Rational Use of Drug Ali Abad hospital April 12 th, 2005.
-
Upload
quentin-matthews -
Category
Documents
-
view
230 -
download
0
Transcript of Rational Use of Drug Ali Abad hospital April 12 th, 2005.
Rational Use of DrugRational Use of Drug
Ali Abad hospitalAli Abad hospitalApril 12April 12thth, 2005, 2005
PLANPLAN
Main Concepts-DefinitionsMain Concepts-Definitions
Problems of Irrational Use of DrugsProblems of Irrational Use of Drugs
Programmation Chart: 3 approachesProgrammation Chart: 3 approaches• Change prescribing habitsChange prescribing habits• Improve knowledge of doctors and pharmacistsImprove knowledge of doctors and pharmacists• Improve drug managementImprove drug management
Generic MedicineGeneric Medicine
What is it?What is it?
ICD: International Common ICD: International Common DenominationDenomination
Same active ingredient, same dosage, Same active ingredient, same dosage, same route of administrationsame route of administration
Same therapeutic effectSame therapeutic effect
Generic MedicineGeneric Medicine
Why using generics?Why using generics?
Less expensive to produceLess expensive to produce
Easier to buy Easier to buy
Easier to useEasier to use
Generic MedicineGeneric Medicine
How using generics?How using generics?
Packing when the patient submits Packing when the patient submits the presciption to the pharmacistthe presciption to the pharmacist
Pre-packingPre-packing
Essential DrugEssential Drug
What is it?What is it?
Medicines which cover the most urgent needs for the population
Essential drugEssential drug
Why using essential drugs?Why using essential drugs?
Good benefit-risk ratioGood benefit-risk ratio
Efficacity provedEfficacity proved
Safe useSafe use
Essential DrugEssential Drug
How using it?How using it?
Following standardized guidelinesFollowing standardized guidelines
EDLEDL Specific for each Specific for each
country, according to its country, according to its priorities in the health priorities in the health policy.policy.
Limited number and Limited number and types of drugs available types of drugs available at each level of health at each level of health servicesservices
In Afghanistan, list In Afghanistan, list established by the established by the BPHS; it consists of 237 BPHS; it consists of 237 medicines and items of medicines and items of medical material, medical material, available at 4 levelsavailable at 4 levels
EDLEDL
Type of HFType of HFNumber of Number of medicines medicines availableavailable
Total Total Number of Number of
itemsitems
HPHP 1515 2424
BHCBHC 4848 7676
CHCCHC 8080 120120
DHDH 8484 137137
STGSTG
A systematically A systematically developped developped collection of collection of statements statements designed to assist designed to assist prescribers prescribers decisions about decisions about appropriate health appropriate health care for specific care for specific clinical clinical circumstancescircumstances
Definition of RUDDefinition of RUD
The Rational Drug Use requires that patients The Rational Drug Use requires that patients receive medicines appropriate to their receive medicines appropriate to their clinical needs, in doses that meet their clinical needs, in doses that meet their individual requirements, for an adequate individual requirements, for an adequate period of time, and at the lowest cost to period of time, and at the lowest cost to them and the community. them and the community.
WHO, 1998WHO, 1998
Surveys about RUDSurveys about RUD
Prescribing Prescribing indicatorsindicators
Average number of drugs/encounterAverage number of drugs/encounter
% of encounters with ≥1 ATB% of encounters with ≥1 ATB
% of encounters with ≥1 injection% of encounters with ≥1 injection
% of drugs prescribed from EDL% of drugs prescribed from EDL
Patients Care Patients Care indicatorsindicators
% of drugs actually dispensed% of drugs actually dispensed
% of drugs adequally labeled% of drugs adequally labeled
Patients’ knowledge of correct dosagePatients’ knowledge of correct dosage
Facility Facility indicatorindicator
Availability of key drugsAvailability of key drugs
ResultsResultsComparison AMI clinics 2004/Standard INRUD/SCA 2002
61,3
4,9
92,1
81,1
73,2
30
10
100 100 100
50,5
5,5
89,2
79
1,10
20
40
60
80
100
120
% encounters withan ATB prescribed
% encounters withan injection
% drugs prescribedfrom EDL
% drugs actuallydispensed
% correct labeling
drug cores
perc
en
tag
es
AMI Clinics/BLS 2004
Golden Standard INRUD
SCA survey 2002
From the prescriberFrom the prescriber
Lack of knowledge about diagnosis, Lack of knowledge about diagnosis, therapeuticstherapeutics
Acquired habitsAcquired habits False beliefs about illness and drugsFalse beliefs about illness and drugs Economic motivations Economic motivations
Between patient and prescriberBetween patient and prescriber
Patient’s demand: lack of knowledge, Patient’s demand: lack of knowledge, family pressurefamily pressure
Quality of communicationQuality of communication
Work EnvironmentWork Environment
Influence of drugs availabilityInfluence of drugs availability Availability of diagnosis servicesAvailability of diagnosis services Lack of spaceLack of space WorkloadWorkload Availability of female staffAvailability of female staff
By changing prescribing habitsBy changing prescribing habits
Standardization of therapeutic schemesStandardization of therapeutic schemes Audits: prescription control sheetAudits: prescription control sheet
By improving knowledge of doctors By improving knowledge of doctors and pharmacistsand pharmacists
Specific trainingsSpecific trainings Printed educational material:Printed educational material: Therapeutic manuals (guidelines, EDL)Therapeutic manuals (guidelines, EDL) Clinical litterature (Salamati magazine)Clinical litterature (Salamati magazine) Posters (most frequently used drugs Posters (most frequently used drugs
dosages, tables of dilution, preparation dosages, tables of dilution, preparation and storage of antiseptic solutions...)and storage of antiseptic solutions...)
Improving the dispensation to the Improving the dispensation to the patient (1/1)patient (1/1)
Possibility of packaging by Possibility of packaging by advanceadvance
Correct labeled packetsCorrect labeled packets:: Name of the patientName of the patient Name and dosage of the drugName and dosage of the drug Schedule and durationSchedule and duration
Improving the dispensation to the Improving the dispensation to the patient (1/2)patient (1/2)
Explanations and advice to the patient:Explanations and advice to the patient:
How and when to take the treatmentHow and when to take the treatment Potential side effects, in which case he Potential side effects, in which case he
must stopmust stop Advise not to take other medication at the Advise not to take other medication at the
same time if not compatiblesame time if not compatible When he must come back if no improvmentWhen he must come back if no improvment