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Perspectives and achievements with Rational Pharmacotherapy Meeting under Danish EU presidency Implementation of Rational Pharmacotherapy Copenhagen, November 6, 2002 WHO/EURO Kees de Joncheere, Regional Adviser Pharmaceuticals

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Overview of the presentation Pharmaceutical policies in Europe Rational use of medicines Comparing European countries Improving the prescribing and use of medicines Concluding remarks

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Challenges for pharmaceutical policies in Europe Equitable access for patients to effective, safe and good quality medicines Enhancing appropriate use of medicines for better health outcomes Ensuring value for money Balance with industrial policy objectives Values underpinning health systems : equity, quality, solidarity, participation and accountability

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Pharmaceutical policies and the EU EU regulatory framework and legislation National responsibilities on pricing and reimbursement (subsidiarity) Transparency directive Industrial policy communication 1995 Single market communication 1998 Public health communication 2000 Portugal 2000, EU MINE, DG5/health High Level committee, G 10, Review 2000-1

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Medicines and Public health in EU Future of the European system for evaluations and supervision of medicinal products Relevance of the added therapeutic value of medicinal products ( registration criteria ? Placebo or comparator?) Aspects determining innovation and research Rational use of medicinal products Importance and evolution trends for the information systems Increasing use of generic medicines Adoption of EU public health action plan, 2002

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Rational use of medicines Right patient with right indication Right medicine Right dose/administration Right information Right moment to stop or change

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Inappropriate use leads to Adverse effects Sub-optimal outcomes Waste of resources ( money, health professionals and patients time)

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Why are drugs not used rationally ? Lack of training and knowledge Marketing practices Financial incentives for irrational use Availability problems Patient expectations Prescribing as a means to finish the consultation Health systems and services effects

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Measuring and monitoring the use of medicines Describe and compare existing situations and patterns Identify differences and potential problems Monitor results of interventions Lessons drawn from other countries` experiences

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From drug utilisation to cost- effective intervention (1) Drug utilisation studies tend to be descriptive, aggregated data : WHAT? Indicator studies more focused on rational drug use: WHAT? HOW MUCH? Qualitative studies WHY?

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From drug utilisation to cost- effective intervention (2) Intervention studies HOW MUCH? WHY? (intervention) HOW MUCH NOW? Conclusion DOES IT WORK? IS THE INTERVENTION EFFECTIVE? Management studies IS THE INTERVENTION REPRODUCABLE? IS IT COST-EFFECTIVE?

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Examples of indicators (WHO/INRUD) Prescribing indicators Average number of drugs per encounter (