Transcript Document

RUD useful references;












Rational Drug Use: Consumer Education and Information
Estimating Drug Requirements: A Practical Manual
Public Education in Rational Drug Use
Report of an Informal Consultation. Geneva, 23-26 November 1993
Rational Use of Drugs in the South-East Asia Region
Report of an Intercountry Consultative Meeting. New Delhi, 7-11 June 1993
Producing National Drug and Therapeutic Information -- The Malawi
Approach to Developing Standard Treatment Guidelines
Clinical Pharmacology. The European Challenge
The Rational Use of Drugs.
Report of the Conference of Experts. Nairobi, 25-29 November 1985
The Use of Essential Drugs.
Eighth Report of the WHO Expert Committee
(including the Tenth Model List of Essential Drugs)
WHO Drug Information
International Nonproprietary Names (INN) for Pharmaceutical Substances
Lists 1-73 of Proposed INN and Lists 1-35 of Recommended INN
Cumulative List No. 9
International Nonproprietary Names (INN) for Pharmaceutical Substances:
Names for Radicals and Groups, Comprehensive List July 1997
Guidelines on the Use of International Nonproprietary Names (INN) for
Pharmaceutical Substances
14 Feb. 2002
JSPS visit Showa University
ARN
RUD useful references; (cont.)









The Use of Common Stems in the Selection of International
Nonproprietary Names (INN) for Pharmaceutical Substances,
March 1999
WHO Model Prescribing Information Series
WHO Model Prescribing Information: Drugs Used in the Treatment
of Streptococcal Pharyngitis and Prevention of Rheumatic Fever
WHO Model Prescribing Information: Drugs Used in HIV-Related
Infections
WHO Model Prescribing Information: Drugs Used in Leprosy
WHO Model Prescribing Information: Drugs Used in Skin Diseases
WHO Model Prescribing Information: Drugs Used in Parasitic
Diseases
Second edition
WHO Model Prescribing Information: Drugs Used in Sexually
Transmitted Diseases and HIV Infection
WHO Model Prescribing Information: Drugs Used in Anaesthesia
14 Feb. 2002
JSPS visit Showa University
ARN
Challenges

Despite the growing body of knowledge on rational use
interventions, numerous studies have documented the
continuing widespread irrational prescribing of drugs.

injection therapy can also be an example of irrational drug use.

knowledge alone is not enough to change behaviour, and that
complex and multifaceted solutions are needed.

Many new drugs and second-line drugs are very expensive and
accordingly unaffordable for many governments and consumers.
14 Feb. 2002
JSPS visit Showa University
ARN
Challenges (cont.)

Drugs and therapeutics committees may have
difficulty to run in situations where Medical and
pharmacy training is still very traditional; with much
emphasis on drug knowledge and very little on public
health, prescribing skills, drug management and
patient care.

Influence of pharmaceutical representatives
Doctors often gets visits from these representatives
introducing new drugs or reminding doctors of their
products.
Doctors should stick to the principles of rational
prescribing.
14 Feb. 2002
JSPS visit Showa University
ARN
Expected outcomes for 2000-2003

Development of national standard treatment
guidelines and essential drugs lists

Support for problem-based and skill-based inservice training programmes

Drugs and therapeutics committees established
and operating effectively

International technical guidelines and standards
on traditional medicine expanded
14 Feb. 2002
JSPS visit Showa University
ARN
Rational Drug Use by Consumers
Establishing effective drug information
systems to provide independent and
unbiased drug information -- including on
traditional medicine -- to the general
public and to improve drug use by
consumers
14 Feb. 2002
JSPS visit Showa University
ARN
Progress

An extensive review by WHO of public education on drugs
provided valuable insight into strategies used, and their
strengths and weaknesses (Public Education in Rational
Drug Use: A Global Survey).

WHO guide to investigating drug use in the community has
contributed to a growing body of knowledge on consumer
understanding, attitudes and practices regarding drug use.
(How to Investigate Drug Use in Communities).

Support independent sources of drug information. Experiences
with independent drug bulletins are being shared with
developing countries through networks such as the
International Society of Drug Bulletins.

Development of drug information centres. These are important
source of independent drug information. Linking these centres
electronically contributes to sharing of information and
experience.
14 Feb. 2002
JSPS visit Showa University
ARN
Challenges

The consumer takes the final decision about whether and where to
seek health care, what medicine is actually taken , how much and
when, and from what source. These decisions are influenced by
knowledge, culture, drug promotion and personal finances.

Independent drug information and public education about drug use
are complicated and costly and have always been underserved and
underfunded. They also tend to be organized by NGOs thus with
informal networks and objective evaluation of interventions and
publication of the results are not easily arranged.

Lack of independent drug information and advice. Worldwide, some
50% of people fail to take their medicines correctly. Part of the
problem is that self-medication is widespread.

