Irrational Drug Use

8/9/2019 Irrational Drug Use

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IRRATIONAL DRUG USE

Problems of Irrational Drug Use 1


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Problems of Irrational DrugUse:

Objectives Identify magnitude and nature ofinappropriate drug utilization

Understand the adverse impacts of

inappropriate use of drugs Describe factors which inuence the

decisionma!ing process

Identify factors which inuence the

behavior of prescribers and patients

Discuss speci"c medication useproblems



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#hat is $ational Use ofDrugs%

&he rational use of drugs re'uires that patients receive&he rational use of drugs re'uires that patients receive

medicines appropriate to their clinical needs( in doses thatmedicines appropriate to their clinical needs( in doses that

meet their own individual re'uirements( for an ade'uatemeet their own individual re'uirements( for an ade'uate

period of time( and at the lowest cost to them and theperiod of time( and at the lowest cost to them and thecommunity)community)

*#+O ,-../*#+O ,-../


Appropriate indicationAppropriate indication

Appropriate drugAppropriate drug Appropriate administration, dosage, and durationAppropriate administration, dosage, and duration Appropriate patientAppropriate patient Appropriate patient informationAppropriate patient information

Appropriate evaluationAppropriate evaluation


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Irrational Use of Drugs 0Pathology of Prescribing

&he use of drugs when no drug therapy is indicated

&he use of wrong drugs for a speci"c conditionre'uiring drug therapy

&he use of drugs with doubtful or unproven e1cacy

&he use of drugs of uncertain safety status

2ailure to prescribe available( safe( 3 e4ectivedrugs

Incorrect administration( dosages( or durationProblems of Irrational Drug Use 4


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56amples of 7ommonInappropriate Prescribing

Practices &he overuse of antibiotics andantidiarrheals for nonspeci"c childhooddiarrhea

Indiscriminate use of injections formalaria

8ultiple or overprescription

Use of antibiotics for mild( nonbacterialinfection( e)g)( U$I

&onics and multivitamins for malnutrition

Unnecessary use of e6pensiveantihypertensives



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7omponents of the DrugUse 9ystem


Drug ImportsDrug Imports

LocalLocal

ManufactureManufacture

HospitalHospitaloror

HealthHealthCenteCenterr

Private Physician orPrivate Physician or

Other PractitionerOther Practitioner Pharmacist orPharmacist or

Drug TraderDrug Trader

The DrugThe Drugupplyupply

ProcessProcess

Provider andProvider andConsumer !ehaviorConsumer !ehavior

Illness PatternsIllness Patterns

""

Pu#licPu#lic


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2actors UnderlyingIrrational Use of Drugs


inefficient

management non$

availa#ility of

re%uired

drugs

Drug upplyDrug upplyDrug upplyDrug upply

availa#ility of

unsafe drugs informal

prescri#ers etc&

Drug 'egulationDrug 'egulationDrug 'egulationDrug 'egulation

promotion misleading

claims

IndustryIndustryIndustryIndustry

lac( of educationand training

lac( of druginformation

heavy patient load

pressure toprescri#e

generali)ation oflimited #eliefs

misleading #eliefs

a#out efficacy

PrescribersPrescribers drug

misinformati

on

misleading

#eliefs

ina#ility to

communicatepro#lems

PatientsPatients


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Impact of InappropriateUse of Drugs


'educed

%uality of

therapy

mor#iditymortality

*aste of

resources 'is( of

un+antedeffects

patients rely on

unnecessary drugs

Psycho$social

impacts

'educed availa#ilityincreased cost

adverse reactions

#acterial resistance


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Drugs per 7ase by ge ;roup:5) ??@


OneOne3%3%

T+oT+o14%14%

ThreeThree27%27%

ourour26%26%

iveive17%17%

i-i-13%13%

OneOne1%1%

T+oT+o9%9%

ThreeThree29%29%

ourour35%35%

iveive19%19%

!i"!i"6%6%

.nder /.nder / ive 0 Overive 0 Over


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Drugs Per 7ase AyDiagnosis

5) ??@

Problems of Irrational Drug Use 1#ll 7asesll 7asesDiarrheaDiarrhea$esp)Dis)$esp)Dis)9!in9!in ;)I);)I) 8usculos!el8usculos!el.

??

