Transcript Document

National “prescribing rule”;
 Newly prescribed drugs is provided for not more
than 2 weeks
 Long term medications is provided for not more
than 3 months
 Other medications is provided for not more than 1
month
 OCPs is provided for not more than 6 months.
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Lazaros et. al. JAMA 279: 1200, 1998
Meta analysis (39 prospective studies in Toronto)
Serious ADRS requiring hospitalization
causing permanent disability or death = 6.7%
Fatal ADRS = 0.32%
= ADR  4 - 6th leading cause of death.
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or
HUSM experience
Errors in prescribing process;
Wrong dose
Wrong frequency
Wrong duration
Wrong administration technique
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Patient factors:
Failure to take drug or partial compliance
Taking more drugs than instructed
Self-treatment
Wrong technique of administration
Taking expired drugs
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Explanations:
 Lack of knowledge
 Influenced by others
 Negative attitudes
 Own experience
 Own perceptions
 Difficult/complicated regimen
 Extremes of age and need for assistance
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P-Drug workshop 1999
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WHO Organisational Structure
Yasuhiro
Suzuki
Jonathan Quick
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WHO's mission in medicines for 2000–2003 includes four
main objectives:
Policy
 Access
 Quality and Safety
 Rational Use of Drugs

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WHO’s Mission in Essential Drugs and Medicines
Policy
To help save lives and improve health by:
closing the huge gap between the potential that
essential drugs have to offer and the reality that for
millions of people – particularly the poor and
disadvantaged -- medicines are unavailable,
unaffordable, unsafe or improperly used.
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WHO’s Mission in Essential Drugs and Medicines Policy
(cont.)
The Organization works to fulfill its mission in
essential drugs and medicines policy by:
providing global guidance on essential drugs and
medicines, and working with countries at their
request to implement national drug policies to
ensure equity of access to essential drugs, drug
quality and safety, and rational use of drugs.
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Rational Use of Drugs
Ensure therapeutically sound and
cost-effective use of drugs by health
professionals and consumers
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Rational Use of Drugs
Improving the use of drugs by health
workers and the general public is crucial
to:
 reduce morbidity and mortality
from communicable and noncommunicable diseases, and
 contain drug expenditure.
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Rational Use of Drugs
A sound rational drug use programme in any
country has three elements:

Rational drug use strategy and monitoring advocating rational drug use, identifying and
promoting successful strategies, and securing
responsible drug promotion.

Rational drug use by health professionals

Rational drug use by consumers
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Rational drug use strategy and
monitoring
Support countries in implementing and
monitoring a national strategy to promote
rational use of drugs by health
professionals and consumers.
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Rational drug use by health
professionals
Develop national standard treatment
guidelines, essential drugs lists,
educational programmes and other
effective mechanisms to promote rational
drug use by health professionals.
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Priorities for global guidance for 2000–2001
– Review of the development, dissemination and use of the
WHO Model List of Essential Drugs
– Review and dissemination of WHO Standard Treatment
Guidelines
– Training materials and curriculum review for undergraduate
training
– Guidelines for Drugs and Therapeutics Committees
– International training materials and training in public
education
– International training materials and training in pharmacoeconomics
– Regional rational drug use training courses in French and
Spanish (?for African countries)
– Standard indicators and protocols to monitor drug promotion
practices
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What are essential drugs?
"Essential drugs are those drugs that
satisfy the health care needs of the
majority of the population;
they should therefore be available at all
times in adequate amounts and in the
appropriate dosage forms, and at a
price that individuals and the community
can afford."
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History of Essential Drug List
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1897 – Aspirin was introduced as the first synthetic
pharmaceutical
1941 – Introduction of first modern antibiotics i.e
Penicillin
1943 – First commercial antimalarial
1944 – First antituberculous drug
1950’s – Introduction of oral contraceptives,
antidiabetics and antipsychotics
1977 – WHO published first model list of Essential
drugs (208)
1997 – WHO’s 10th model list of essential drugs (306)
The 11th Model List -- describing just over 300 drugs -- was revised in November
1999 and published in December 1999.
N.B: Malaysia’s EDL contains 419 items and a supplemental list
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Progress on PRUD activities;

Extensive research has shown that standard treatment guidelines,
essential drugs lists and formularies do promote rational prescribing of
drugs by prescribers.

By the end of 1999, 157 countries had an essential drugs list.

135 countries have developed national treatment guidelines, of which 112
have been updated in the last five years.
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There are now more than 100 national formularies,
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By the end of 1999, 88 countries in all six WHO regions had introduced
the essential drugs concept into curricula for medicine and pharmacy
students.
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Progress on PRUD activities; (cont.)
The WHO Guide to Good Prescribing has
proved to be another invaluable tool.
Translated into 18 languages and now
available on at least six different web-sites, it
continues to be one of the Organization’s
most successful publications. Primarily
intended for undergraduate medical students
who are about to enter the clinical phase of
their studies, it provides step-by-step
guidance on the process of rational
prescribing.
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Progress on PRUD activities; (cont.)

The WHO Model List of Essential Drugs, and regional
and international rational drug use courses, form a
large part of ongoing WHO efforts to improve drug
use by health professionals.
 International training courses for university teachers
in problem-based pharmacotherapy teaching are held
every year in Europe, Africa and Latin America.
 Two randomized controlled trials with over ten
centres in developed and developing countries have
shown that the teaching methods transfer lasting
skills in rational prescribing.
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Progress on PRUD activities; (cont.)
WHO Monographs on Selected Medicinal
Plants :
are also doing much to promote rational drug
use, but in the area of traditional medicine.
The Monographs were recently
recommended by the European Commission
to Member States as an authoritative
reference.
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Other Activities:

International Conference of Drug Regulatory Authorities
(ICDRA)

International Conference on Harmonisation (ICH)
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WHO Programme for International Drug Monitoring
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UMC (Uppsala monitoring centre)
– the Global Intelligence Network for Benefits and Risks in
Medicinal Products
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The WHO Collaborating Centre for Drug Statistics
Methodology
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