Rational Pharmacotherapy And Drug Information. Rational Pharmacotherapy The best medical treatment...
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Transcript of Rational Pharmacotherapy And Drug Information. Rational Pharmacotherapy The best medical treatment...
Rational PharmacotherapyRational Pharmacotherapy
AndAnd
Drug InformationDrug Information
Rational PharmacotherapyRational Pharmacotherapy
The best medical treatment The best medical treatment
under the present under the present
circumstancescircumstances
Best from the viewpoint of Best from the viewpoint of
the patient and societythe patient and society
Drug information:Drug information:
AAll facts and evidence on ll facts and evidence on drug, in particular its drug, in particular its therapeutic usetherapeutic use
IIn contrast to:n contrast to:
DDrug advertisementrug advertisement
Chain of events:Chain of events:
SSources of informationources of information
DDecision on rational pharmacotherapyecision on rational pharmacotherapy
CCreation of informationreation of information
DDisseminationissemination
Sources of informationSources of information
RRandomized clinical trialsandomized clinical trials
EEpidemiological studiespidemiological studies
OOther studiesther studies
If no studies: If no studies: EExtrapolationxtrapolation
Extrapolation is a Extrapolation is a necessity!necessity!
When and how to do it When and how to do it ??
EExamples:xamples:
Gender – age – raceGender – age – race
Diseases – drugs Diseases – drugs (synonymous/analogues)(synonymous/analogues)
Rules for extrapolation Rules for extrapolation between drugs:between drugs:
''AAnalogous' chemistrynalogous' chemistrySSame mode of actioname mode of actionCComparable chemistryomparable chemistry
Studies have – in some Studies have – in some respects – shown similar respects – shown similar efficacy and adverse reactionsefficacy and adverse reactions
The Life StudyThe Life Study
aatenolol versus tenolol versus llosartanosartan
llosartan,osartan,better than better than aatenololtenolol
Press Press RRelease:elease:COZAAR,COZAAR,better than ß-blockersbetter than ß-blockers
All doctors and agencies haveAll doctors and agencies have
to take a greater responsibilityto take a greater responsibility
in demanding and supportingin demanding and supporting
needed studiesneeded studies
((iimportant head-to-head studies)mportant head-to-head studies)
Decision on rationalityDecision on rationality
EffectEffect
Adverse Reactions Adverse Reactions xx Price Price
Parameter of efficacy:Parameter of efficacy:
QQualitatively correctualitatively correct
RReal versus surrogateeal versus surrogate
QQuantitatively correctuantitatively correct
RReduction:eduction:
per cent or per cent or per cent per cent
pointpoint
How large shouldHow large shouldthe effect be the effect be ??
It depends on:It depends on:
TThe diseasehe disease
OOther treatmentsther treatments
AAdverse reactionsdverse reactions
PPricerice
Have to solve the Have to solve the problem ?problem ?
AAsk the patientssk the patients
StatisticsStatistics
SSignificantignificant
AAlmost significanlmost significan
TTrends towards significant rends towards significant
differencedifference
NNumerial differenceumerial difference
AAnd much morend much more
Drug Information should beDrug Information should be
CCorrectorrect
CCompleteomplete
CComparativeomparative
CComprehensibleomprehensible
ImplementationImplementation
TThe most difficult part he most difficult part !!
Many studies:Many studies:
wwritten feed-back is easyritten feed-back is easy
but not very effectivebut not very effective
Academic detailing isAcademic detailing is
time-consuming and difficult,time-consuming and difficult,
but more effectivebut more effective
J01J01 intervention:intervention: - 6,1 %- 6,1 %
control:control: + 4,8 %+ 4,8 %
MacrolidesMacrolides intervention:intervention: - 18,5 %- 18,5 %
(J01FA)(J01FA) control: control: - 3,1 %- 3,1 %
PivmecillinamPivmecillinam intervention:intervention: - 15,7 %- 15,7 %
(J01CA08)(J01CA08) control:control: + 3,7 %+ 3,7 %
Development in the use of antibiotics Development in the use of antibiotics
(from 1999-2 to 2000-2)(from 1999-2 to 2000-2)
Disturbing factor (barriers)Disturbing factor (barriers)AAggressive advertisingggressive advertising
TThe press creating dramatic storieshe press creating dramatic stories
DDoctors indolenceoctors indolence
PPatients unrealistic and selfish atients unrealistic and selfish
demandsdemands
LLegal views versus biologyegal views versus biology
CComplacent and bureaucratic omplacent and bureaucratic
administrationadministration
Politicians:Politicians:
IndustrialIndustrial
versusversus
Health PolitiesHealth Polities
Wishes for the dayWishes for the day
WWhat is rational pharmacotherapy hat is rational pharmacotherapy ??
HHow it is created and implemented ow it is created and implemented ??
WWhy so many differences in EU hy so many differences in EU ??
MMutual benefit utual benefit ??