Transcript What_influences

Promoting Rational Drug Use
in the Community
What influences drug use
by consumers
Objectives
To be able to:
 Identify various factors which influence
drug use by consumers
 Recognise relative importance of the
factors with respect to efforts to promote
rational drug use by consumers
What influences drug use by consumers
Promoting Rational Drug Use in the Community
WHO
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The session
 Various factors which influence drug use
by consumers
 by level of influence
 related both to environment and behaviour
 provides a basis to analyse problems
 to be used in the development of
interventions
What influences drug use by consumers
Promoting Rational Drug Use in the Community
WHO
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Layers of influence
 the family level
 the community
 the health service institution
 the national level
 the international level
What influences drug use by consumers
Promoting Rational Drug Use in the Community
WHO
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The family level
 perceived need for drugs
 ideas about efficacy and safety
 uncertainty - poly-pharmacy
 division of drug consumption roles
 cost of medicines
 literacy level
 the power of medicines
What influences drug use by consumers
Promoting Rational Drug Use in the Community
WHO
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Perceived safety and efficacy
 related to colour, taste and shape of
medicines
 related to dosage form
 depends on compatibility between medicine
and the person
 depends on cause of illness
 related to past experiences
 new medicines perceived to be better
What influences drug use by consumers
Promoting Rational Drug Use in the Community
WHO
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Gender roles and medicines
Philippines
 mothers buy
 mothers give to
children
 neighbours or
relatives give
advice
 husband not
consulted
generally
What influences drug use by consumers
Promoting Rational Drug Use in the Community
Pakistan
 fathers buy
 mothers give to
children
 men have
information about
medicines and
tell wives how to
use them
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The community level
 local drug-use culture
 drug supply system
 community information channels
What influences drug use by consumers
Promoting Rational Drug Use in the Community
WHO
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Community drug distribution
Town
Drugstores (35%)
Neighbourhood
stores (40%)
Clinics (2%)
Hospital (1%)
MEDICINES (n=1324)
Doctors (7%)
Household stocks and
free-clinics (8%)
Neighbours and
relatives (5%)
Neighbourhood
Source: Hardon A (1991). Confronting ill health: medicines, self-care and the
poor in Manila
What influences drug use by consumers
Promoting Rational Drug Use in the Community
WHO
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The health institution level
 utilisation of health service
 quality of health worker prescribing
 quality of communication during consultation
 quality of medicine dispensing
 regular supply of medicines
 cost of medicines
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Promoting Rational Drug Use in the Community
WHO
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Extent to which health worker advice
is sought
 Thailand: 7% of 1755 episodes (rural)
 Philippines: 8% of 1411 episodes (urban)
20% of 422 episodes (rural infants)
 Pakistan: 56% in NGO-PHC area, 48% in
controls (rural)
 Ghana: 42% in urban, 43% in rural
What influences drug use by consumers
Promoting Rational Drug Use in the Community
WHO
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The national level
 Implementation of essential drugs policy
 Drug promotion
 Drug costs, financing and reimbursement
policies
 Advocacy by consumer and patient
organizations
 Health communication on medicines in
school curricula, and in TV and radio
programmes
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WHO
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Drug promotion
 Industry expenditure on marketing:
research = 2 : 1
 In fact 35% of sales revenues for drug
marketing
 Commercial drug info : public funded drug
info = 50 : 1 (UK)
 Drug promotion emphasises benefit, often
lacking information on risks
What influences drug use by consumers
Promoting Rational Drug Use in the Community
WHO
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WHO ethical criteria on drug
promotion (adopted in 1988)
 consistent with national health policy
 contains reliable claims
 contains no omission which can lead to
health risks
 should not be designed to disguise its real
nature
What influences drug use by consumers
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WHO
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Ethical criteria adoption:
 WHO (1988): ethical criteria only adopted
in 17 out of 42 national drug policies
 Australia (1995): only 29% of 140
advertisements to the public contain
warnings or cautions about health risks
What influences drug use by consumers
Promoting Rational Drug Use in the Community
WHO
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OTC advertising: IOCU study
 238 OTC ads in 11 countries reviewed
(1994)
 most ads do not comply with WHO ethical
criteria
 75% do not mention side-effects nor
contraindications
What influences drug use by consumers
Promoting Rational Drug Use in the Community
WHO
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Increase in promotion towards
consumers
 prescription drugs are increasingly
registered as OTC drugs
 before patient was ignorant and prescriber
the target, now consumer is target as
“expert” in need of info.
 direct to consumer advertising of
prescription drugs increases
 increase in promotion of life style drugs
What influences drug use by consumers
Promoting Rational Drug Use in the Community
WHO
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Top DTCA expenditures
 137 million US$ on Claritin
 93 million US$ Viagra*: to treat
impotence/improve sexual performance
 75 million US$ on Xenical*: to reduce
weight
 57 million US$ on Zyrtec
 45 million US$ on Zyban*: to quit smoking
*life-style drugs
What influences drug use by consumers
Promoting Rational Drug Use in the Community
WHO
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The international level
 Implementation of multilateral agreements
affecting drugs
 Health consequences of global trade
agreements
 Donor support for essential drugs
programmes
 Global consumer advocacy
 The Internet
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Promoting Rational Drug Use in the Community
WHO
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Zyban: Information from the
Internet
 Nicotine-free ZYBAN is a prescriptionstrength medicine
 ZYBAN is the first nicotine-free pill
approved to help you quit smoking
 You start taking ZYBAN and continue to
smoke
 ZYBAN is priced lower than other smoking
cessation therapy
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Promoting Rational Drug Use in the Community
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Activity tasks
 Participants should have read the case
studies prior to session
 Appoint a rapporteur and facilitator
 Facilitator should check if case study has
been read. If not, allow for time
 The facilitator guides the discussion
 Answer discussion questions
 Rapporteur reports in plenary
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DTCA discussion questions
 Make an inventory of the ways in which
prescription drugs are promoted to
consumers in the Philippines
 Discuss use of Viagra by young men as
aphrodisiac. What factors influence it?
 Define possible solutions to this misuse
 Discuss pros and cons of DTCA in the
Philippines
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Discussion questions: drugs used as
abortifacients
 What medicines are used as abortifacients
in the Philippines
 What are health risks?
 What factors determine this misuse?
 What can be done to discourage this
misuse?
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