Trainer's Guide
Trainer's Guide
Problems of Irrational
Drug Use
Problems of Irrational Use of Drugs
TRAINER'S GUIDE
OBJECTIVES
Participants will be able to:
1. Identify the magnitude and nature of inappropriate drug
utilization in several settings.
2. Understand the adverse impacts of inappropriate use of
drugs.
3. Describe the factors that influence the decision‑making
process in drug use.
4. Identify factors that influence the behavior of prescribers
and patients in choosing specific medication therapies.
5.Relate these issues to specific medication use problems in
their own settings.
PREPARATION
1. Read the Session Notes.
2. Prepare a list of medication use problems to be referred to
in the Activities section that follows.
VISUAL AIDS
1. Title Slide
2. Objectives
3. What is Rational Use of Drugs?
4. Rational Use of Drugs = Pathology of Prescribing
5. Examples of commonly Encountered Inappropriate Prescribing
Practices
6. Components of the Drug Use System
7. Factors Underlying Irrational Use of Drugs
8. Impact of Inappropriate Use of Drugs
9. Activity 1-Meaning of Appropriate Use
10. Drugs per Case by Age Group
11. Drugs per Case by Diagnosis
12. % of Patients Receiving Antibiotics
13. % of Patients Receiving Injections
14. Injection Use by Diagnosis
15. URI Treatment Pattern
16. Other Drug Use Problems
17. Average Number of Drugs per Patient
18. % Prescribed as Generics
19. % Receiving Antibiotics
20. % Receiving Injections
21. Average Consultation Time
22. Average Dispensing Time
23. % Patients Knowing Drug Dosing
24. % of Key Drugs in Stock
25. Activity 2-Identifying a Priority Problem
26. Conclusion
ORGANIZATION AND KEY COMPONENTS OF SESSION
First Component
( (30 minutes) ( VA 's 1-8
Defining Rational Use of Drugs
Note that the definition presented is based on a medical model.
Other people have different perceptions of what is irrational. For
a storekeeper, selling a profitable but unnecessary drug may be
rational. For a poor patient, buying one antibiotic tablet may be
rational.
Note for trainer: Do not spend undue time discussing the
examples given.
Second component
( (30 minutes) ( VA 9
Activity 1-Meaning of Appropriate Use
This is a short activity, which has the aim of showing that
different people have different perspectives about what is
"rational" or "appropriate". Explain clearly that we are interested
in the real world situation not the "ideal" situation. Emphasize
that we are looking for the perspectives of the person
identified.
Third Component
( (30 minutes) ( VA's 10-15
Examples of Irrational Use
This component covers various examples of how drug use can be
characterized. Point out that drug use can be characterized for all
diagnoses combined, or for specific diseases. Do not try to compare
practices for under 5 and over 5 subgroups. Focus on how few
patients received no drugs, no antibiotics, or no injections.
Fourth Component
((30 minutes)(VA's 16 -24
Drug Use Patterns in Developing Countries
In this component of the session highlight the variation between
countries. Point out that variations may be due to differences in
morbidity patterns, but are often due to differing practices which
do not have a clinical basis. Try not to elicit suggestions for the
reasons for the extreme outliers. Point out that very low levels
may also reflect inappropriate use, for example, if antibiotics are
unavailable and not always used when they are needed.
Fifth Component
( (45 minutes) ( VA 25
Activity 1: Identifying a Priority Problem.
The point of this activity is to show that while there are many
different problems in drug use, it is possible to develop
priorities for addressing them.
Conclusion
( (15 minutes) ( VA 26
At the end of the session summarize the key point that drug use
can be characterized and measured in a systematic way.
Slide 1
1
Problems of Irrational Drug
Problems of Irrational Drug
Use
Use
Slide 2
Problems of Irrational Drug Use
2
Problems of Irrational Drug Use:
Problems of Irrational Drug Use:
Objectives
Objectives
•
•
Identify magnitude and nature of inappropriate
Identify magnitude and nature of inappropriate
drug utilization
drug utilization
•
•
Understand the adverse impacts of
Understand the adverse impacts of
inappropriate use of drugs
inappropriate use of drugs
•
•
Describe factors which influence the decision-
Describe factors which influence the decision-
making process
making process
•
•
Identify factors which influence the behavior of
Identify factors which influence the behavior of
prescribers and patients
prescribers and patients
•
•
Discuss specific medication use problems
Discuss specific medication use problems
Slide 3
Problems of Irrational Drug Use
3
What is Rational Use of Drugs?