Purchases of drugs in certain localities take place in the private
sector, where prescribing and selling functions are often combined.
Profit motives and pressure to please the patient can lead to overtreatment of mild illnesses, overuse of injections and misuse of antiinfective drugs.
14 Feb. 2002
JSPS visit Showa University
ARN
Expected outcomes for 2000-2003

Effective systems of drug information
that are accessible to all health workers and
the general public, through provision of
training material and regional and national
training courses, and technical support to
international networks of drug information
centres.
 Public education in rational drug use and
consumer empowerment
through operational research, and
development and provision of new training
materials and courses.
14 Feb. 2002
JSPS visit Showa University
ARN
14 Feb. 2002
JSPS visit Showa University
ARN
Activities in Japan













April 1998: Japanese version of P-Drug manual
28 Oct. 98: 13th Fujigoko Clinical Pharmacological Conference
10 Oct. 98: P-Drug Network (P-Net-J) founded
15 Oct. 98: P-Net-J website founded (http://p-drug.UMIN.ac.jp)
6 Dec. 98: 1st P-Drug Workshop – Hamamatsu, Shizuoka (Facilitator
Hans Hogerzeil)
1 Apr. 99: P-Net-J Regulation
27-29 Aug. 99: 2nd P- Drug Workshop, Hieizan, Shiga (Facilitator K.
Kafle)
9-11 Aug. 99: 3rd P-Drug Workshop, Machida, Tokyo (Facilitator K.
Barnes)
30 Sep. 2000: 7th Course for Certified Clinical Pharmacologist by JCPT
11 Nov. 2000: 6th Meeting of Japanese Society for
Pharmacoepidemiology (Symposium)
16 Nov. 2000: 10th Meeting of Japanese Society for Clinical
Psychopharmacology (Plenary lecture)
18th Feb. 2001 20th Meeting of Japanese Society of Oral Therapeutics
and Pharmacology (Plenary lecture)
? 2001: 4th P-Drug Workshop
14 Feb. 2002
JSPS visit Showa University
ARN
RUD in Malaysia:






-
-
Drug regulation (MOH/Pharmaceutical division/NPCB/DCA)
RUD meeting in Sarawak 1995 with WHO involvement (?first)
Bi-Regional Working Group Meeting on Hospital Pharmaceutical
& Therapeutic Committee and Drug Information Service13 - 15
October 1999, Penang, Malaysia
PRUD workshop in Kuala Lumpur – August 2001
Scientific meetings of professional Societies and Associations;
MSPP
USM
National Poison Centre (and Drug information)
RUD teaching in School of Medical Sciences USM.
Research and Ethical Committee
Pharmacy and Therapeutics Committee
DIU/DUC
Clinical Trial Unit
Regular Therapeutic Update Seminars
14 Feb. 2002
JSPS visit Showa University
ARN
Examples of regional activities by NGOs incl.
associations
 First Asian CPT Conference, Yokyakarta,
Indonesia, 1993
 ICIUM- 1-4 April 1997, Chiengmai, Thailand
 Padang, Indonesia 9-21 Oct. 2000 – Training
Course on Promoting Rational Drug Use
 Kuala Lumpur, August 2001- Workshop on
Rational Pharmacotherapy
 Manila, Philippines 19-28 Oct. 2001-1st Asian
Course in Problem-based Pharmacotherapy
Teaching
14 Feb. 2002
JSPS visit Showa University
ARN
Other Centres of activity worldwide
Newcastle – Australia
 Boston – USA
 Gronigen – Netherlands
 Cape Town – South Africa
 Individual efforts in respective countries

N.B: It is important that the educational activities are conducted to
the right target group, eg. Medical teachers, prescribers, decision
makers in family. School children has been shown to be effective in
dissemination of information.
14 Feb. 2002
JSPS visit Showa University
ARN
WHO model (Guide to Good Prescribing)
Process of Rational Prescribing
Define the patient’s problem
Specify the Therapeutic objective
Verify whether your P-Treatment is suitable for this patient
Start the Treatment
Give information, instructions and warnings
Monitor and stop treatment
14 Feb. 2002
JSPS visit Showa University
ARN
WHO model (Guide to Good Prescribing)
Process of Rational Prescribing –Rahman’s modification
Define the patient’s problem (after careful evaluation)
Specify the Therapeutic objective
Management Plan
(Pharmacological and Non-pharmacological)
Choose and verify P-Drug
Write Prescription
Give information, instructions and warnings
Execute Treatment
Cont./stop
treatment
14 Feb. 2002
Monitor and stop treatment
JSPS visit Showa University
Review
treatment
ARN
Do The right things right (K-action)
5 `rights' of medication:
 right patient
 right drug
 right dose
 right route
 right frequency
14 Feb. 2002
JSPS visit Showa University
ARN
In conclusion;
It is our duty to provide health
care for mankind through rational
approach and providing rational
management as part of overall
rational patient care.
14 Feb. 2002
JSPS visit Showa University
ARN
Doctors must not say;
Don’t tell me what to do
14 Feb. 2002
JSPS visit Showa University
ARN
No. of physicians in the U.S. = 70,000
Accidental death caused by physicians per year = 120,000

accidental death per physicians = 0.171
(source: U.S. Dept. of Health and Human Services)
cf.
No. of gun owners in the U.S. = 80,000,000
No. of accidental gun death per year = 1500
No. of accidental gun death per gun owner = 0.0000188
Statistically doctors are approximately 9000 more dangerous than
gun owners.
14 Feb. 2002
JSPS visit Showa University
ARN
Summary

Drugs need to be used rationally

Irrational use of drugs is occurring

Definition of rational use of drugs need to consider national,
economic and socio-cultural background in respective community

Efforts to promote RUD is worldwide

Focus of activities should be at international, national, prescribers
and consumers level

There are many challenges in tackling irrational use of drugs

Cooperation among parties involved in promotion of RUD
including pharmaceutical industry should be strengthened

Doctors must maintain the noble status of their profession
14 Feb. 2002
JSPS visit Showa University
ARN
14 Feb. 2002
JSPS visit Showa University
ARN
ARIGATO GOZAIMAS
14 Feb. 2002
JSPS visit Showa University
ARN