Rational Use of Medicine

Presented byDr.Muhammad UmairPharm.DMPhil. (Clinical)LecturerLahore Pharmacy College of Lahore Medical & Dental College

Definition “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”(WHO, 1985)

Rational Use of Medicine (RUM) The aim of any pharma-management system is to deliver the correct medicine to the patient Appropriate selection, procurement, and distribution are precursors to RUM. RUM fulfils following criteria; Appropriate indication Appropriate medicine Appropriate dosage Correctly dispensed Appropriately informed patients Patient adherence

Examples of Irrational Use of Medicine (IUM)

Poly Pharmacy Average no. of medicines per prescription Unnecessary medication/ no medicine needed Antibiotics misuse (RTIs) Wrong Medicine Less than 40% patients are treated according to STGs Ineffective Medicine/ Medicine with doubtful efficacy

Multivitamins, Tonics Unsafe Medicines Anabolic steroids for athletes and as appetizers for children

Underuse of available effective medicine No therapy for mental disorders ORT for diarrhoea Incorrect use of medication Incomplete antibiotic therapy

Factors Causing IUM1)INTERNATIONAL LEVEL Drug promotion and marketing Misleading, biased, scientifically inaccurate Encourage over use High cost Market dynamics Invest more in developed countries2)NATIONAL LEVEL Weak Laws and Regulations Poor quality medicines Poor HRM Economic status

Factors Causing IUM3)HEALTH SYSTEMS LEVEL Unreliable suppliers Poor planning of the drug needs Poor infrastructure for storage Poor information management systems Lack of monitoring and supervision4)PRESCRIBERS LEVEL Lack of information and training Outdated prescribing practices Heavy patient load Pressure from pharma-industries (Conflict of interest)

Factors Causing IUM5)DISPENSING LEVEL Lack of qualification and training Heavy patient load 6)PATIENTS & COMMUNITY LEVEL Non adherence Cultural beliefs Accessibility Affordability Education Availability

Adverse Impact of IUM Impact of Quality of Medicine Therapy and Medical Care Impact on Antimicrobial Resistance Impact on Cost Psychosocial Impact

Vicious Circle Leading to IUM

Intervention Strategies to Improve Medicine Use EDUCATIONAL STRATEGIES Training of prescribers Formal education In-service education (CME) Supervisory visits Printed materials Clinical literature Treatment guidelines & formularies Others Patient education Influence opinion leader

MANAGERIAL STRATEGIES Monitoring supervising & feedback D & TC Health survey teams Government inspectors Self assessment Selection procurement & distribution Limited procurement list Drug use review Regional drug committees Prescribing and dispensing approaches Structured medicine order forms Diagnostic and treatment guidelines Course of therapy packaging

ECONOMIC STRATEGIES Price setting Capitation based budgeting Reimbursement and user fees Insurance REGULATORY STRATEGIES Medicine registration Limited medicine lists Prescribing restrictions Dispensing restrictions

Developing a Strategy There are six steps to develop a strategy to promote RUM given as; Identify the problem and recognize the need for action Identify underlying causes and motivating factors List possible interventions Assess recourses available for action Choose intervention(s) to test Monitor the impact and restructure the intervention

Core Policies to Promote RUM

1)A mandated multi-disciplinary national body to coordinate medicine use policies

2)Clinical guidelines3)Essential medicines list based on treatments of

choice4)Drugs and therapeutics committees in districts

and hospitals5)Problem-based pharmacotherapy training in

undergraduate curricula6)Continuing in-service medical education as a

licensure requirement

7)Supervision, audit and feedback8)Independent information on medicines9)Public education about medicines10) Avoidance of perverse financial incentives11) Appropriate and enforced regulation12) Sufficient government expenditure to ensure

availability of medicines and staff

Ready to Jump ???