medicine information to promote rum nani sukasediati edm- wco indonesia
TRANSCRIPT
Medicine Information to promote RUM
Nani Sukasediati
EDM- WCO Indonesia
Outline
1. Rational use of medicine (RUM)
2. Factors and strategies related to RUM
3. Information and education in RUM
4. WHO Ethical Criteria
1.
Rational Use of Medicine
Rational/Quality/Prudent Use Patients receive medications appropriate to their
clinical needs, in doses that meet their own individual requirements, for an adequate period of time, at the lowest cost to them and their community
Therapeutically sound medicines used by the health professionals and cost effective
Principles :- correct - Cost-effective- Evidence based : quality, safety, efficacy
- Comply to the guideline
Patient careManaging Medicine
supply
Rational use of medicines
RATIONAL USE/QUALITY USE/PRUDENT USE OF MEDICINES IN GPP
Identify drug problem
Dev. of care plan
Implement of c p
Review of c p
selection
procurement
distribution
Use of med
Medical care
Nursing care
Pharmaceutical care
Medicines should not be seen as a chemical
But a chemical plus information for its correct use
(RD WHO Searo, 2nd ICIUM 2004)
2.
Factors and strategies
related to RUM
Factors influencing medicines use
workloadworkload
InformationInformation
SupervisionSupervision
TrainingTraining
trainingtrainingROLEROLEMODELMODEL
InformationInformation
FinanceFinance
InformationInformation
EXPIREDEXPIREDDATEDATE
availabilityavailability
Culture Culture
reliabilityreliability
ConsultationConsultationtimetime
behaviorbehavior
INFOINFO
MedicineMedicineuseuse
PrescribersPrescribersSupplySupply
PatientPatient dispenser
STRATEGY TO PROMOTE RUM
EDUCATIONEDUCATION
MANAGERIAL/FINANCINGMANAGERIAL/FINANCING
REGULATION/ POLICIESREGULATION/ POLICIES
3.
Information and education
to promote RUM
WHO 12 key interventions ↑ RUM1. Est. multidisciplinary national body to coordinate policy
on medicines use (Dir. of Promoting RUM, MoH) 2. Use of STG3. National EDL4. Est. D/PTC in hospital and district5. Incl. problem based pharmacotherapy training in
undergraduate curricula6. CPD as licensure requirement CPD PUKA.ppt7. Supervision, audit, feedback8. Independent information on medicines9. Public education on medicines10.Avoidance of conflicting financial incentives11.Use appropriate and enforced regulation12.Sufficient gov’t expenditure : availability med and staff
Training for Health provider
Advocacy LG U
HCshospital
Approach
Community empowerment CBIA
MODULESMODULES
Promoting RUM Promoting RUM
Monitoring, supervisionMonitoring, supervision
Education Education
~ Technical assistant
Education on medicines
Main targets :
• Community / consumers, lay person. Significant portion and leverage
• Health professionals : CPD, basic curricula
• Decision maker : advocacy on financing, LGU health expenditure
Consumers/Layman education of RUM
• Knowledgeable ?
• Awareness, alert ?
• Skilled in selection and decision?
• Changing habit and behavior ?
better use of medicine
Education methods for layman• Written passive:
– Posters, banners, leaflets– Booklet– Articles (magazine, newspapers)
• Oral : – Lectures (passive)– Discussion groups, interactive discussion (active)
• Media passive and active– TV, films– Radio : spot, jingle,– Video– Traditional media (puppet show, street plays)
CBIA – Cara Belajar Ibu Aktif
• Format : small discussion group• Method : interactive discussion, presided by
tutor • Participants : mothers/woman belongs to civil
society, religious group• Discussion objects : medicines stored in their
household, medicines at their surrounding • Purpose : enhance their skill in selection
medicine through understanding the API and its benefit.
Health professionals : MTP (QIMC)Health professionals : MTP (QIMC)
Adult learning processAdult learning processSelf initiative learning processSelf initiative learning process Monitoring:
problem identification & measurement
Description of the recent situation
Training:problem solving
Reflection of Reflection of previous experienceprevious experience
Problem solving & scientific/reality
testing
Planning:setting target of improvement
80%80%
20%20%Agreement on target
of improvement
Follow quality improvement management cycleFollow quality improvement management cycle
4.
WHO Ethical Criteria
for Medicine Promotion 1988
WHO report 2005
• Irrational use of AM : greatest contribution to AM resistant
Pneumonia, disentry, gonorrhoe, hopsitals infection : 70-90% to first line AM
The more we use them, the more we lose them (Strama).
• 2,3-7m hepatitis B & C cases and 160 ths new cases HIV using 15b injection/year. 50% are not in steril condition
• ADR : 4-10% in patients in developing countries.
• 2/3 world pop have access to medicines, half of them are prescribed incorrect
• 50% medicines in the world, are being prescribed, dispensed, and sold incorrect. and 50% of patients use it inappropriate
• WHO Promotion budget on RUM 0,2% $2,3b (’02-’03) vs global sales promotion of precription drugs $282,5b (’00)
Summary of studies in Indonesia• Suryawati, 1997
• Permenkes 386/1994 ttg periklanan
• Spot survey
- 69% tdk menyebut bhn aktif
- 29-36% indikasi tdk benar
- 20% menulis informasi produsen
- 31% memberi informasi menyesatkan
Pills, Politics and Practice 25 YEARS OF PROMOTING PEOPLE-CENTRED MEDICINES POLICY
Regulation of medicine promotion
• In 2004, 89 countries (46%, WHO survey) reported that they regulated drug promotion
• Often delegated to industry self-regulation
• Few resources: for example, in Canada less than 1 full-time dedicated staff person, no fines or sanctions since 1978
• WHO Ethical Criteria for Medicinal Drug Promotion, 1988
• First international ethical standard • Aim is to support rational drug use, public
health– Specific types of information must be provided in
advertising– Promotion should not take advantage of concern for
health– Should not be disguised as education or science – Generally, direct-to-consumer advertising of
prescription– drugs should not be allowed.
Objective
“The main objective … is to support and
encourage the improvement of health care
through the rational use of drugs.”
- WHO Ethical Criteria for Medicinal Drug
Promotion
Criteria
• Ethical criteria : varies among society, should lay the foundation for proper behavior concerning promotion of medicines, consistent with truthfulness and righteousness, should assist in judging if promotional practice are in within the acceptable ethical standards
Criteria
• Applicability and implementation Promotion : general principles for ethical standard, do not constitues legal obligation
• Promotion :all informations, persuasive activities by manufactures, and distributors, the effect of which to induce prescription, supply, purchase and/or use of medicine
available in the country, scientific/evidence based
comparison should be factual• Advertising : appropriate language, should help people
make rational decision• Free samples on OTC to public promotional : difficult to
justify• Information for patients : leaflets, package inserts, booklets
• Medical representative
• Free samples of prescription medicine
• Symposia and other scientific meeting
• PMS and Dissemination information
• Promotion of exported medicines
n=102 internal medicine residents Am J Med 2001; 110:551
A little38%
A lot 1%
None61%
How much influence do sales representatives have on your prescribing?
n=102 internal medicine residents Am J Med 2001; 110:551
A little33%
A lot 51%
None16%
How much influence do sales representatives have on other physicians' prescribing?
Summary
• Empowerment in medicine use is the key issues to promote RUM : through cross cut community
• 3 target groups of information and education : consumers/lay person, health providers/professionals, decision makers.
• Particular methods of empowerment has been developed
• How to disseminate the method of CIE