Rational Use of DrugRational Use of Drug

Ali Abad hospitalAli Abad hospitalApril 12April 12thth, 2005, 2005

PLANPLAN

Main Concepts-DefinitionsMain Concepts-Definitions

Problems of Irrational Use of DrugsProblems of Irrational Use of Drugs

Programmation Chart: 3 approachesProgrammation Chart: 3 approaches• Change prescribing habitsChange prescribing habits• Improve knowledge of doctors and pharmacistsImprove knowledge of doctors and pharmacists• Improve drug managementImprove drug management

GENERIC MEDICINEGENERIC MEDICINE

Generic MedicineGeneric Medicine

What is it?What is it?

ICD: International Common ICD: International Common DenominationDenomination

Same active ingredient, same dosage, Same active ingredient, same dosage, same route of administrationsame route of administration

Same therapeutic effectSame therapeutic effect

Generic MedicineGeneric Medicine

Why using generics?Why using generics?

Less expensive to produceLess expensive to produce

Easier to buy Easier to buy

Easier to useEasier to use

Generic MedicineGeneric Medicine

How using generics?How using generics?

Packing when the patient submits Packing when the patient submits the presciption to the pharmacistthe presciption to the pharmacist

Pre-packingPre-packing

ESSENTIAL DRUGESSENTIAL DRUG

Essential DrugEssential Drug

What is it?What is it?

Medicines which cover the most urgent needs for the population

Essential drugEssential drug

Why using essential drugs?Why using essential drugs?

Good benefit-risk ratioGood benefit-risk ratio

Efficacity provedEfficacity proved

Safe useSafe use

Essential DrugEssential Drug

How using it?How using it?

Following standardized guidelinesFollowing standardized guidelines

ESSENTIAL DRUG ESSENTIAL DRUG LISTLIST

EDLEDL Specific for each Specific for each

country, according to its country, according to its priorities in the health priorities in the health policy.policy.

Limited number and Limited number and types of drugs available types of drugs available at each level of health at each level of health servicesservices

In Afghanistan, list In Afghanistan, list established by the established by the BPHS; it consists of 237 BPHS; it consists of 237 medicines and items of medicines and items of medical material, medical material, available at 4 levelsavailable at 4 levels

EDLEDL

Type of HFType of HFNumber of Number of medicines medicines availableavailable

Total Total Number of Number of

itemsitems

HPHP 1515 2424

BHCBHC 4848 7676

CHCCHC 8080 120120

DHDH 8484 137137

STANDARD STANDARD TREATMENT TREATMENT GUIDELINESGUIDELINES

STGSTG

A systematically A systematically developped developped collection of collection of statements statements designed to assist designed to assist prescribers prescribers decisions about decisions about appropriate health appropriate health care for specific care for specific clinical clinical circumstancescircumstances

Definition of RUDDefinition of RUD

The Rational Drug Use requires that patients The Rational Drug Use requires that patients receive medicines appropriate to their receive medicines appropriate to their clinical needs, in doses that meet their clinical needs, in doses that meet their individual requirements, for an adequate individual requirements, for an adequate period of time, and at the lowest cost to period of time, and at the lowest cost to them and the community. them and the community.

WHO, 1998WHO, 1998

Surveys about RUDSurveys about RUD

Prescribing Prescribing indicatorsindicators

Average number of drugs/encounterAverage number of drugs/encounter

% of encounters with ≥1 ATB% of encounters with ≥1 ATB

% of encounters with ≥1 injection% of encounters with ≥1 injection

% of drugs prescribed from EDL% of drugs prescribed from EDL

Patients Care Patients Care indicatorsindicators

% of drugs actually dispensed% of drugs actually dispensed

% of drugs adequally labeled% of drugs adequally labeled

Patients’ knowledge of correct dosagePatients’ knowledge of correct dosage

Facility Facility indicatorindicator

Availability of key drugsAvailability of key drugs

ResultsResultsComparison AMI clinics 2004/Standard INRUD/SCA 2002

61,3

4,9

92,1

81,1

73,2

30

10

100 100 100

50,5

5,5

89,2

79

1,10

20

40

60

80

100

120

% encounters withan ATB prescribed

% encounters withan injection

% drugs prescribedfrom EDL

% drugs actuallydispensed

% correct labeling

drug cores

perc

en

tag

es

AMI Clinics/BLS 2004

Golden Standard INRUD

SCA survey 2002

PROBLEMS OF PROBLEMS OF IRRATIONAL USE OF IRRATIONAL USE OF

DRUGSDRUGS

CAUSESCAUSES

From the prescriberFrom the prescriber

Lack of knowledge about diagnosis, Lack of knowledge about diagnosis, therapeuticstherapeutics

Acquired habitsAcquired habits False beliefs about illness and drugsFalse beliefs about illness and drugs Economic motivations Economic motivations

Between patient and prescriberBetween patient and prescriber

Patient’s demand: lack of knowledge, Patient’s demand: lack of knowledge, family pressurefamily pressure

Quality of communicationQuality of communication

Work EnvironmentWork Environment

Influence of drugs availabilityInfluence of drugs availability Availability of diagnosis servicesAvailability of diagnosis services Lack of spaceLack of space WorkloadWorkload Availability of female staffAvailability of female staff

HOW IMPROVING HOW IMPROVING RATIONAL USE OF RATIONAL USE OF

DRUGS?DRUGS?

By changing prescribing habitsBy changing prescribing habits

Standardization of therapeutic schemesStandardization of therapeutic schemes Audits: prescription control sheetAudits: prescription control sheet

By improving knowledge of doctors By improving knowledge of doctors and pharmacistsand pharmacists

Specific trainingsSpecific trainings Printed educational material:Printed educational material: Therapeutic manuals (guidelines, EDL)Therapeutic manuals (guidelines, EDL) Clinical litterature (Salamati magazine)Clinical litterature (Salamati magazine) Posters (most frequently used drugs Posters (most frequently used drugs

dosages, tables of dilution, preparation dosages, tables of dilution, preparation and storage of antiseptic solutions...)and storage of antiseptic solutions...)

Improving the dispensation to the Improving the dispensation to the patient (1/1)patient (1/1)

Possibility of packaging by Possibility of packaging by advanceadvance

Correct labeled packetsCorrect labeled packets:: Name of the patientName of the patient Name and dosage of the drugName and dosage of the drug Schedule and durationSchedule and duration

Improving the dispensation to the Improving the dispensation to the patient (1/2)patient (1/2)

Explanations and advice to the patient:Explanations and advice to the patient:

How and when to take the treatmentHow and when to take the treatment Potential side effects, in which case he Potential side effects, in which case he

must stopmust stop Advise not to take other medication at the Advise not to take other medication at the

same time if not compatiblesame time if not compatible When he must come back if no improvmentWhen he must come back if no improvment