determinants of rational use of medicines dr a k sharma prof & head dept of pharmacology afmc,...
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Determinants ofDeterminants of
Rational Use of MedicinesRational Use of MedicinesDr A K SharmaDr A K Sharma
Prof & HeadProf & HeadDept of PharmacologyDept of Pharmacology
AFMC, Pune.AFMC, Pune.
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Rational use of medicines
Patients receive medications:
• Appropriate to their clinical needs
• In doses meeting their individual requirement
• For an adequate period of time
• At lowest cost to them & their community
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Pattern of use of medicines
Globally, use of medicines at all levels is
frequently:
• Inappropriate
• Ineffective
• Inefficient
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Most misused medicines
• Antimicrobial agents
• Analgesics
• Vitamins
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Factors for irrational use
• Lack of knowledge in prescribers & patients
• Unrestricted availability of medicines
• Inappropriate promotion of medicines
• Profit motives from selling medicines
• Overwork of health personnel
• Lack of diagnostic facilities
• Inadequate govt regulations or their enforcement
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PrerequisitesPrerequisitesto curbto curb
Irrational use of medicinesIrrational use of medicines
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Prerequisites to curb irrational use of medicines
Monitoring of prescribing, dispensing and
patient use so as to know:
• Types of irrational use
• Amount of irrational use
• Reasons for irrational use
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Monitoring of use of medicines
Aggregate medicine consumption data:
• To identify expensive medicines of lower efficacy
• To compare actual consumption versus expected consumption from morbidity data
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Monitoring of use of medicines
Anatomical Therapeutic Classification / Defined Daily Dose methodology:
• To compare medicine consumption among institutions, regions and countries
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Monitoring of use of medicines
At primary health care facility level:
• Prescribing indicators
• Patient care indicators
• Facility indicators
• Complementary indicators
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PrescribingPrescribingindicatorsindicators
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Prescribing indicators
Mean no. of medicines prescribed perPrescription:
Risk of following increases with increase in
no. of medicines prescribed:
• Medicine antagonism
• Duplication of medicines
• Adverse effects, Compliance error
• Cost of treatment
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Prescribing indicators
Percentage of medicines prescribed by generic name: Use of brand names increases:• Cost of treatment
• Risk of payment of a share of the profit to the prescriber
• Risk of duplication of medicines
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Prescribing indicators
Percentage of prescriptions containing
antimicrobials and percentage of anti-
microbials prescribed from all prescribed
medicines:
Overuse of antimicrobials can lead to:• Development of medicine resistance• Super-infections• Allergies and other health hazards
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Prescribing indicators
Percentage of prescriptions containing injectables and percentage of injectable medicines prescribed from all prescribed medicines:
Disadvantages of injections are:
• Inconvenient, Painful, Less safe
• Reqm of skilled personnel to administer
• Higher cost
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Prescribing indicators
Percentage of prescriptions containingvitamin ppr.s and percentage of vitamin ppr.s prescribed from all prescribed medicines:
• Overuse may be due to belief among many patients and some prescribers that they are useful to improve general health & quality of life
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Prescribing indicators
Percentage of medicines prescribed from
the essential medicines list or formulary:
• Higher proportion of medicines prescribed from EML suggests it is probably due to the increased availability of essential medicines
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PatientPatientcarecare
indicatorsindicators
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Patient care indicators
Average consultation / dispensing time:
• Calculated by dividing the total time taken to consult / dispense medicines to series of patients by the number of patients.
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Patient care indicators
Percentage of medicines adequately labeled:
• Examine medicine packages / bottles, the patient had actually received.
Percentage of patients with knowledge ofcorrect dose:
• Time of administration and quantity for each medicine that was actually dispensed should be evaluated
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FacilityFacilityindicatorsindicators
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Facility indicators
Availability of essential medicines list or
formulary to practitioners:
• Prescribers are asked whether any essential medicines list or formulary exists in the dept during the study period
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Facility indicators
Percentage of key medicines available:
• Key medicines: Essential medicines from national EML to treat common health problems in that area
Availability of Std treatment guidelines:
• Prescribers are asked whether any such guidelines exists in the dept during the study period
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Complementary Complementary indicatorsindicators
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Complementary indicators
• Percentage of prescriptions in accordance with clinical guidelines
• Average medicine cost per encounter
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MeasuresMeasurestoto
improve RUMimprove RUM
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Measures to improve RUM
• Any medicine should be prescribed only when reasonable
• Prescribe minimum reqd no. of medicines
• Prefer cheaper but effective & safe medicine
• Prescribe medicines by generic names, in proper dosage form, dose and for adequate period
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Measures to improve RUM
• Availability of essential medicines
• Follow standard treatment guidelines
• Inform patient adequately about the use
• Monitor the patient: Benefits & Adversities
• Training of prescribers for RUM
• Programs for public awareness
• Reform in drug legislation be considered
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