Transcript Determinants of Rational Use of Medicines

Determinants of
Rational Use of Medicines
Dr A K Sharma
Prof & Head
Dept of Pharmacology
AFMC, Pune.
Rational use of medicines
Patients receive medications:
• Appropriate to their clinical needs
• In doses meeting their individual requirement
• For an adequate period of time
• At lowest cost to them & their community
Pattern of use of medicines
Globally, use of medicines at all levels is
frequently:
• Inappropriate
• Ineffective
• Inefficient
Most misused medicines
• Antimicrobial agents
• Analgesics
• Vitamins
Factors for irrational use
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Lack of knowledge in prescribers & patients
Unrestricted availability of medicines
Inappropriate promotion of medicines
Profit motives from selling medicines
Overwork of health personnel
Lack of diagnostic facilities
Inadequate govt regulations or their
enforcement
Prerequisites
to curb
Irrational use of medicines
Prerequisites to curb
irrational use of medicines
Monitoring of prescribing, dispensing and
patient use so as to know:
• Types of irrational use
• Amount of irrational use
• Reasons for irrational use
Monitoring of use of medicines
Aggregate medicine consumption data:
• To identify expensive medicines of lower
efficacy
• To compare actual consumption versus
expected consumption from morbidity data
Monitoring of use of medicines
Anatomical Therapeutic Classification /
Defined Daily Dose methodology:
• To compare medicine consumption among
institutions, regions and countries
Monitoring of use of medicines
At primary health care facility level:
• Prescribing indicators
• Patient care indicators
• Facility indicators
• Complementary indicators
Prescribing
indicators
Prescribing indicators
Mean no. of medicines prescribed per
Prescription:
Risk of following increases with increase in
no. of medicines prescribed:
• Medicine antagonism
• Duplication of medicines
• Adverse effects, Compliance error
• Cost of treatment
Prescribing indicators
Percentage of medicines prescribed by
generic name:
Use of brand names increases:
• Cost of treatment
• Risk of payment of a share of the profit to
the prescriber
• Risk of duplication of medicines
Prescribing indicators
Percentage of prescriptions containing
antimicrobials and percentage of antimicrobials prescribed from all prescribed
medicines:
Overuse of antimicrobials can lead to:
• Development of medicine resistance
• Super-infections
• Allergies and other health hazards
Prescribing indicators
Percentage of prescriptions containing
injectables and percentage of injectable
medicines prescribed from all prescribed
medicines:
Disadvantages of injections are:
• Inconvenient, Painful, Less safe
• Reqm of skilled personnel to administer
• Higher cost
Prescribing indicators
Percentage of prescriptions containing
vitamin ppr.s and percentage of vitamin
ppr.s prescribed from all prescribed
medicines:
• Overuse may be due to belief among
many patients and some prescribers that
they are useful to improve general health
& quality of life
Prescribing indicators
Percentage of medicines prescribed from
the essential medicines list or formulary:
• Higher proportion of medicines prescribed
from EML suggests it is probably due to
the increased availability of essential
medicines
Patient
care
indicators
Patient care indicators
Average consultation / dispensing time:
• Calculated by dividing the total time taken
to consult / dispense medicines to series
of patients by the number of patients.
Patient care indicators
Percentage of medicines adequately
labeled:
• Examine medicine packages / bottles, the
patient had actually received.
Percentage of patients with knowledge of
correct dose:
• Time of administration and quantity for
each medicine that was actually dispensed
should be evaluated
Facility
indicators
Facility indicators
Availability of essential medicines list or
formulary to practitioners:
• Prescribers are asked whether any
essential medicines list or formulary exists
in the dept during the study period
Facility indicators
Percentage of key medicines available:
• Key medicines: Essential medicines from
national EML to treat common health
problems in that area
Availability of Std treatment guidelines:
• Prescribers are asked whether any such
guidelines exists in the dept during the
study period
Complementary
indicators
Complementary indicators
• Percentage of prescriptions in accordance
with clinical guidelines
• Average medicine cost per encounter
Measures
to
improve RUM
Measures to improve RUM
• Any medicine should be prescribed only
when reasonable
• Prescribe minimum reqd no. of medicines
• Prefer cheaper but effective & safe medicine
• Prescribe medicines by generic names, in
proper dosage form, dose and for adequate
period
Measures to improve RUM
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Availability of essential medicines
Follow standard treatment guidelines
Inform patient adequately about the use
Monitor the patient: Benefits & Adversities
Training of prescribers for RUM
Programs for public awareness
Reform in drug legislation be considered
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