RATIONAL USE OF Medicine2.pptx

RATIONAL USE OF
MEDICINE; THE ROLE
OF PHARMACIST
Presented by: Steven Egili
(Bsc, BPharm, PharmD)
Moderator: Pharm. (Mrs) Izekor
1

OUTLINE
 Introduction
 Definition
 Factors causing Irrational Use of Medicines (IUM)
 Aspects of Irrational Use of Medicines
 Possibility of rational prescribing in UBTH
 Components of rational use of medicine program
 Role of a pharmacist in the promotion of rational use of medicine
 Case study
 Conclusion
 References
2

Introduction
Definition:
Medicines: are substances that have the ability to influence the
physiological and biochemical activity of the cells in the body
 They are used in diagnosis, prevention and treatment/management
of illnesses
 The full potential of medicines is only realized when used rationally
(WHO, 1996)
3

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)
5

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 fulfills following criteria;
• Appropriate indication
• Appropriate medicine
• Appropriate dosage
• Correctly dispensed
• Appropriately informed patients
• Patient adherence 6

Importance of RUM
Factors that have led sudden realization for rational drug use
are.
 Drug explosion/ proliferation
 Efforts to prevent the development of resistance
 Growing awareness
 Increased cost of the treatment
 Consumer protectionAct.
7

IRRATIONAL USE OF
MEDICINE
Medically inappropriate, ineffective, and economically
inefficient use of pharmaceuticals
(Vance and Millington 1986)
8

Impact of inappropriate
use of medicine
• Reduced quality of therapy:
morbidity, mortality
• Risk of unwanted effects:
adverse reactions, bacterial resistance
• Waste of resources :
reduced availability, increased cost
• Psychological impact
9

Many Factors Influence Use of
Medicines
.
Prescriber,
dispenser&
their work Places
Rational Use Of
Medicine
Policy, Legal
and Regulatory framework
Patient &
community
Drug Supply System
10

Factors…..
 Patient: misinformation, cultural practices and beliefs,
communication barriers/ access to pharmacists patient
demands/expectations
 Prescribers: lack of updated information, heavy patient load,
generalization of limited knowledge, misleading beliefs about
drugs efficacy
 Industry pressure: from sales targets, use of unqualified sales
rep, misleading claims, quality of medicines.
11

Factors……
 Pharmacists:
• lack of access to updated drug information to
health care providers (registration/ subscription
may be required to access certain journals)
• lack of training/ update training, few or no
research work in practice e.g. hospital setting
• Generic substitution at every clinic visit
• Time factor/ no counselling room
12

Factors….
 Drug distribution network (inefficient management) drug
supply, availability of these medicines, and quality of
medicines.
 Drug regulations and policies: Pharmacy laws and
implementation of these laws, informal prescribers ,lack of
regulation enforcement
 Workplace: heavy patient load, pressure to prescribe,
lack of adequate lab capacity, insufficient staffing
13

Diagnosing
 Inadequate examination of patient
 Incomplete communication between patient and doctor
 Lack of documented medical history
Prescribing
 Under prescribing
 Incorrect prescribing
 Extravagant prescribing
 Overprescribing
 Multiple prescribing
Aspects of Irrational Use of
Medicines
14

Aspects….
Dispensing
 Incorrect interpretation of the prescription
 Inadequate treatment monitoring
 Retrieval of wrong ingredients
 Inaccurate counting, compounding, or pouring
 Inadequate labeling
 Unsanitary procedures
 Poor-quality packaging materials
15

Aspects…..
Patient adherence
 Poor labeling
 Inadequate oral instructions
 Inadequate counseling to encourage adherence
 Inadequate follow-up or support of patients
 Treatments or instructions that do not consider the patient’s
beliefs, environment, or culture
 Medication burden
16

Possibility of rational
prescribing
Step I Patient Problem
• Identify Pt problem
• Detailed history
• Drug history
Step II Diagnosis
• A prerequisite to RUM
18

Possibility..
Step III Therapeutic Objective
 Therapeutic objective of RA?
Possible interventions
Step IV Select Treatment
 Life style modification
 Drug selection (safety, efficacy, cost, ease of adm)
19

Possibility..
 Step V Start treatment
 Step VI results of Treatment
 Step VII Conclusion of therapy
20

COMPONENTS OF RUM PROGRAM
 Drug use indicators
 Drug and Therapeutics Committee
 Standard Treatment Guidelines (STGs)
 Educational intervention: training, printed material, media
based approaches
 Drug Information service: Physician, Public, News letter,
videos verbal, Withstand promotional pressure
21

DRUG USE INDICATORS
used as measures of performance in
three general areas related to the
rational use of drugs in primary care:
Prescribing
practices
Patient care
Facility specific
factors
22

Prescribing Indicators
Indications Standard Values
1. Average number of drugs per encounter 1.6 - 1.8
2.Percentage of encounters with an antibiotic prescribed 20.0 - 26.8%
3.Percentage of encounters with an injection prescribed 13.4 - 24.1%
4.Percentage of drugs prescribed by generic name 100.0%
5.Percentage of drugs prescribed from the essential drug list or
formulary
100.0%
23

Patient-care indicators
Indications Standard
Values
Average consultation time (minutes) ≥10
Average dispensing time (seconds) ≥90
Percentage of medicines actually dispensed 100%
Percentage of medicines adequately labeled 100%
Percentage of patients with knowledge of correct doses 100%
24

Facility-specific indicators
Indications Standard Values
Availability of essential medicines list or formulary to practitioners 100%
Percentage key medicines available 100%
25

