Transcript Overview : Rational Use of Medicine for Safer Therapeutics

Rational Use of Medicine
Dr. Anjan Adhikari
MBBS, MD,
R G Kar Medical College
Kolkata
Drugs/Medicines can
do good
Drugs can do harm
Whenever a drug is
taken a risk is taken
Rational Use of Drugs/Medicines
• "Rational use of drugs requires that patients receive
medications appropriate to their clinical needs, in
doses that meet their own individual requirements
for an adequate period of time, and the lowest cost
to them and their community."
• But it actually means:
• Right drug for right person at right time in
right dose, duration & frequency and
obviously at right cost.
• Right Drug for Right Person at
Right Time in Right Dose..........
• But……
• Safe & Effective Drugs are first priority
• Once a patient with clinical problems has
been evaluated and a diagnosis is
reached, the physician can select any one
of the variety of therapeutic approaches.
• Medication, surgery, radiation, physical
therapy, health education, counseling,
further consultation and no therapy are
some of the options available.
• Of these options, drug/medicine therapy is
by far the one most commonly chosen.
Usually prescriptions of medications are the
results of 67% cases of physician patient
contact.
Rational Use of Drugs/Medicines
• As much as 50% of the health budget of
developing countries is used for buying drugs.
• Worldwide more than 50% of all medicines
are
prescribed,
dispensed
or
sold
inappropriately, while 50% of patients fail to
take them correctly.
• Medicines are nothing in
themselves but are the very hands
of god if employed with reason &
prudence.
--Alexandrian physician Herophilus 300 B. C.
• Successful action of any drug, not only
depend on the potency and efficacy of the
drug, the advice from trained professionals,
health care service providers, the rational
and judicious prescribing, dissemination of
adequate information to the patient about
drug use but also on other factors like
purchasing power of the patient, patient’s
knowledge about the use of drug & dose,
adverse drug reaction, storage conditions of
the drug, adherence to therapy, etc.
• There are four facets of drug use in any
society, namely the pharmaceutical
industries,
wholeseller-retailerpharmacist chains, the physician and
the patients.
• Any defect at any point of this chain can
lead to irrational use of drugs in the
society.
Drug Use Process
• Medically inappropriate, ineffective, and economically
inefficient use of pharmaceuticals is commonly observed
in the health care system throughout the world especially
in the developing countries.
• However, various forms of inappropriate prescribing
often remain unnoticed by those who are involved in
health sector decision making or delivery of health
services.
• This problem will usually come to the attention of health
decision makers or managers when there is an acute
shortage of pharmaceutical budget and action for cost
efficiency is required.
• The need for promoting appropriate use of drugs in the
health care system is not only because of the financial
reasons but also for other reasons.
• Appropriate use of drugs is also one essential element in
achieving quality of health and medical care for patients
and the community.
• Obviously, this should also become the concern of
practitioners.
• Actions or intervention programs to promote the
appropriate use of drugs should, therefore, be
continuously implemented and systematically
incorporated as an integral part of the health care
system.
• These requirements will be fulfilled if the process of
prescribing is appropriately followed.
• This will include steps in defining patient’s problems (or
diagnosis); in defining effective and safe treatments
(drugs and non-drugs); in selecting appropriate drugs,
dosage and duration; in writing a prescription; in giving
patients adequate information; and in planning to
evaluate treatment responses.
• Criteria for irrational medicine use:
• Appropriate indication. The decision to prescribe
drug(s) is entirely based on medical rationale and that
drug therapy is an effective and safe treatment.
• Appropriate drug. The selection of drugs is based on
efficacy, safety, suitability and cost considerations.
• Appropriate patient. No contra-indications exist and the
likelihood of adverse reactions is minimal and the drug is
acceptable to the patient.
• Appropriate information. Patients should be provided
with relevant, accurate, important and clear information
regarding his or her condition and the medication(s) that
are prescribed.
• Appropriate monitoring. The anticipated and
unexpected effects of medications should be
appropriately monitored.
• Unfortunately, in the real world, treatment
patterns do not always conform to these criteria
and can be classified as inappropriate or
irrational prescribing.
