Transcript RATIONAL USE OF DRUGS

Rational Use of Drug
Ali Abad hospital
April 12th, 2005
PLAN
 Main
Concepts-Definitions
 Problems

of Irrational Use of Drugs
Programmation Chart: 3 approaches
• Change prescribing habits
• Improve knowledge of doctors and pharmacists
• Improve drug management
GENERIC MEDICINE
Generic Medicine

What is it?
ICD: International Common
Denomination
Same active ingredient, same dosage,
same route of administration
Same therapeutic effect
Generic Medicine

Why using generics?
Less expensive to produce
Easier to buy
Easier to use
Generic Medicine
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How using generics?
Packing when the patient submits
the presciption to the pharmacist
Pre-packing
ESSENTIAL DRUG
Essential Drug

What is it?
Medicines which cover the most urgent
needs for the population
Essential drug
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Why using essential drugs?
Good benefit-risk ratio
Efficacity proved
Safe use
Essential Drug

How using it?
Following standardized guidelines
ESSENTIAL DRUG
LIST
EDL
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Specific for each
country, according to
its priorities in the
health policy.
Limited number and
types of drugs
available at each level
of health services
In Afghanistan, list
established by the
BPHS; it consists of
237 medicines and
items of medical
material, available at
4 levels
EDL
Type of HF
Number of
medicines
available
Total
Number of
items
HP
15
24
BHC
48
76
CHC
80
120
DH
84
137
STANDARD
TREATMENT
GUIDELINES
STG
A systematically
developped
collection of
statements
designed to assist
prescribers
decisions about
appropriate health
care for specific
clinical
circumstances
Definition of RUD
The Rational Drug Use requires that patients
receive medicines appropriate to their
clinical needs, in doses that meet their
individual requirements, for an adequate
period of time, and at the lowest cost to
them and the community.
WHO, 1998
Surveys about RUD
Prescribing
indicators
Average number of drugs/encounter
% of encounters with ≥1 ATB
% of encounters with ≥1 injection
% of drugs prescribed from EDL
Patients Care
indicators
% of drugs actually dispensed
% of drugs adequally labeled
Patients’ knowledge of correct dosage
Facility
indicator
Availability of key drugs
Results
Comparison AMI clinics 2004/Standard INRUD/SCA 2002
120
100
100
100
100
92,1
89,2
81,1
percentages
80
79
73,2
AMI Clinics/BLS 2004
Golden Standard INRUD
SCA survey 2002
61,3
60
50,5
40
30
20
10
4,9
5,5
1,1
0
% encounters with
an ATB prescribed
% encounters with
an injection
% drugs prescribed
from EDL
drug cores
% drugs actually
dispensed
% correct labeling
PROBLEMS OF
IRRATIONAL USE OF
DRUGS
CAUSES
From the prescriber
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Lack of knowledge about diagnosis,
therapeutics
Acquired habits
False beliefs about illness and drugs
Economic motivations
Between patient and prescriber
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Patient’s demand: lack of knowledge,
family pressure
Quality of communication
Work Environment
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Influence of drugs availability
Availability of diagnosis services
Lack of space
Workload
Availability of female staff
HOW IMPROVING
RATIONAL USE OF
DRUGS?
By changing prescribing habits


Standardization of therapeutic schemes
Audits: prescription control sheet
By improving knowledge of doctors
and pharmacists
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Specific trainings
Printed educational material:
Therapeutic manuals (guidelines, EDL)
Clinical litterature (Salamati magazine)
Posters (most frequently used drugs
dosages, tables of dilution, preparation
and storage of antiseptic solutions...)
Improving the dispensation to the
patient (1/1)
Possibility of packaging by
advance
Correct labeled packets:
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Name of the patient
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Name and dosage of the drug
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Schedule and duration
Improving the dispensation to the
patient (1/2)
Explanations and advice to the patient:
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How and when to take the treatment
Potential side effects, in which case he
must stop
Advise not to take other medication at the
same time if not compatible
When he must come back if no improvment