What is Rational Use of Drugs?
The rational use of drugs requires that patients receive
medicines
The rational use of drugs requires that patients receive
medicines
appropriate to their clinical needs, in doses that meet their
own individual
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
requirements, for an adequate period of time, and at the lowest
cost to
them and the community.
them and the community.
(WHO 1988)
(WHO 1988)
l
l
Appropriate indication
Appropriate indication
l
l
Appropriate drug
Appropriate drug
l
l
Appropriate administration, dosage, and duration
Appropriate administration, dosage, and duration
l
l
Appropriate patient
Appropriate patient
l
l
Appropriate patient information
Appropriate patient information
l
l
Appropriate evaluation
Appropriate evaluation
Emphasize that this is medical model.
Slide 4
Problems of Irrational Drug Use
4
Irrational Use of Drugs = Pathology
Irrational Use of Drugs = Pathology
of Prescribing
of Prescribing
•
•
The use of drugs when no drug therapy is indicated
The use of drugs when no drug therapy is indicated
•
•
The use of wrong drugs for a specific condition
The use of wrong drugs for a specific condition
requiring drug therapy
requiring drug therapy
•
•
The use of drugs with doubtful or unproven efficacy
The use of drugs with doubtful or unproven efficacy
•
•
The use of drugs of uncertain safety status
The use of drugs of uncertain safety status
•
•
Failure to prescribe available, safe, & effective drugs
Failure to prescribe available, safe, & effective drugs
•
•
Incorrect administration, dosages, or duration
Incorrect administration, dosages, or duration
Request an example of each practice from participants.
Slide 5
Problems of Irrational Drug Use
5
Examples of Common Inappropriate
Examples of Common Inappropriate
Prescribing Practices
Prescribing Practices
•
•
The overuse of antibiotics and antidiarrheals for
The overuse of antibiotics and antidiarrheals for
nonspecific childhood diarrhea
nonspecific childhood diarrhea
•
•
Indiscriminate use of injections for malaria
Indiscriminate use of injections for malaria
•
•
Multiple or over-prescription
Multiple or over-prescription
•
•
Use of antibiotics for mild, non-bacterial
Use of antibiotics for mild, non-bacterial
infection, e.g., URI
infection, e.g., URI
•
•
Tonics and multivitamins for malnutrition
Tonics and multivitamins for malnutrition
•
•
Unnecessary use of expensive
Unnecessary use of expensive
antihypertensives
antihypertensives
Elicit 2-3 others from participants.
Slide 6
Problems of Irrational Drug Use
6
Components of the Drug Use
Components of the Drug Use
System
System
Drug Imports
Drug Imports
Local
Local
Manufacture
Manufacture
Hospital
Hospital
or
or
Health
Health
Cente
Cente
r
r
Private Physician or
Private Physician or
Other Practitioner
Other Practitioner
Pharmacist or
Pharmacist or
Drug Trader
Drug Trader
The Drug
The Drug
Supply
Supply
Process
Process
Provider and
Provider and
Consumer Behavior
Consumer Behavior
Illness Patterns
Illness Patterns
+
+
Public
Public
Key points:
relationship of demand and supply
multiple outlets for drugs
many decision-makers effect system
Slide 7
Problems of Irrational Drug Use
7
Factors Underlying Irrational
Factors Underlying Irrational
Use of Drugs
Use of Drugs
•
•
inefficient
inefficient
management
management
•
•
non-availability
non-availability
of required
of required
drugs
drugs
Drug Supply
Drug Supply
Drug Supply
•
•
availability of
availability of
unsafe drugs
unsafe drugs
•
•
informal
informal
prescribers
prescribers
•
•
etc.
etc.
Drug Regulation
Drug Regulation
Drug Regulation
•
•
promotion
promotion
•
•
misleading
misleading
claims
claims
Industry
Industry
Industry
•
•
lack of education
lack of education
and training
and training
•
•
lack of drug
lack of drug
information
information
•
•
heavy patient load
heavy patient load
•
•
pressure to
pressure to
prescribe
prescribe
•
•
generalization of
generalization of
limited beliefs
limited beliefs
•
•
misleading beliefs
misleading beliefs
about efficacy
about efficacy
Prescribers
Prescribers
Prescribers
•
•
drug
drug
misinformation
misinformation
•
•
misleading
misleading
beliefs
beliefs
•
•
inability to
inability to
communicate
communicate
problems
problems
Patients
Patients
Patients
Emphasize interrelationship of factors and that problems rarely
have single cause.
