Transcript FINprioritising_revised8SepCatherine

Promoting Rational Drug Use
in the Community
Prioritising Community Drug Use Problems
Session objectives
Develop
 Overview of most common categories
of problems concerning drug use by
consumers
 Insight into methods and relevant
criteria that can be used to prioritise
problems
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Common forms of inappropriate use
1) Not using the drug in the way intended
by the prescribing doctor
 not knowing or forgetting all or part of the
recommendations
 insufficient motivation
 poverty no access or other external
constraints
 those who have a change of mind or decide not
to follow the recommendations.
(adherence concordance compliance - discuss)
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Common forms of inappropriate use
2) Self-medication with prescription drugs
from a variety of sources
 regular pharmacies
 grocery stores and markets
 from traditional healers
 from friends and family
 old drugs
 internet sales
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Common forms of inappropriate use
3) Misuse of antibiotics
 over-prescription/ over-use
– eg for simple diarrhoea, coughs and colds
 use of unnecessarily complex drugs
 sub-optimal dose
– drugs too expensive for full course
– user not aware of how and how long to take
Other categories commonly misused –
antimalarials psychotropics
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Common forms of inappropriate use
4) Misuse of injections
 over-use because
– perception of greater effectiveness
– higher fee for health provider
 un-safe use because
– re-use of syringes in facilities
– poor sterilisation
– use of patients own syringes
 consequences
– costs to health services
– unnecessary risks
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Common forms of inappropriate use
5) Overuse of relatively safe drugs
common categories include
 vitamins
 analgesics
 tonics
 antidiarrhoeals (for adults)
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Common forms of inappropriate use
6) unsafe use of herbal and traditional
medicines.
7) use of inessential combination drugs
8) use of needlessly expensive drugs
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Prioritising
1 Identify major problems
2 Analyse the problems and identify the
key reasons why they are problems
3 From the key reasons identify criteria
for priority setting
4 Select key criteria
5 Rank/rate problems using criteria
6 Discuss and evaluate results
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Prioritising - possible criteria
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scale of the problem
seriousness of the adverse effects
economic cost
appropriateness for intervention
…..
…..
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Rating looks at each problem
separately
Antibiotic
misuse

Health
3
consequences
Economic
costs
3
Affects
whole
communities
1
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Ranking compares problems against
criteria

Antibiotic
misuse
Health
2
consequences
Misuse
Injections
Analgesic
overuse
3
1
Waste of
money
Affects
whole
communities
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Enhancing stakeholder participation
 What is the community perception
 Need to identify, understand and
respect different perspectives on a
problem
 Helps to ensure appropriate, “owned” and
effective analyses and interventions
 Different methods can be used to
enhance stakeholder intervention
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Prioritising community drug use problems
 Unpick the problems – for whom is it a
problem? What are the consequences and
who is most affected? How does it
relate to other problems?
 Be selective – you may need to prioritise
which problems you have the time and
resources to address
 You can use different criteria and tools
to prioritise
 Stakeholder involvement important for
success
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