RESUMO
Introduction: Guideline development gathered pace in India after the inception of National Rural Health Mission (NRHM) in 2005. However, there is a lack of adequate information about guideline development process, review, and update. This paper reports on the systematic appraisal of Indian guidelines related to maternity management (MM) and family planning (FP) using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, which was one of the components of a pilot research in 2012-13. Materials and Methods: Forty-four selected guidelines about MM and FP, identified through a consensus building workshop, were independently appraised by two appraisers with AGREE instrument having six different domains. Mean item scores, domain scores, and standardized scores were calculated by averaging the scores across the two appraisers. Results: Most guidelines scored high in scope and purpose and clarity of presentation. However, they had little documentation about the development group member details, incorporation of patient views, evidence search method, method chosen for formulating recommendations, tools for application, potential barriers, cost implications, and information about the funding body. Nonclinical guidelines scored higher than clinical guidelines (P = 0.01) for MM in the domain applicability. Clinical FP guidelines scored higher than nonclinical guidelines in the domain of rigor of development (0.01). Conclusion: Despite being clinically sound, Indian guidelines score poorly due to weak documentation about their development process. It is recommended that the guideline development process be improved with systematic documentation for achieving standardization.
RESUMO
Background and Objectives: Majority of Ayurveda, Unani, Siddha, Homeopathy, Yoga (AYUSH) practitioners use allopathic drugs. This study was conducted to assess frequency of use of AYUSH and Allopathic drugs, and rationality of allopathic drugs in prescriptions of AYUSH practitioners. Methods: This cross sectional study was conducted after collecting prescriptions from patients attending clinics of AYUSH practitioners over a period of 5 weeks. Total 401 prescriptions were collected from patients after written informed consent. National list of Essential Medicines 2003, India and other parameters like drug dose, route of administration, indication were used to assess rationality of Allopathic drugs. Descriptive statistics was used for analysis. Results: Total 1037 drugs were studied from 401 prescriptions of AYUSH medicine practitioners. Total 999 (97.65%) Allopathy drugs were prescribed which contained 620 (62.06%) single drugs and 379 (37.93%) fixed drug combinations(FDCs) . 91.52% of total prescriptions contained only allopathic drugs. 19 (4.73%) prescriptions had combination of Ayurveda and Allopathic drugs while one(0.25%) prescription had combination of Homeopathy and Allopathic drugs. Out of 14 AYUSH presriptions containing only AYUSH drugs,13 (3.24%) prescriptions belonged to homoeopathy and one to Ayurveda.Proper diagnosis was written only in 29 (7.23%) prescriptions . 64% of total prescriptions reflected irrational use of Allopathic drugs.Irrational prescribing practices were found high in FDCs (37.13%) as compared with single drugs (26.92%) Conclusion: Allopathic drugs are highly and irrationally prescribed by AYUSH practitioners. Maximum irrational prescribing practice was seen in FDCs as compared to single drugs.