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Determinants ofDeterminants of
Rational Use of MedicinesRational Use of MedicinesDr A K SharmaDr A K Sharma
Prof & HeadProf & HeadDept of PharmacologyDept of Pharmacology
AFMC, Pune.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
• 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
PrerequisitesPrerequisitesto curbto curb
Irrational use of medicinesIrrational 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
PrescribingPrescribingindicatorsindicators
Prescribing indicators
Mean no. of medicines prescribed perPrescription:
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 anti-
microbials 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 containingvitamin 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
PatientPatientcarecare
indicatorsindicators
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 ofcorrect dose:
• Time of administration and quantity for each medicine that was actually dispensed should be evaluated
FacilityFacilityindicatorsindicators
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 Complementary indicatorsindicators
Complementary indicators
• Percentage of prescriptions in accordance with clinical guidelines
• Average medicine cost per encounter
MeasuresMeasurestoto
improve RUMimprove 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
• 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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