Slide 8
Problems of Irrational Drug Use
8
Impact of Inappropriate
Impact of Inappropriate
Use of Drugs
Use of Drugs
Reduced
Reduced
quality of
quality of
therapy
therapy
•
•
morbidity
morbidity
•
•
mortality
mortality
Waste of
Waste of
resources
resources
Risk of
Risk of
unwanted
unwanted
effects
effects
•
•
patients rely on
patients rely on
unnecessary drugs
unnecessary drugs
Psycho-social
Psycho-social
impacts
impacts
•
•
Reduced availability
Reduced availability
•
•
increased cost
increased cost
•
•
adverse reactions
adverse reactions
•
•
bacterial resistance
bacterial resistance
Slide 9
Problems of Irrational Drug Use
9
Activity 1
Activity 1
Meaning of Appropriate Use
Meaning of Appropriate Use
Slide 10
Problems of Irrational Drug Use
10
Drugs per Case by Age Group:
Drugs per Case by Age Group:
E. Java & W. Kalimantan, Indonesia, 1987
E. Java & W. Kalimantan, Indonesia, 1987
One
One
3%
3%
Two
Two
14%
14%
Three
Three
27%
27%
Four
Four
26%
26%
Five
Five
17%
17%
Six
Six
+
+
13%
13%
One
One
1%
1%
Two
Two
9%
9%
Three
Three
29%
29%
Four
Four
35%
35%
Five
Five
19%
19%
Six
Six
+
+
6%
6%
Under 5
Under 5
Five & Over
Five & Over
Average for both Adults and Children =3.8 Drugs.
Slide 11
Problems of Irrational Drug Use
11
All Cases
All Cases
Diarrhea
Diarrhea
Resp
Resp
.
.
Dis
Dis
.
.
Skin
Skin
G.I.
G.I.
Musculoskel
Musculoskel
.
0
0
1
1
2
2
3
3
4
4
5
5
# Drugs per Case
# Drugs per Case
Under Five
Under Five
Five & Over
Five & Over
Drugs Per Case By Diagnosis
Drugs Per Case By Diagnosis
E. Java & W. Kalimantan, Indonesia, 1987
E. Java & W. Kalimantan, Indonesia, 1987
Possible discussion:
Why are there such small differences by diagnosis?
Slide 12
Problems of Irrational Drug Use
12
None
None
12%
One
One
56%
Two
Two
29%
Three/More
Three/More
3%
None
None
35%
One
One
36%
Two
Two
27%
Three/More
Three/More
2%
5 & Over
5 & Over
Under 5
Under 5
% Of Patients Receiving
% Of Patients Receiving
Antibiotics
Antibiotics
E. Java & W. Kalimantan, Indonesia, 1987
E. Java & W. Kalimantan, Indonesia, 1987
Possible discussion:
What would you expect the real need for antibiotics to be?
Slide 13
Problems of Irrational Drug Use
13
None
None
56%
One
One
34%
Two or More
Two or More
10%
None
None
26%
One
One
54%
Two or More
Two or More
20%
Under 5
Under 5
5 & Over
5 & Over
% Of Patients Receiving Injections
% Of Patients Receiving Injections
E. Java & W. Kalimantan, Indonesia, 1987
E. Java & W. Kalimantan, Indonesia, 1987
Possible discussion:
Why is use of injections higher in adults than children?
Slide 14
Problems of Irrational Drug Use
14
Antibiotics
Antibiotics
Analgesic
Analgesic
Cough/Cold
Cough/Cold
Antihist
Antihist
.
.
Others
Others
0
0
0.2
0.2
0.4
0.4
0.6
0.6
0.8
0.8
1
1
1.2
1.2
1.4
1.4
Average # of Drugs Per Case
Average # of Drugs Per Case
Under Five
Under Five
Five & Over
Five & Over
ARI Treatment Pattern
ARI Treatment Pattern
E. Java & W. Kalimantan, Indonesia, 1987
E. Java & W. Kalimantan, Indonesia, 1987
Possible Discussion:
Which drugs are appropriate for ARI?
