Rational use of medicine

Rational use of medicine

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  RationalUseofMedicine Presented by Dr.Muhammad Umair Pharm.D MPhil.(Clinical) Lecturer Lahore Pharmacy College of Lahore Medical & Dental College
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  Definition “The rational useof 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, 1985)
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  Rational Use ofMedicine (RUM) The aim of any pharma-management system is to deliver the correct medicine to the patient Appropriate selection, procurement, and distribution are precursors to RUM. RUM fulfils following criteria; Appropriate indication Appropriate medicine Appropriate dosage Correctly dispensed Appropriately informed patients Patient adherence
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  Examples of IrrationalUse of Medicine (IUM) Poly Pharmacy Average no. of medicines per prescription Unnecessary medication/ no medicine needed Antibiotics misuse (RTIs) Wrong Medicine Less than 40% patients are treated according to STGs Ineffective Medicine/ Medicine with doubtful efficacy Multivitamins, Tonics Unsafe Medicines Anabolic steroids for athletes and as appetizers for children
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  Underuse of availableeffective medicine No therapy for mental disorders ORT for diarrhoea Incorrect use of medication Incomplete antibiotic therapy
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  Factors Causing IUM 1)INTERNATIONAL LEVEL Drug promotion and marketing Misleading, biased, scientifically inaccurate Encourage over use High cost Market dynamics Invest more in developed countries 2) NATIONAL LEVEL Weak Laws and Regulations Poor quality medicines Poor HRM Economic status
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  Factors Causing IUM 3)HEALTH SYSTEMS LEVEL Unreliable suppliers Poor planning of the drug needs Poor infrastructure for storage Poor information management systems Lack of monitoring and supervision 4) PRESCRIBERS LEVEL Lack of information and training Outdated prescribing practices Heavy patient load Pressure from pharma-industries (Conflict of interest)
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  Factors Causing IUM 5)DISPENSING LEVEL Lack of qualification and training Heavy patient load 6) PATIENTS & COMMUNITY LEVEL Non adherence Cultural beliefs Accessibility Affordability Education Availability
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  Adverse Impact ofIUM Impact of Quality of Medicine Therapy and Medical Care Impact on Antimicrobial Resistance Impact on Cost Psychosocial Impact
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  Vicious CircleLeadingto IUM
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  Intervention Strategies toImprove Medicine Use EDUCATIONAL STRATEGIES Training of prescribers Formal education In-service education (CME) Supervisory visits Printed materials Clinical literature Treatment guidelines & formularies Others Patient education Influence opinion leader
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  MANAGERIAL STRATEGIES Monitoring supervising& feedback D & TC Health survey teams Government inspectors Self assessment Selection procurement & distribution Limited procurement list Drug use review Regional drug committees Prescribing and dispensing approaches Structured medicine order forms Diagnostic and treatment guidelines Course of therapy packaging
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  ECONOMIC STRATEGIES Price setting Capitationbased budgeting Reimbursement and user fees Insurance REGULATORY STRATEGIES Medicine registration Limited medicine lists Prescribing restrictions Dispensing restrictions
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  Developing a Strategy Thereare six steps to develop a strategy to promote RUM given as; Identify the problem and recognize the need for action Identify underlying causes and motivating factors List possible interventions Assess recourses available for action Choose intervention(s) to test Monitor the impact and restructure the intervention
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  Core Policies toPromote RUM 1) A mandated multi-disciplinary national body to coordinate medicine use policies 2) Clinical guidelines 3) Essential medicines list based on treatments of choice 4) Drugs and therapeutics committees in districts and hospitals 5) Problem-based pharmacotherapy training in undergraduate curricula 6) Continuing in-service medical education as a licensure requirement
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  7) Supervision, auditand feedback 8) Independent information on medicines 9) Public education about medicines 10) Avoidance of perverse financial incentives 11) Appropriate and enforced regulation 12) Sufficient government expenditure to ensure availability of medicines and staff
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  Ready to Jump???