Hudibia clinical guidelines
Guide for primary care
Address the patient's general health
Symptoms
Chronic conditions
Tuberculosis (TB)
- Tuberculosis (TB): diagnosis
- Drug-sensitive (DS) TB: routine care
HIV
- HIV: diagnosis
- HIV: routine care
- Start or change ART in the patient with HIV
Chronic respiratory disease
- Asthma and COPD: diagnosis
- Asthma: routine care
- COPD: routine care
Chronic diseases of lifestyle
- Cardiovascular disease (CVD) risk: diagnosis
- Cardiovascular disease (CVD) risk: routine care
- Diabetes: diagnosis
- Diabetes: routine care
- Hypertension: diagnosis
- Hypertension: routine care
- Heart failure
- Stroke
- Ischaemic heart disease (IHD): initial assessment
- Ischaemic heart disease (IHD): routine care
- Peripheral vascular disease (PVD)
Mental health
- Admit the mentally ill patient
- Depression: diagnosis
- Depression and/or anxiety: routine care
- Tobacco smoking
- Alcohol/drug use
- Schizophrenia
- Dementia
Musculoskeletal disorders
- Chronic arthritis
- Gout
- Fibromyalgia
Women’s health
- Contraception
- The pregnant patient
- Routine antenatal care
- Routine postnatal care
- Prevention of mother-to-child transmission (PMTCT) of HIV
- Menopause
Palliative care
- Life-limiting illness: routine palliative care
Epilepsy
- Epilepsy: routine care
Other pages
- Exposed to infectious fluid: post-exposure prophylaxis
- Protect yourself from occupational infection
- Protect yourself from occupational stress
- Communicate effectively
- Support the patient to make a change
Glossary
Prescribe rationally
Assess the patient needing a prescription
| Assess | Note |
|---|---|
| Diagnosis | Confirm the patient’s diagnosis, that the medication is necessary and that the benefits outweigh the risks. |
| Other conditions | Adjust dose or change to an alternative medication. |
| Other medications | Check all medications for possible interactions. |
| Allergies | If known allergy or previous bad reaction to medicine, discuss with doctor. |
| Age | If > 65 years: use lower doses, avoid unnecessary medications. |
| Pregnant/breastfeeding | Check if medication is safe. |
| Response to treatment | Assess if treatment is effective. If not, change therapy. |
Advise the patient needing a prescription
- Explain why the medication is needed, its effect, and risks if taken incorrectly.
- Explain when and how to take the medication and for how long.
- Educate on importance of adherence and resistance risks.
- Advise on possible side effects and what to do if they occur.
- Warn about herbal/over-the-counter medicine interactions.
Treat the patient needing a prescription
- Ensure correct prescriber and complete prescription details.
- Confirm the patient needs antibiotics; avoid unnecessary use.
- If possible, do microbiological tests before antibiotic treatment.
- Use shortest effective antibiotic course.
PRESCRIPTION
Doctor: Dr G. Robert
Address: Harley Street, Cape Town, South Africa
Tel: +27 21 791 2114
Date: 01/02/2016
Treatment: Amoxicillin
Dose: 500mg 8 hourly orally for 5 days
Patient Name: Ms Jimmy Deeds
Address: 14 Lexington Avenue
Age: 57
/Signature/
Address the patient's general health
Assess the patient's general health at every visit
| Assess | When to assess | Note |
|---|---|---|
| Symptoms | Every visit | Manage symptoms as on symptom pages. |
| TB | Every visit | If cough ≥ 2 weeks, weight loss, night sweats, fever ≥ 2 weeks, chest pain on breathing or blood-stained sputum, exclude TB. |
| Family planning | Every visit | Discuss patient’s contraception needs and pregnancy plans. If pregnant, give antenatal care. If HIV positive and planning pregnancy, advise contraception until viral load < 1000 copies/mL. |
| Sexual health | Every visit | Ask about genital symptoms. Ask about sexual orientation, risky behaviour (new or >1 partner, unreliable condom use, risky alcohol/drug use), and sexual problems. |
| Depression | Every visit | In the past month, has patient: 1) felt down, depressed, hopeless or 2) felt little interest or pleasure in doing things? If yes to either, assess further. |
| Alcohol/drug use | Every visit | In the past year, has patient: 1) drunk ≥ 4 drinks/session, 2) used illegal drugs, 3) misused prescription/OTC meds? If yes to any, assess further. |
| Smoking | Every visit | If patient smokes tobacco, support patient to change. |
| Older person risk | Every visit if > 65 years | If change in function, confusion or strange behaviour, assess. Consider dementia if ≥ 6 months of memory, disorientation, or coping issues. Use lower doses and avoid unnecessary meds. |
| CVD risk | If ≥ 40 years or ≥ 2 risk factors | Assess CVD risk at first visit, then depending on risk. Risk factors include smoking, family history, BMI > 25, large waist circumference, hypertension, diabetes, cholesterol > 5.2. |
| BP | First visit, then depending on result | Check BP regularly. |
| BMI | Yearly | BMI = weight (kg) ÷ height (m²). If BMI > 25, counsel. If < 18.5, refer for nutrition support. |
| Diabetes screen | If ≥ 45 years or BMI ≥ 25 with 1 other risk factor | Check glucose. Risk factors include inactivity, family history, gestational diabetes, high-risk ancestry. |
| HIV | If status unknown / If sexually active: yearly / If pregnant: at 32 weeks | Test for HIV. |
| Cervical screen | When needed | Do cervical screen. |
| Breast check | First visit, then yearly | Check for breast and axilla lumps. |