Slide 15
Problems of Irrational Drug Use
15
Other Drug Use Problems
Other Drug Use Problems
•
•
Incorrect treatment of malaria
Incorrect treatment of malaria
–
–
incorrect use of chloroquin injection
incorrect use of chloroquin injection
•
•
Poor compliance with TB therapy
Poor compliance with TB therapy
–
–
causes treatment failure and resistant
causes treatment failure and resistant
organisms
organisms
•
•
Underuse of effective drugs
Underuse of effective drugs
–
–
hypertension
hypertension
–
–
depression
depression
•
•
Hospital drug use problems
Hospital drug use problems
–
–
antibiotic misuse for surgical prophylaxis
antibiotic misuse for surgical prophylaxis
Ask participants which other problems are important in their
environment.
Slide 16
Problems of Irrational Drug Use
16
Yemen
Yemen
Uganda
Uganda
Sudan
Sudan
Malawi
Malawi
Indonesia
Indonesia
Bangladesh
Bangladesh
Zimbabwe
Zimbabwe
Tanzania
Tanzania
Nigeria
Nigeria
Nepal
Nepal
Ecuador
Ecuador
Guatemala
Guatemala
Eastern Caribbean
Eastern Caribbean
Jamaica
Jamaica
Ghana
Ghana
Cameroon
Cameroon
El Salvador
El Salvador
0
0
1
1
2
2
3
3
4
4
5
5
Average Number of Drugs
Average Number of Drugs
Average Number of Drugs per
Average Number of Drugs per
Patient
Patient
Public Sector Drug Use Indicator Studies 1990-1993
Public Sector Drug Use Indicator Studies 1990-1993
Possible discussion for all indicator slides:
1.) Why are countries different?
2.) What is gold standard value?
Slide 17
Problems of Irrational Drug Use
17
Sudan
Sudan
Indonesia
Indonesia
Zimbabwe
Zimbabwe
Tanzania
Tanzania
Nigeria
Nigeria
Nepal
Nepal
Ecuador
Ecuador
Guatemala
Guatemala
Eastern Caribbean
Eastern Caribbean
Ghana
Ghana
Cameroon
Cameroon
El Salvador
El Salvador
Jamaica
Jamaica
0
0
20
20
40
40
60
60
80
80
100
100
% Generic
% Generic
% Prescribed as Generics
% Prescribed as Generics
Public Sector Drug Use Indicator Studies 1990-1993
Public Sector Drug Use Indicator Studies 1990-1993
Slide 18
Problems of Irrational Drug Use
18
Yemen
Yemen
Uganda
Uganda
Sudan
Sudan
Malawi
Malawi
Indonesia
Indonesia
Bangladesh
Bangladesh
Zimbabwe
Zimbabwe
Tanzania
Tanzania
Nigeria
Nigeria
Nepal
Nepal
Ecuador
Ecuador
Guatemala
Guatemala
Eastern Caribbean
Eastern Caribbean
Jamaica
Jamaica
Ghana
Ghana
Cameroon
Cameroon
El Salvador
El Salvador
0
0
20
20
40
40
60
60
80
80
100
100
% of encounters receiving antibiotics
% of encounters receiving antibiotics
% Receiving Antibiotics
% Receiving Antibiotics
Public Sector Drug Use Indicator Studies 1990-1993
Public Sector Drug Use Indicator Studies 1990-1993
Slide 19
Problems of Irrational Drug Use
19
Yemen
Yemen
Uganda
Uganda
Sudan
Sudan
Malawi
Malawi
Indonesia
Indonesia
Bangladesh
Bangladesh
Zimbabwe
Zimbabwe
Tanzania
Tanzania
Nigeria
Nigeria
Nepal
Nepal
Ecuador
Ecuador
Guatemala
Guatemala
Eastern Caribbean
Eastern Caribbean
Jamaica
Jamaica
Ghana
Ghana
Cameroon
Cameroon
El Salvador
El Salvador
0
0
20
20
40
40
60
60
80
80
100
100
% of encounters receiving injections
% of encounters receiving injections
% Receiving Injections
% Receiving Injections
Public Sector Drug Use Indicator Studies 1990-1993
Public Sector Drug Use Indicator Studies 1990-1993
Slide 20
Problems of Irrational Drug Use
20
Malawi
Malawi
Indonesia
Indonesia
Tanzania
Tanzania
Nigeria
Nigeria
Nepal
Nepal
0
0
1
1
2
2
3
3
4
4
5
5
6
6
7
7
Average Consultation Time (
Average Consultation Time (
mins
mins
)
)
Average Consultation Time
Average Consultation Time
Public Sector Drug Use Indicator Studies 1990-1993
Public Sector Drug Use Indicator Studies 1990-1993
Discuss reasons for short consultation times when the workload
is low.