,,

>>

BB

CC

E Drugs per 7aseE Drugs per 7ase

Under 2iveUnder 2ive

2ive 3 Over2ive 3 Over


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F Of Patients $eceivingntibiotics

5) ??@


GoneGone

,>F

OneOne

HF

&wo&wo

>-F

&hree8ore&hree8ore

BF

GoneGoneBF

OneOneBHF

&wo&wo

>@F

&hree8ore&hree8ore>F

3 3

OverOverUnderUnder


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% Of Patients ReceivingInjections

E. Java & W. a!i"antan# In$onesia# '


1one1one/23

OneOne

453

T+o or MoreT+o or More673

1one1one823

OneOne

/53

T+o or MoreT+o or More873

.nder /.nder / / 0 Over/ 0 Over


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$I &reatment Pattern5) ??@

Problems of Irrational Drug Use 13Anti#ioticsAnti#iotics AnalgesicAnalgesic Cough9ColdCough9Cold Antihist&Antihist& OthersOthers

77

7&87&8

7&57&5

7&27&2

7&:7&:

66

6&86&8

6&56&5

Average ; of Drugs Per CaseAverage ; of Drugs Per Case

.nder ive.nder ive

ive 0 Overive 0 Over


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Other Drug Use Problems

Incorrect treatment of malaria

$ incorrect use of chloro'uin injection

Poor compliance with &A therapy

$ causes treatment failure and resistantorganisms

Underuse of e4ective drugs

$ hypertension

$ depression

+ospital drug use problems

$ antibiotic misuse for surgical prophyla6is



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Ave(age N)"*e( of D()gs +e(Patient

P)*!ic Secto( D()g Use In$icato( St)$ies ,-


cuador

?uatemala?uatemala>astern Cari##ean>astern Cari##ean

@amaica@amaica

?hana?hana

CameroonCameroon

>l alvador>l alvador

77 66 88 44 55 //

Average 1um#er of DrugsAverage 1um#er of Drugs


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% P(esc(i*e$ as Gene(icsPublic 9ector Drug Use Indicator 9tudies

>???>??B


udanudan

IndonesiaIndonesia

=im#a#+e=im#a#+e

Tan)aniaTan)ania

1igeria1igeria

1epal1epal

>cuador>cuador

?uatemala?uatemala

>astern Cari##ean>astern Cari##ean

?hana?hana

CameroonCameroon


@amaica@amaica

77 8787 5757 2727 :7:7 677677

3 ?eneric3 ?eneric


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F $eceiving ntibioticsPublic 9ector Drug Use Indicator 9tudies

>???>??B


cuador


@amaica@amaica

?hana?hana

CameroonCameroon


77 8787 5757 2727 :7:7 677677

3 of encounters receiving anti#iotics3 of encounters receiving anti#iotics


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F $eceiving InjectionsPublic 9ector Drug Use Indicator 9tudies

>???>??B


cuador


@amaica@amaica

?hana?hana

CameroonCameroon


77 8787 5757 2727 :7:7 677677

3 of encounters receiving inections3 of encounters receiving inections


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verage onsu a on&ime

Public 9ector Drug Use Indicator 9tudies

>???>??B


Mala+iMala+i

IndonesiaIndonesia

Tan)aniaTan)ania

1igeria1igeria

1epal1epal

77 66 88 44 55 // 22 BB

Average Consultation Time minsAverage Consultation Time mins


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verage Dispensing &imePublic 9ector Drug Use Indicator 9tudies

>???>??B

Problems of Irrational Drug Use 2#

Tan)aniaTan)ania

1igeria1igeria

1epal1epal

>astern Carri#ean>astern Carri#ean

?hana?hana

77 /7/7 677677 6/76/7 877877

Average Dispensing Time secondsAverage Dispensing Time seconds


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F Patients =nowing DrugDosing

Public 9ector Drug Use Indicator 9tudies >???>??B


Mala+iMala+i

IndonesiaIndonesia

!angladesh!angladesh

Tan)aniaTan)ania

1igeria1igeria

1epal1epal

>astern Cari##ean>astern Cari##ean

?hana?hana

77 8787 5757 2727 :7:7 677677

3 patients +9 dosing (no+ledge3 patients +9 dosing (no+ledge


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F of =ey Drugs in 9toc!Public 9ector Drug Use Indicator 9tudies

>???>??B


Mala+iMala+i

Tan)aniaTan)ania

1igeria1igeria

1epal1epal

>cuador>cuador

CameroonCameroon

?hana?hana


?uatemala?uatemala

@amaica@amaica

77 8787 5757 2727 :7:7 677677

3 of (ey drugs in stoc(3 of (ey drugs in stoc(


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7onclusion

Drug use is the end of the therapeuticconsultation)

+ealth professionals have aresponsibility to ensure that the rightdrug is prescribed( dispensed and ta!en)

8ethods e6ist to measure drug use andto change practices)

Improving drug use improves the 'ualityof care and fre'uently lowers cost)


Irrational Drug Use

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