61 Journal of Pharmaceutical Health Services Research, 2021, Vol 12, 61–68 doi:10.1093/jphsr/rmaa010 Research Paper © The Author(s) 2021. Published by Oxford University Press on behalf of Royal Pharmaceutical Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com Research Paper National standard treatment guidelines: their impact on medicine use indicators in a resource-limited setting Harriet Rachel Kagoya 1, * , , Honoré Mitonga 1, , Dan Kibuule 2, and Timothy Rennie 2, 1 School of Public Health, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia and 2 School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia *Correspondence: Harriet Rachel Kagoya, School of Public Health, University of Namibia, Private Bag 13301, Windhoek, Namibia. Tel: +264-0-816873619; Email: kharrietrachel@yahoo.com Received June 22, 2020; Accepted October 12, 2020. Abstract Objectives Standard treatment guidelines improve patient care outcomes. Few studies assess the impact of standard treatment guidelines on population-level medicine use indicators in resource limited settings in sub-Saharan Africa, where the burden of disease is greatest. The objective of this study was to determine the immediate and long-term impact of the national standard treat- ment guidelines on medicine use indicators at the population-level in Namibia. Methods An interrupted time-series modeling of the impact of national standard treatment guide- lines implemented in Namibia in 2011, on population-level medicine use indicators. Antibiotic, gen- eric and polypharmacy prescribing indicators were abstracted from the national Pharmaceutical Information System, over an eight-year period, 2007– 2015. This generated 15-quarterly time points. The impact was estimated by changes in trends of the indicators, immediately and after the intervention using R-software. The immediate impact was refected by level change while long term impact was determined by trends/quarterly change after standard treatment guideline implementation. Key fndings Data points from 522 Pharmaceutical Information System reports from 38 health facilities were included. The eight-year period estimates were, 2.9 ± 0.1 medicines prescribed per outpatient, 48.1 ± 2.5% of prescriptions had an antibiotic and 74.0 ± 4.2% of medicines were prescribed by generic name. Of the 13 regions, 61.3% and 53.8% had a decline in the average medicines per prescription and prescriptions with antibiotics respectively, as well as 53.8% of the regions had an increase in prescribing of generic medicines immediately after implementation of the standard treatment guidelines. Thereafter, quarterly trends in the three indicators did not signifcantly improve after the intervention at national and in all regions, except for generic pre- scribing in Oshikoto region, 4.5% (95% CI: 2.6 – 6.3%, P < 0.001). Conclusion Whilst national standard treatment guidelines immediately improved medicine use in- dicators, it is discouraging that the improvement over time was marginal across regions and was not sustained at the national level. Robust point of care interventions is needed for sustained and effective implementation of standard treatment guidelines. Keywords: impact; medicine use indicators; Namibia; treatment guidelines Downloaded from https://academic.oup.com/jphsr/article/12/1/61/6067479 by guest on 03 August 2022