Essential drug concept and rational use of medicines

Essential drug concept and rational use of medicines

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  Essential Medicine ListConcept and Rational Use of Medicine For BNS 1st Year Dr. Pravin Prasad 1st Year Resident, MD Clinical Pharmacology Institute of Medicine, Maharajgunj, Kathmandu 1st December, 2015 (Mangsir 14, 2072), Tuesday General Pharmacology
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  Objectives  Introduction toClinical Pharmacology  Terminologies and abbreviations used in Pharmacology  Drug Nomenclature • Essential Drug Concept • Rational use of Drugs
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  Essential Medicine(Drug) Concept •“Those drugs that satisfy the priority of healthcare needs of the population” – World Health Organization • Selection on the basis of: • Public health relevance • Evidence on efficacy and safety • Comparative cost effectiveness
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  Essential Medicine Concept •Should be available within the context of functioning health systems: • At all times • In adequate amounts • In appropriate dosage forms • With assured quality, and • With adequate information • At an affordable price to individual and community
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  Essential Medicine Concept •Includes • Drug name • Dosage forms • Dosage strength • Indications ?? • Includes single formulations • Fixed drugs are included only if its efficacy is proven to be higher • Anti-Tubercular Agents • Anti-Malarial Agents • Drugs listed as Main List and Complementary List
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  Essential Medicine Concept •First Model List of Essential Drugs by WHO in 1977 AD • Current Edition – 19th Edition, April 2015 (Amended August 2015) • Separate List for Paediatric Population – 5th Edition (2015) • Nepal’s Essential Medicine List: • National List of Essential Medicines • Current Edition: 2011, 4th • No separate list for paediatric population • Modified for different level of health facilities • 368 medicines
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  Objectives  Introduction toClinical Pharmacology  Terminologies and abbreviations used in Pharmacology  Drug Nomenclature  Essential Drug Concept • Rational use of Drugs
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  Rational Use ofMedicines (Drugs) • The 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 at the lowest cost to them and their community. WHO conference of experts Nairobi 1985 • So, what would you understand by Irrational use of Medicines? • Irrational or non-rational use is the use of medicines in a way that is not compliant with rational use as defined above.
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  Why Rational Useis Important?? Irrational Use has various harms as follows:  Ineffective & unsafe treatment  over-treatment of mild illness  inadequate treatment of serious illness  Increased morbidity (Adverse Drug Events, prolonged illness) and mortality  Distress, harm and cost burden to patient and community as a whole  Increased drug resistance
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  Why medicines areused irrationally?? • Lack of information • Role models – Teachers or seniors • Lack of diagnostic facilities/Uncertainty of diagnosis – medicine for all possible causes • Demand from the patient • Patient load • Promotional activities of pharmaceutical industries • Drug promotion and exaggerated claim by companies • Defective drug supply system & ineffective drug regulation
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  Influences over choosingtreatment options
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  Irrational Use: Fewexamples • Injudicious use of antimicrobials: Antibiotics in Viral fever and diarrhea • Unnecessary combinations • Use of drugs not related to diagnosis • Incorrect route • Incorrect dosing – under or overdose • Incorrect duration – prolong or short term use • Unnecessary use of expensive medicines • Unsafe use of corticosteroids • Polypharmacy
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  Moving towards RationalUse…
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  Educational Strategies Training forProviders • Undergraduate education • Continuing in-service medical education (seminars, workshops) • Face-to-face persuasive outreach e.g. academic detailing • Clinical supervision or consultation Printed Materials • Clinical literature and newsletters • Formularies or therapeutics manuals • Persuasive print materials Media-Based Approaches • Posters • Audio tapes, plays • Radio, television
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  Managerial Strategies Changes inselection, procurement, distribution to ensure availability of essential drugs • Essential Drug Lists, morbidity-based quantification, kit systems Strategies aimed at prescribers • targeted face-to-face supervision with audit, peer group monitoring, structured order forms, evidence-based standard treatment guidelines Dispensing strategies • course of treatment packaging, labelling, generic substitution
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  Economic Strategies Avoid perversefinancial incentives • prescribers’ salaries from drug sales • insurance policies that reimburse non-essential drugs or incorrect doses • flat prescription fees that encourage polypharmacy by charging the same amount irrespective of number of drug items or quantity of each item
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  Regulatory Strategies Drug registration Banningunsafe drugs - but beware unexpected results • Substitution of a second inappropriate drug after banning a first inappropriate or unsafe drug Regulating the use of different drugs to different levels of the health sector e.g. • Licensing prescribers and drug outlets • Scheduling drugs into prescription-only & over-the-counter Regulating pharmaceutical promotional activities
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  That will beall for today!! • Next class we will be discussing about: • Routes of Drug Administration • Assignments for you….. Posters making • Use A4 papers • Don’t get stressed - its something you have been doing • Thank you!