Slide 21
Problems of Irrational Drug Use
21
Tanzania
Tanzania
Nigeria
Nigeria
Nepal
Nepal
Eastern
Eastern
Carribean
Carribean
Ghana
Ghana
0
0
50
50
100
100
150
150
200
200
Average Dispensing Time (seconds)
Average Dispensing Time (seconds)
Average Dispensing Time
Average Dispensing Time
Public Sector Drug Use Indicator Studies 1990-1993
Public Sector Drug Use Indicator Studies 1990-1993
Point out that times are measured in seconds not minutes and
that training of dispensers can have good effects. Begin to discuss
that dispensing time includes both preparation of drugs to dispense
and dispensing communication.
Slide 22
Problems of Irrational Drug Use
22
Malawi
Malawi
Indonesia
Indonesia
Bangladesh
Bangladesh
Tanzania
Tanzania
Nigeria
Nigeria
Nepal
Nepal
Eastern Caribbean
Eastern Caribbean
Ghana
Ghana
0
0
20
20
40
40
60
60
80
80
100
100
% patients w/ dosing knowledge
% patients w/ dosing knowledge
% Patients Knowing Drug Dosing
% Patients Knowing Drug Dosing
Public Sector Drug Use Indicator Studies 1990-1993
Public Sector Drug Use Indicator Studies 1990-1993
Possible discussion:
What should patients know about their drugs?
Slide 23
Problems of Irrational Drug Use
23
Malawi
Malawi
Tanzania
Tanzania
Nigeria
Nigeria
Nepal
Nepal
Ecuador
Ecuador
Cameroon
Cameroon
Ghana
Ghana
El Salvador
El Salvador
Guatemala
Guatemala
Jamaica
Jamaica
0
0
20
20
40
40
60
60
80
80
100
100
% of key drugs in stock
% of key drugs in stock
% of Key Drugs in Stock
% of Key Drugs in Stock
Public Sector Drug Use Indicator Studies 1990-1993
Public Sector Drug Use Indicator Studies 1990-1993
Slide 24
Problems of Irrational Drug Use
24
Activity 2
Activity 2
Identifying a Priority Problem
Identifying a Priority Problem
Slide 25
Problems of Irrational Drug Use
25
Conclusion
Conclusion
•
•
Drug use is the end of the therapeutic
Drug use is the end of the therapeutic
consultation
consultation
•
•
Health professionals have a responsibility to
Health professionals have a responsibility to
ensure that the right drug is prescribed,
ensure that the right drug is prescribed,
dispensed and taken.
dispensed and taken.
•
•
Methods exist to measure drug use and to
Methods exist to measure drug use and to
change practices.
change practices.
•
•
Improving drug use improves the quality of
Improving drug use improves the quality of
care and frequently lowers cost.
care and frequently lowers cost.
_956583626.ppt
Impact of Inappropriate
Use of Drugs
Reduced quality of therapy
morbidity
mortality
Waste of resources
Risk of unwanted effects
patients rely on unnecessary drugs
Psycho-social impacts
Reduced availability
increased cost
adverse reactions
bacterial resistance
Problems of Irrational Drug Use
Problems of Irrational Use of Drugs
_956583657.ppt
Average Number of Drugs per Patient
Public Sector Drug Use Indicator Studies 1990-1993
Yemen
Uganda
Sudan
Malawi
Indonesia
Bangladesh
Zimbabwe
Tanzania
Nigeria
Nepal
Ecuador
Guatemala
Eastern Caribbean
Jamaica
Ghana
Cameroon
El Salvador
0
1
2
3
4
5
Average Number of Drugs
Problems of Irrational Drug Use
Possible discussion for all indicator slides:
1.) Why are countries different?
2.) What is gold standard value?
Problems of Irrational Use of Drugs
_956583672.ppt
Average Consultation Time
Public Sector Drug Use Indicator Studies 1990-1993
Malawi
Indonesia
Tanzania
Nigeria
Nepal
0
1
2
3
4
5
6
7
Average Consultation Time (mins)
Problems of Irrational Drug Use
Discuss reasons for short consultation times when the workload
is low.
