Promoting Drug and Therapeutics Committees in the Developing World.
-
Upload
kimberly-annabel-robinson -
Category
Documents
-
view
260 -
download
2
Transcript of Promoting Drug and Therapeutics Committees in the Developing World.
Promoting Drug and Therapeutics Committees in the Developing World
Promoting Drug and Therapeutics
Committees in the Developing World
Terry Green
John Chalker
Kathleen Holloway
Rational Pharmaceutical Management Plus
World Health Organization
March 2004
RPM + is supported by the U.S. Agency for
International Development
What is a DTC?Drug & Therapeutics Committees The committee designated to ensure the safe &
effective use of medicines in health facilities develops policies for managing drug use administers and manages the formulary system evaluates the clinical use of drugs
DTCs are important because there is widespread inappropriate use of medicines Polypharmacy, antibiotic overuse, injection overuse and
non-sterile injections, non-compliance with guidelines… leading to increased antimicrobial resistance, spread of
hepatitis B/C & HIV, waste of resources, increased adverse drug reactions and poor patient outcome
Responsibilities of a DTC
Regular Assessment(1) ABC/VEN(2) Indicator Studies(3) Drug use evaluation(4) Regular review of reports of medication errors and ADRs
Establishing Standards(1) EML & STG development(2) Evaluating drugs(3) Drug Use Evaluation criteria
Correcting problems to achieve standards(1) Interventions to promote rational drug use(2) Interventions to prevent medication errors, quality problems, stock-outs & ADRs
Investigating reported problems(1) Investigation of medication errors, drug quality problems, stock-outs and ADRs(2) Qualitative investigation why a drug use problem exists
DTC’s role to ensure quality of therapeutic care
Objectives of the MSH/WHO DTC Project
To promote DTCs in the developing world
DTCs have been shown to be effective in promoting rational drug use in developed countries, but there has been minimal use of these committees in developing countries
Interventions during 2000-3 DTC training materials were developed by MSH
and WHO
“Drug and Therapeutics Committees: a practical guide” developed by WHO and MSH and published in 2004
4 international and 8 national courses conducted in Asia, Africa, Latin America, E.Europe & aimed at doctors, pharmacists, hospital administrators & MOH officials
Follow-up workshop for participants
Structure & content of training course 16 half -day modules and a field trip to
hospitals Formulary management
Drug Selection Determining efficacy, safety, cost, quality Adding and deleting drugs
Identifying drug use problems Qualitative and quantitative methods
Strategies to improve drug use Educational, managerial, and regulatory
strategies
Training follow-up activities
E-mail correspondence with participants
DTC Web site Workplans displayed and progress reported Discussion boards Announcements Links to resources
Follow-up workshop in Africa
Training results 361 people trained from 56 countries
87 (24%) responded to follow-up e-mail request
57 (16%) participants had undertaken 152 DTC related activities
24 (7%) participants from 10 countries attended the follow-up workshop for active participants
Post-course country DTC activities
29 training courses organized by DTC participants 72 DTCs in 14 countries created/restructured 9 new drug selection processes in 6 countries STGs developed in 12 institutions in 6 countries 7 DUEs undertaken in 4 countries 8 ABC/VEN analyses undertaken in 5 countries 7 ADR reporting systems developed in 5 countries 8 training programmes on rational use of drugs in 6
countries
Major problems identified by participants to implement DTCs Lack resources and institutional support
Non-compliance with essential drug list (formularies)
Non-compliance with STGs
Pharmaceutical company influences
Decreasing revenues with improved drug use
Solutions proposed by participants Use locally collected evidence on irrational drug
use to convince officials Provide incentives to DTC members e.g. training,
recognition by administration for DTC work Develop specific Terms of Reference approved by
healthcare administrators Link procurement to STGs and formularies Provide training to DTC members & administrators Build a critical mass of activity to show
administration the value of the committee and demonstrate that DTC activities can save money
Link procurement to DTC’s formulary/EDL
Conclusions Key Lessons DTCs can be promoted and implemented in
developing countries through a combination of training and active follow-up support
Increased follow-up support increased the productivity of many DTC course participants
Policy Implications Promotion of DTCs is possible in resource poor
settings and can result in improved use of medicines but requires institutional support and investment from government and donors
Future Research Rigorous evaluation of the impact of DTCs on drug
use and costs saved from improved use