DRUG AND THERAPEUTICS COMMITTEE
Providing Advice On All Aspects Of Drug Management
 developing drug policies
 evaluating and selecting drugs for the formulary list
 developing (or adapting) and implementing STGs
 assessing drug use to identify problems
 conducting interventions to improve drug use
 managing adverse drug reactions and medication errors
 informing all staff members about drug use issues, policies and decisions.
26

USES OF STGs
 providing guidance to health professionals on the diagnosis
and treatment of specific clinical conditions
 orienting new staff about accepted norms in treatment
providing prescribers with justification for prescribing
decisions made in accordance with STGs
 providing a reference point by which to judge the quality of
prescribing
 aiding efficient estimation of drug needs and setting
priorities for procuring and stocking drugs. 27

Role of the
Pharmacist
in RUM
28

Role of a pharmacist in the promotion
of rational use of medicine
Member of the drug and therapeutic
committee
Drug procurement
Drug storage
Dispensing
Patient education
Pharmacovigilance
Drug information service
Pharmaceutical care
29

PROMOTING RATIONAL USE OF
DRUGS IN DISPENSING SETUP
 The Pharmacist shall keep all controlled drugs in a locked
cabinet under his/her own direct supervision and control.
 The Pharmacist must check validity of the prescription and
identity of the patient before dispensing
 The Pharmacist shall consult the prescribing doctor if there is
any doubt about the prescription.
 The Pharmacist shall only dispense controlled drugs if the
prescription provided by the physician is complete and valid. 30

Promoting…
 The Pharmacist shall properly label and mark containers to avoid
undue intermixing that may cause harm to the patient.
 The Pharmacist shall provide complete information to the patient
about the prescribed drug he/she is dispensing including cautions,
warnings and clear direction for use.".
31

Under the current regulation, the pharmacist is not permitted
either to refill or substitute a generically equivalent controlled drug
unless discussed with the physician
The Pharmacist shall provide complete information to the patient
about the prescribed drug he /she is dispensing including cautions,
warnings and clear direction for use.
Promoting…
32

CASE STUDY
DEMOGRAPHIC DATA
• Patient J.R is a 4 year old male child. Urhobo by tribe and resides with the parents
at Benin City
CHIEF COMPLAINT:
• Patient reported to NHIS & staff Clinic on 19 of August with a chief compliant of a
sensation on the throat, throat discomfort, stooling, vomiting, generalized body
weakness, fever, headache, and loss of appetite.
HISTORY OF PRESENT ILLNESS
• Patient reported to have started experiencing symptoms of body weakness and fever
2 days ago.
33

Case…
REVIEW OF SYSTEM
Weigth: 19kg
CVS: BP-92/50mmHg (89/46mmHg), Pulse rate- 148bpm (120-160bpm)
CHEST: Respiratory rate- 24bpm (breaths/min) (20-30bpm)
ABDOMEN: Flat and tender.
CNS: Conscious and alert
TEMPERATURE: 37.6 degrees Celsius
Physical examination
patient JR is calm, febrile, pale, acyanosed, dehydrated , no pulmonary edema, Pupil is
equal and bilateral reactive to light.
Lab inv: NA 34

Case…
WORKING DIAGNOSIS: Malaria URTI
WORKING PLAN:
 Arteether: A-B injection: 60 mg OD x 3days
 Paracetamol Injection: 200 mg immediately
 Artesunate + Amodiaquinne 150mg/50mg: 2 satchets OD x 3
days
 Cefuroxime Suspension 100ml: l0mls BiD x5days
 Ibuprofen Syrup 100mls: 10mls TDS x5days
 Multivite Syrup: 5mls TDS x5 days
 Vitamin C Syrup (Ascorbic Acid): 5mls TDS x5days
 Vitamin B Complex Syrup: TDS x5days
 Chlorpheniramine Syrup (Piriton): 5mls OD x3days.
35

Identifying a Priority
Problem
Potential problem
 Inadequate oral instruction
 Inadequate counselling to encourage adherence
 Incomplete communication between patient and doctor
Actual problem
 Poly pharmacy
 Non adherence to STG
 Multiple prescribing
 Increased medical cost
 Incorrect prescribing
 Use of drug therapy for a self- limiting condition
36

RECOMMENDATIONS
• Need for review of current policies and systems in the hospital
• Prescribers should be encouraged to comply with the standard
therapeutic guidelines
• Educational and behavioral intervention and use of pre-
packaged drugs would probably improve the dispensing
practice
• Infrastructural facelift of the dispensing units is also
necessary
• A review of the drug procurement and selection policy may be
necessary to reduce medicine cost 37

Conclusion
Medication use is the end of the therapeutic consultation. Ensuring
that the correct medication is given to the correct patient is a high
priority for all health professionals. RUM in UBTH can be
significantly improved when Health planners and prescribers uses
available guidelines provided to improve the quality of care
provided to their patients.
38

References
NAFDAC (2007): The Journey to Pharmacovigilance – Nigeria tells its story. National
Agency for Food and Drug Administration and Control, Nigeria, 2007.
www.pop.org.ph/v3/HERO/pharmacovigilance (accessed 13/09/08).
RATIONAL DRUG USE by Dr Sneha Ambwani* Dr A K Mathur **, Health
Administrator Vol : XIX Number 1: 5-7
Vance MA, Millington WR. (1986) Principles of irrational drug therapy. Int J Health
Serv. 1986;16(3):355–61.
WHO (1985) The rational use of drugs, Report on the conference of experts Nairobi,
25-29 Nov.1985 sponsored by W.H.O. Geneva.
World Health Organisation (1996): Essential drugs: Looking back and exploring the
future. WHO Drug Information. 1996; 10(2).
World Health Organisation. (1988) Guidelines for Developing National Drug Policies.
Geneva: World Health Organisation; 1988.
39

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