with varying
blood pressures can be recruited to serve as test
subjects, and healthcare providers can be asked
to measure each person's blood pressure to within
5 mm Hg. Providers would also be required to select
the correct cuff size.
The same type of test can be provided
for doctors in the form of case scenarios, to
test their knowledge of the clinical practice
guidelines.
Once the guidelines have been
finalized, they can be printed as a booklet, printed
on laminated cards for quick reference, or turned
into posters for placing on the walls of primary
health clinics.