Problems of Irrational Use of Drugs
_956583679.ppt
% Patients Knowing Drug Dosing
Public Sector Drug Use Indicator Studies 1990-1993
Malawi
Indonesia
Bangladesh
Tanzania
Nigeria
Nepal
Eastern Caribbean
Ghana
0
20
40
60
80
100
% patients w/ dosing knowledge
Problems of Irrational Drug Use
Possible discussion:
What should patients know about their drugs?
Problems of Irrational Use of Drugs
_956583687.ppt
Activity 2
Identifying a Priority Problem
Problems of Irrational Drug Use
Problems of Irrational Use of Drugs
_956583690.ppt
Conclusion
Drug use is the end of the therapeutic consultation
Health professionals have a responsibility to ensure that the
right drug is prescribed, dispensed and taken.
Methods exist to measure drug use and to change practices.
Improving drug use improves the quality of care and frequently
lowers cost.
Problems of Irrational Drug Use
Problems of Irrational Use of Drugs
_956583683.ppt
% of Key Drugs in Stock
Public Sector Drug Use Indicator Studies 1990-1993
Malawi
Tanzania
Nigeria
Nepal
Ecuador
Cameroon
Ghana
El Salvador
Guatemala
Jamaica
0
20
40
60
80
100
% of key drugs in stock
Problems of Irrational Drug Use
Problems of Irrational Use of Drugs
_956583676.ppt
Average Dispensing Time
Public Sector Drug Use Indicator Studies 1990-1993
Tanzania
Nigeria
Nepal
Eastern Carribean
Ghana
0
50
100
150
200
Average Dispensing Time (seconds)
Problems of Irrational Drug Use
Point out that times are measured in seconds not minutes and
that training of dispensers can have good effects. Begin to discuss
that dispensing time includes both preparation of drugs to dispense
and dispensing communication.
Problems of Irrational Use of Drugs
_956583665.ppt
% Receiving Antibiotics
Public Sector Drug Use Indicator Studies 1990-1993
Yemen
Uganda
Sudan
Malawi
Indonesia
Bangladesh
Zimbabwe
Tanzania
Nigeria
Nepal
Ecuador
Guatemala
Eastern Caribbean
Jamaica
Ghana
Cameroon
El Salvador
0
20
40
60
80
100
% of encounters receiving antibiotics
Problems of Irrational Drug Use
Problems of Irrational Use of Drugs
_956583668.ppt
% Receiving Injections
Public Sector Drug Use Indicator Studies 1990-1993
Yemen
Uganda
Sudan
Malawi
Indonesia
Bangladesh
Zimbabwe
Tanzania
Nigeria
Nepal
Ecuador
Guatemala
Eastern Caribbean
Jamaica
Ghana
Cameroon
El Salvador
0
20
40
60
80
100
% of encounters receiving injections
Problems of Irrational Drug Use
Problems of Irrational Use of Drugs
_956583661.ppt
% Prescribed as Generics
Public Sector Drug Use Indicator Studies 1990-1993
Sudan
Indonesia
Zimbabwe
Tanzania
Nigeria
Nepal
Ecuador
Guatemala
Eastern Caribbean
Ghana
Cameroon
El Salvador
Jamaica
0
20
40
60
80
100
% Generic
Problems of Irrational Drug Use
Problems of Irrational Use of Drugs
_956583641.ppt
% Of Patients Receiving Antibiotics
E. Java & W. Kalimantan, Indonesia, 1987
None
12%
One
56%
Two
29%
Three/More
3%
None
35%
One
36%
Two
27%
Three/More
2%
5 & Over
Under 5
Problems of Irrational Drug Use
Possible discussion:
What would you expect the real need for antibiotics to be?
Problems of Irrational Use of Drugs
_956583650.ppt
ARI Treatment Pattern
E. Java & W. Kalimantan, Indonesia, 1987
Antibiotics
Analgesic
Cough/Cold
Antihist.
Others
0
0.2
0.4
0.6
0.8
1
1.2
1.4
Average # of Drugs Per Case
Under Five
Five & Over
Problems of Irrational Drug Use
Possible Discussion:
Which drugs are appropriate for ARI?
Problems of Irrational Use of Drugs
_956583653.ppt
Other Drug Use Problems
Incorrect treatment of malaria
incorrect use of chloroquin injection
Poor compliance with TB therapy
causes treatment failure and resistant organisms
Underuse of effective drugs
hypertension
depression
Hospital drug use problems
antibiotic misuse for surgical prophylaxis
Problems of Irrational Drug Use
Ask participants which other problems are important in their
environment.
