Burçak Deniz DEDEOĞLU, MD. PhD.Head of Rational Drug Use Department

Ministry of Health of TurkeyGeneral Directorate of Pharmaceuticals and Pharmacy

RATIONAL DRUG USEACTIVITIES

RATIONAL DRUG USE

The rational use of drugs requires that patients receive medications 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 their community.

2 Conference of Experts on the Rational Use of Drugs, World Health Organization,

Nairobi, Kenya, WHO/CONRAD/WP/RI, (25-29.12.1985).

Rely on accurate diagnosis in treatment planning, Determine the right drug, right dose, right time, and

the correct way of the application, Assess the success of treatment, side effects and

compliance, Predict the interactions in use of multiple drug, Assess the practicability and the cost of treatment.

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PRINCIPLES of RATIONAL DRUG USE

World Health Organization, conf. of experts, Kenya-Nairobi, 1985.

• Efficacy• Safety• Appropriateness • Cost

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INAPPROPRIATE USAGES

Polypharmacy Unnecessary and excessive use of drugs Incompatible prescribing with clinical guidelines Inappropriate personal treatments Inappropriate choice of new drugs

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The institution that provides the coordination Evidence-based clinical guidelines The essential drugs list Drug and treatment committees Pharmacotherapy and prescribing trainings Continuous medical education Health staff feedback Public awareness and education

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WORLD HEALTH ORGANIZATION RECOMMENDATIONS

STAKEHOLDERS

Decision maker of which drug will use (doctor) Supplier of the drug (pharmacist) Applier of the drug (nurse, patient/relatives) Producer

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INSTITUTIONALISATION

Rational drug use department was established within the General Directorate of Pharmaceuticals and Pharmacy - 12 October 2010.

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Advertisement Training Guidelines Hospitals Legislations Drug boxes Pharmaceutical waste management Meetings Time temperature indicator Monitoring and evaluation

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ADVERTISEMENT10

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“MY DRUG;NEITHER LESS, NOR MORE! ”

Slogan, logo, mascot Short films Newspaper advertisements Leaflet Bill poster

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MEDIA

Health programs in national TV and radio channels. Web site; www.akilciilac.gov.tr

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INFORMATIVE VIDEOS

Informative videos related, routes of administration of all drugs forms and issues must be considered.

Rational Drug Use websiteHospital and family health centers waiting rooms, TV.

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TRAINING15

TRAINING PROGRAMS

Primary school curriculum Medical school curriculum Faculty of pharmacy curriculum

Medical Specialty Exam

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DISTANCE TRAINING

VLE-RADUS project about RDU was prepared by Refik Saydam National Public Health Agency.

Pilot practice for the family physicians in Ankara.

Distance training modules of Turkish Pharmacist Association.

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TRAINING IN STATE HOSPITAL

Sincan State Hospital, 27.01.2011 Çubuk State Hospital, 06.04.2011 Gölbaşı State Hospital.

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FACE TO FACE TRAINING ACTIVITIES

Turkish Pharmacological Society Turkish Pharmacists Association

Training activities for the physicians, pharmacists and auxiliary health care personnel.

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TEBRP (Assistance for pharmaceutical care)

The installation of the CD which was prepared by Turkish Pharmacist Association, was completed for pharmacies.

It was sent to all family and community health centers for free.

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GUIDELINES21

DIAGNOSIS AND TREATMENT GUIDELINES FOR THE PRIMARY CARE

The guideline, prepared by Refik Saydam National Public Health Agency, is in the update period.

Interviews to provide access to the web database of the guideline.

Interviews to provide access to the web database of the formulary.

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DIAGNOSIS AND TREATMENT GUIDELINES FOR THE SECONDARY CARE

Guidelines for the secondary care. Meetings with the societies.

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HOSPITALS

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SERVICE QUALITY STANDARDS

Addition of new topics about rational drug use to Service Quality Standards in Hospitals.

“Health Performance and Quality Regulations” entered into force on 1 July 2011

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Standards

Arrangements to ensure rational drug use Set up a team, responsible for rational drug use A representative from management, physicians and

pharmacists should be in team;

İn relation to rational drug use;Hospital policy should be determinedActivities should be planned and implemented

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Standards

The arrangements for the awareness in patients. Patients should be informed about the use of drugs. Arrangements such as brochures, posters, videos ın

areas frequently used by patients. Inpatient trainings.

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PHARMACOVIGILANCE

General Directorate of Pharmaceuticals and Pharmacy, Drug Safety Monitoring, Evaluation Department An integral part of Rational Drug Use 405 “pharmacovigilance contact persons” in hospitals

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PHARMACEUTICALS TRACK & TRACE SYSTEM

Follow-up of drugs throughout the country First in the world Data matrix

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LEGISLATIONS

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TANITIM YÖNETMELİĞİ

Recommendation letter to the related societies to include a session about the rational drug use at congresses.

The Regulation on Promotional Activities of Medicinal Products for Human Use.

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THE REGULATION on PROMOTIONAL ACTIVITIES

The Regulation on Promotional Activities of Medicinal Products for Human Use, Second part, Scientific and Educational Activities, Article 7 (6);

“In meetings supported by license/permit holders, a session will placed on rational drug use. The content of this session will be under the presentations, training materials and diagnostic treatment guidelines approved by the Ministry.”

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DRUG BOXES33

Safe drug box cap design for drugs with narrow therapeutic index,

Slogans about rational drug use on drug boxes,

Big font size on the direction for use…

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PHARMACEUTICAL WASTE MANAGEMENT

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PHARMACEUTICAL WASTES

Ministry of Environment and Urbanism Legislation for Management of Hazardous Waste Legislation for Management of Pharmaceutical Waste Drug collection campaigns ???

Ekolojik Enerji Ltd. Şti. (İstanbul)İZAYDAŞ (Kocaeli)

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MEETINGS

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Related Societies, Rational Drug Use Representatives meeting; 20.01.2011

81 Provincial Health Directorates, Rational Drug Use Representatives meeting; 24-27.05.2011

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ICIUM(International Conferencefor Improving Use of Medicines)

November 14-18, 2011 Antalya-Turkey

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TIME TEMPERATURE INDICATOR

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WORLD HEALTH ORGANİZATİON RECOMMENDATİONS

Cold chain drugs The color of the indicator will change if any problem

occurs Preventing the destruction of drugs that are not yet

robust, although the nonsuitable conditions

Increasing the reliability in the use of drugs

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MONITORING AND EVALUATION

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In order to determine the effectiveness of the program; monitoring and evaluation was planned before and during the programme periodically.

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Surveys for physicians, pharmacists, nurses and public.

Questionnaire applications, Simulated patient visits, Focus group surveys, Evaluation studies for drugs in houses.

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THANKS FORYOUR ATTENTION…

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