Transcript INRUD
INRUD International Network for Rational Use of Drugs “Better health through research” INRUD is a cooperative international venture to address in an innovative way the problem of inappropriate use of drugs, with an interdisciplinary approach. By using a network approach, it is hoped that effective and realistic policy and program options to improve rational use of drugs can be identified. Inauguration: 1990 Ghana Nigeria Uganda Zimbabwe Tanzania Nepal Bangladesh Philippines Thailand Indonesia Support Groups: MSH (Arlington), Drug Policy Group-Harvard (Boston), WHO-EDM IHCAR (Stockholm), Clinical Pharmacology-University of Newcastle (Australia), Strategy An interdisciplinary focus, linking clinical and social science; Activities originating from country-based core group of individuals representing MOH, universities, NGOs, and private sector institutions; Belief in the importance of sharing relevant experiences and in technical cooperation among participant individuals; Emphasis on understanding behavioral aspects of drug use, particularly the beliefs and motivations of providers and consumers; Promotion of well-designed research studies to understand these behavioral factors, leading to reproducible interventions to improve drug use; Development of useful tools for research, including standard research methodologies, simplified sampling and data collection strategies, and user-accessible computer software. Factors influencing drug use Informational & marketing: Unbiased information Influence of industry Characteristics of providers: Knowledge deficits Acquired habits DRUG USE Work environment: Workload & staffing Drug availability Infrastructure Social structure of providers: Peer norms & Relation Authority, Power Provider-patient interactions: Cultural beliefs Patient demands INRUD framework - for changing drug use problem FORMATIVE STUDIES 1. Define problems with drug use patterns 2. Identify motivating factors, underlying causes INTERVENTION STUDIES 3. List possible interventions 4. Choose intervention (s) to test 5. Conduct controlled study of intervention (s) FOLLOW-UP DROP IMPLEMENT Cost-effective interventions on larger scale REVISE & RESTUDY Partially effective or costly interventions Ineffective, uneconomical interventions IGD to reduce inappropriate injection use 100% IGD Dissemination of IGD results 80% Control (12 HCs) Implementation of other district-wide RDU program 60% IGD (12 HCs) 40% 20% 25 23 21 19 17 15 13 11 9 7 5 3 1 0% Month Source: Long-term impact of small group interventions, Santoso et al., 1996 Significant reduction of inappropriate injections: 1987-1999 100% pharmacy public hospital private hospital health center 80% 60% 40% 20% 0% 1987 Dec'97 Jul'98 Oct'98 Mar'99 Source: Evaluation of NDP implementation, Ministry of Health of Indonesia, 1999 Courses on Promoting Rational Drug Use PRDU Course participants 1990-2000 600 from 41 countries International Conference on Improving the Use of Medicine (ICIUM) Chiangmai, 1-4 April 1997 Jointly sponsored by: WHO-DAP, INRUD, USP, The ARCH Project Presentations of research projects related to promoting rational drug use (published & unpublished) Evaluation on the achievement so far Summary and recommendation: – – – – Best research methodology: RCT, time series Small-group interventions for behavioral aspect of drug use Lots have been done for public primary health care Few have been done for private sector, hospital setting, and chronic diseases http://www.who.int/programmes/dap/icium/ What INRUD offers? Sharing knowledge and experience on research methodology, effective strategies to improve drug use problems PRDU Course INRUD Newsletter Consultancy