Problems of Irrational Use of Drugs
_956583645.ppt
% Of Patients Receiving Injections
E. Java & W. Kalimantan, Indonesia, 1987
None
56%
One
34%
Two or More
10%
None
26%
One
54%
Two or More
20%
Under 5
5 & Over
Problems of Irrational Drug Use
Possible discussion:
Why is use of injections higher in adults than children?
Problems of Irrational Use of Drugs
_956583633.ppt
Drugs per Case by Age Group:
E. Java & W. Kalimantan, Indonesia, 1987
One
3%
Two
14%
Three
27%
Four
26%
Five
17%
Six+
13%
One
1%
Two
9%
Three
29%
Four
35%
Five
19%
Six +
6%
Under 5
Five & Over
Problems of Irrational Drug Use
Average for both Adults and Children =3.8 Drugs.
Problems of Irrational Use of Drugs
_956583637.ppt
Drugs Per Case By Diagnosis
E. Java & W. Kalimantan, Indonesia, 1987
All Cases
Diarrhea
Resp.Dis.
Skin
G.I.
Musculoskel.
0
1
2
3
4
5
# Drugs per Case
Under Five
Five & Over
Problems of Irrational Drug Use
Possible discussion:
Why are there such small differences by diagnosis?
Problems of Irrational Use of Drugs
_956583630.ppt
Activity 1
Meaning of Appropriate Use
Problems of Irrational Drug Use
Problems of Irrational Use of Drugs
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Irrational Use of Drugs = Pathology of Prescribing
The use of drugs when no drug therapy is indicated
The use of wrong drugs for a specific condition requiring drug
therapy
The use of drugs with doubtful or unproven efficacy
The use of drugs of uncertain safety status
Failure to prescribe available, safe, & effective drugs
Incorrect administration, dosages, or duration
Problems of Irrational Drug Use
Request an example of each practice from participants.
Problems of Irrational Use of Drugs
_956583617.ppt
Components of the Drug Use System
Drug Imports
Local
Manufacture
Hospital or
Health Center
Private Physician or
Other Practitioner
Pharmacist or
Drug Trader
The Drug Supply
Process
Provider and
Consumer Behavior
Illness Patterns
+
Public
Problems of Irrational Drug Use
Key points:
relationship of demand and supply
multiple outlets for drugs
many decision-makers effect system
Problems of Irrational Use of Drugs
_956583622.ppt
Factors Underlying Irrational Use of Drugs
inefficient management
non-availability of required drugs
Drug Supply
availability of unsafe drugs
informal prescribers
etc.
Drug Regulation
promotion
misleading claims
Industry
lack of education and training
lack of drug information
heavy patient load
pressure to prescribe
generalization of limited beliefs
misleading beliefs about efficacy
Prescribers
drug misinformation
misleading beliefs
inability to communicate problems
Patients
Problems of Irrational Drug Use
Emphasize interrelationship of factors and that problems rarely
have single cause.
Problems of Irrational Use of Drugs
_956583613.ppt
Examples of Common Inappropriate Prescribing Practices
The overuse of antibiotics and antidiarrheals for nonspecific
childhood diarrhea
Indiscriminate use of injections for malaria
Multiple or over-prescription
Use of antibiotics for mild, non-bacterial infection, e.g.,
URI
Tonics and multivitamins for malnutrition
Unnecessary use of expensive antihypertensives
Problems of Irrational Drug Use
Elicit 2-3 others from participants.
Problems of Irrational Use of Drugs
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Problems of Irrational Drug Use:
Objectives
Identify magnitude and nature of inappropriate drug
utilization
Understand the adverse impacts of inappropriate use of drugs
Describe factors which influence the decision-making process
Identify factors which influence the behavior of prescribers and
patients
Discuss specific medication use problems
Problems of Irrational Drug Use
Problems of Irrational Use of Drugs
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What is Rational Use of Drugs?
The rational use of drugs requires that patients receive
medicines 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 the community.
(WHO 1988)
Appropriate indication
Appropriate drug
Appropriate administration, dosage, and duration
Appropriate patient
Appropriate patient information
Appropriate evaluation
Problems of Irrational Drug Use
Emphasize that this is medical model.
Problems of Irrational Use of Drugs
_956583598.ppt
Problems of Irrational Drug Use
Problems of Irrational Drug Use
Problems of Irrational Use of Drugs
