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.

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

Pattern of use of medicines

Globally, use of medicines at all levels is

frequently:

• Inappropriate

• Ineffective

• Inefficient

Most misused medicines

• Antimicrobial agents

• Analgesics

• Vitamins

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

PrerequisitesPrerequisitesto curbto curb

Irrational use of medicinesIrrational use of medicines

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

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

Monitoring of use of medicines

Anatomical Therapeutic Classification / Defined Daily Dose methodology:

• To compare medicine consumption among institutions, regions and countries

Monitoring of use of medicines

At primary health care facility level:

• Prescribing indicators

• Patient care indicators

• Facility indicators

• Complementary indicators

PrescribingPrescribingindicatorsindicators

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

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

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

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

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

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

PatientPatientcarecare

indicatorsindicators

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.

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

FacilityFacilityindicatorsindicators

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

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

Complementary Complementary indicatorsindicators

Complementary indicators

• Percentage of prescriptions in accordance with clinical guidelines

• Average medicine cost per encounter

MeasuresMeasurestoto

improve RUMimprove RUM

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

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

29