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Rud
This document discusses rational use of drugs (RUD), which it defines as prescribing the right drug at the adequate dose for sufficient duration appropriately for the patient's clinical needs at lowest cost. It notes factors like drug explosion and increased awareness that have led to greater focus on RUD. Causes of irrational drug use include lack of information, faulty training, and promotional activities. Broad categories of commonly misused drugs are also outlined, along with hazards of irrational use. Strategies to improve RUD include educational, managerial, regulatory, and economic approaches.
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Rud
- 1. PRESENTED BY ANJALI.C I YEARM.PHARM GRACE COLLEGE OF PHARMACY RATIONAL USE OF DRUGS (RUD) 1
- 2. DEFINITION • In simplestwords rational use means “prescribing right drug, in adequate dose for the sufficient duration & appropriate to the clinical needs of the patient at lowest cost • WHO: 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 2
- 3. ‘CRITERIA’ FOR USINGMEDICINES • Appropriate indication • Appropriate drug • Affordable • Appropriate administration, dosage and duration • Appropriate patient • Appropriate patient information 3
- 4. FACTORS THAT HAVE LED SUDDEN REALISATION FORRUD Drug explosion Efforts to prevent the developme nt of resistance Growing awareness Increased cost of the treatment Consumer protection Act 4
- 5. REASONS FOR IRRATIONALUSE OF DRUGS Lack of information Faulty & Inadequate training & education of medical graduates Poor communication between health professional & patient Lack of diagnostic facilities/Uncertainity of diagnosis Demand from patient Defective drug supply system &ineffective drug regulation Promotinal activities of pharmaceutical industries Self –medication 5
- 6. SOME BROAD CATEGORIESOF DRUGS WHICH ARE MISUSED OR IRRATIONALLY USED ANTIBIOTICS • Penicillins • Ampicillin • Amoxicillin • Tetracyclins MUSCULO-SKELETAL DRUGS • Dextropropoxyphene • Aspirin • Ibuprofen 6
- 7. CENTRAL NERVOUS SYSTEMDRUGS • Diazepam • Lorazepam • Imipramine,Nortriptalline and Amitriptalline ALIMENTARY SYSTEM DRUGS • Antacids • Laxatives,Purgatives and Lubricants • Antidiarrhoeals RESPIRATORY SYSTEM DRUGS • Bromhexine • Salbutamol 7
- 8. HORMONES • Estrogen-Progestin combinationin high doses(EF forte) used to cause abortion • Anabolic steroids like androlone,stanozolol VITAMINS OTHER MISCELLANEOUS DRUGS • Naphazoline and Xylomethazoline • Oral Antidiabetic drugs:Glibenclamide,Gliclazide,metformin 8
- 9. HAZARDS OF IRRATIONALUSE • Ineffective & unsafe treatment ▫ over-treatment of mild illness ▫ inadequate treatment of serious illness • Exacerbation or prolongation of illness • Distress & harm to patient • Increase the cost of treatment • Increased drug resistance - misuse of anti- infective drugs • Increased Adverse Drug Events • Increased morbidity and mortality 9
- 10. OBSTACLES EXIST INRATIONAL DRUG USE • Lack of objective information & of continuing education &training in pharmacology. • Lack of well organized drug regulatory authority & supply of drugs. • Presence of large number of drugs in the market & the lucrative methods of promotion of drugs employed by pharmaceutical industries. • The prevalent belief that” every ill has a pill” 10
- 11. RATIONAL DRUG USECAN BE MONITORED BY • Aggregate medicine consumption data: • WHO drug use indicators • The Anatomical Therapeutic Chemical (ATC) classification and defined daily dose (DDD) methodology • Drug Utilisation review(DUR) or focused drug use evaluation • Qualitative methods 11
- 12. Selected WHO/INRUD druguse indicators for health care facilities • Prescribing indicators: • Average number of medicines prescribed per patient encounter • % of medicines prescribed by generic name • % of encounters with an antibiotic prescribed • % of encounters with an injection prescribed • % of medicines prescribed from essential medicines list or formulary • Patient care indicators • Average consultation time: • Average dispensing time • % of medicine actually dispensed • % of medicines adequately labelled • % of patients with knowledge of correct doses. 12
- 13. • Facility indicators •Availability of essential medicines list or formulary to practitioners • Availability of clinical guidelines • % of key medicines available • Complementary drug use indicators: • Average medicines cost per encounter • % of prescriber in accordance with clinical guidelines. 13
- 14. STRATEGIES TO IMPRTOVERATIONAL USE OF DRUGS(RUD) • Educational • Managerial • Regulatory • Economic 14
- 15. EDUCATIONAL STRATEGIES • Trainingprescribers • Format education • Continuing Education (CE) • Educational outreach • Patient and public education in drug use 15
- 16. REGULATORY MEASURES • Drugregistration • Evaluation of drug and product information • Scheduling drugs for different levels of use for both prescribing and distribution • Dispensing controls • Specifying minimum level of education for prescriber or health care professional • Restrictions on use of packaging materials of drugs and labelling • Regulating pharmaceutical promotion 16
- 17. MANAGERIAL STRATEGIES • Selection,procurement and distribution of drugs • Limited procurement list • DUR(drug utilization review) 17
- 18. ECONOMIC • Offering incentivesto institutions, patients and providers. • Many insurance agencies and some governments reimburse only if medicines are chosen from a restricted list. 18
- 19. STEPS TO IMPROVERATIONAL DRUG PRESCRIBING Step:- I • Identify the patient’s problem based on symptoms & recognize the need for action. Step:-II • Diagnosis of the disease. Identify underlying cause & motivating factors. Step:-III • List possible intervention or treatment 19
- 20. Step:-IV • Start thetreatment by writing an accurate & complete prescription Step:-V • Given proper information instruction & warning regarding the treatment given Step:-VI • Monitor the treatment to check, if the particular treatment has solved the patient’s problem 20
- 21. ROLE OF PHARMACISTIN THE PROMOTION OF RATIONAL USE OF DRUGS Member of the drug and therapeutics committee Drug procurement Drug storage Dispensing Patient education Pharmacovigilence Drug information services Pharmaceutical care 21
- 22.