• Irrational prescribing may be regarded as
"pathological" pharmacotherapy, where the
above-mentioned criteria are not fulfilled.
• Common patterns of irrational prescribing:
• The use of drugs when no drug therapy is
indicated, e.g., antibiotics for viral upper
respiratory infections.
• The use of the wrong drug for a specific
condition requiring drug therapy, e.g.,
ciprofloxacilin & tinidazole combination in
diarrhoea requiring ORS,
• The use of drugs with doubtful/unproven
efficacy, e.g., the use of antimotility agents in
acute diarrhoea,
• The use of drugs of uncertain safety status, e.g., use of
Baralgan, Nimesulide, Mosapride, etc.
• Failure to provide available, safe, and effective drugs,
e.g., failure to vaccinate against measles or tetanus,
failure to prescribe ORS for acute diarrhoea
• The use of correct drugs with incorrect administration,
dosages, and duration, e.g., the use of IV metronidazole
when suppositories or oral formulations would be
appropriate.
• The use of unnecessarily expensive drugs, e.g. the use
of a third generation, broad spectrum antimicrobial when
a first-line, narrow spectrum agent is indicated.
• Overuse of antibiotics and antidiarrhoeals for
non-specific childhood diarrhea,
• Indiscriminate use of injections, e.g., in malaria
treatment,
• Multiple drug prescriptions,
• Excessive use of antibiotics for treating minor
ARI.
• Minerals and tonics for malnutrition.
• Consumers may have a very different
perspective as what is rational.
• The drug use system is complex and
varies from country to country. Drugs may
be imported or manufactured locally. The
drugs may be used in hospitals or health
centers, by private practitioners and often
in a pharmacy or drug shop where OTC
preparations are sold. In some countries
all drugs are available over the counter.
• Finally, the public includes a very wide
range of people with differing knowledge,
beliefs and attitudes about medicines.
Factors that have led sudden realization for
rational drug use:
●Drug Explosion
●Efforts to prevent the development of resistance
●Growing awareness
●Increased Cost of Treatment
●Consumer Protection Act
Reasons for Irrational drug use:
1).Lack of information
2).Faulty and inadequate training, education of medical and
nursing students.
3).Poor communication between health professionals &
patients
4).Lack of diagnostic facilities/Uncertainity of diagnosis
5).Demand from the patients
6).Defective supply system & ineffective drug regulations
7).Promotional activities of pharmaceutical industries
Impact of Inappropriate Use of Drugs
• The impact of this irrational use of drugs can be seen in
many ways:
• Reduction in the quality of drug therapy leading to
increased morbidity and mortality
• Ineffective & unsafe treatment
• Exacerbation and prolongation of the illness
• Waste of resources leading to reduced availability of
other vital drugs and increased costs
Impact of Inappropriate Use of Drugs
• Distress and harm to the patient
• Increased risk of unwanted affects such as adverse drug
reactions and the emergence of drug resistance, e.g.,
malaria or multiple drug resistant tuberculosis
• Increase the cost of treatment
• Psychosocial impacts, such as when patients come to
believe that there is "a pill for every ill". This may cause
an apparent increased demand for drugs.
So, for Rational Use of Drugs
Appropriate:
- indication
- drug
- dosage & administration,
- patient, and
- information
Requirement for rational drug use
•
Adequate diagnosis : For a correct diagnosis to be made, the prescriber
must have adequate knowledge and motivation, private examination
facilities, and sufficient time to take a history, perform an examination, and
explain to the patient the diagnosis and treatment.
Correct prescribing : To prescribe correctly, the prescriber must know
which drug to prescribe for which diagnosis or complaint and when
treatment without drugs is appropriate.
Appropriate dispensing : For correct dispensing to occur, the dispenser
must be trained, have adequate time, have the necessary materials
(containers, labels), and have a dispensary where it is possible to
communicate with patients.
Patient adherence to treatment (compliance) : Patient adherence to
treatment is dependent on understanding and acceptance of the treatment;
this results from effective communication between prescriber, dispenser and
patient.
Right Drug for Right Person at Right Time in Right Dose..........
Thank you