Rational Use of Medicine Dr. Anjan Adhikari MBBS, MD, R G Kar Medical College Kolkata

1. Rational Use of MedicineDr. Anjan AdhikariMBBS, MD,R G Kar Medical CollegeKolkata

2. Drugs/Medicines can do good • Drugs can do harm • Whenever a drug is taken a risk is taken

4. Rational Use of Drugs/Medicines • "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 the lowest cost to them and their community." • But it actually means: • Right drug for right person at right time in right dose, duration & frequency and obviously at right cost.

5. Right Drug for Right Person at Right Time in Right Dose.......... • But…… • Safe & Effective Drugs are first priority

7. Once a patient with clinical problems has been evaluated and a diagnosis is reached, the physician can select any one of the variety of therapeutic approaches. • Medication, surgery, radiation, physical therapy, health education, counseling, further consultation and no therapy are some of the options available.

8. Of these options, drug/medicine therapy is by far the one most commonly chosen. Usually prescriptions of medications are the results of 67% cases of physician patient contact.

9. Rational Use of Drugs/Medicines • As much as 50% of the health budget of developing countries is used for buying drugs. • Worldwide more than 50% of all medicines are prescribed, dispensed or sold inappropriately, while 50% of patients fail to take them correctly.

10. Medicines are nothing in themselves but are the very hands of god if employed with reason & prudence. --Alexandrian physician Herophilus 300 B. C.

11. Successful action of any drug, not only depend on the potency and efficacy of the drug, the advice from trained professionals, health care service providers, the rational and judicious prescribing, dissemination of adequate information to the patient about drug use but also on other factors like purchasing power of the patient, patient’s knowledge about the use of drug & dose, adverse drug reaction, storage conditions of the drug, adherence to therapy, etc.

12. There are four facets of drug use in any society, namely the pharmaceutical industries, wholeseller-retailer-pharmacist chains, the physician and the patients. • Any defect at any point of this chain can lead to irrational use of drugs in the society.

13. Drug Use Process

14. Medically inappropriate, ineffective, and economically inefficient use of pharmaceuticals is commonly observed in the health care system throughout the world especially in the developing countries. • However, various forms of inappropriate prescribing often remain unnoticed by those who are involved in health sector decision making or delivery of health services. • This problem will usually come to the attention of health decision makers or managers when there is an acute shortage of pharmaceutical budget and action for cost efficiency is required.

15. The need for promoting appropriate use of drugs in the health care system is not only because of the financial reasons but also for other reasons. • Appropriate use of drugs is also one essential element in achieving quality of health and medical care for patients and the community. • Obviously, this should also become the concern of practitioners. • Actions or intervention programs to promote the appropriate use of drugs should, therefore, be continuously implemented and systematically incorporated as an integral part of the health care system.

16. These requirements will be fulfilled if the process of prescribing is appropriately followed. • This will include steps in defining patient’s problems (or diagnosis); in defining effective and safe treatments (drugs and non-drugs); in selecting appropriate drugs, dosage and duration; in writing a prescription; in giving patients adequate information; and in planning to evaluate treatment responses.

17. Criteria for irrational medicine use: • Appropriate indication. The decision to prescribe drug(s) is entirely based on medical rationale and that drug therapy is an effective and safe treatment. • Appropriate drug. The selection of drugs is based on efficacy, safety, suitability and cost considerations. • Appropriate patient. No contra-indications exist and the likelihood of adverse reactions is minimal and the drug is acceptable to the patient. • Appropriate information. Patients should be provided with relevant, accurate, important and clear information regarding his or her condition and the medication(s) that are prescribed. • Appropriate monitoring. The anticipated and unexpected effects of medications should be appropriately monitored.

18. Unfortunately, in the real world, treatment patterns do not always conform to these criteria and can be classified as inappropriate or irrational prescribing. • Irrational prescribing may be regarded as "pathological" pharmacotherapy, where the above-mentioned criteria are not fulfilled.

19. Common patterns of irrational prescribing: • The use of drugs when no drug therapy is indicated, e.g., antibiotics for viral upper respiratory infections. • The use of the wrong drug for a specific condition requiring drug therapy, e.g., ciprofloxacilin & tinidazole combination in diarrhoea requiring ORS, • The use of drugs with doubtful/unproven efficacy, e.g., the use of antimotility agents in acute diarrhoea,

20. The use of drugs of uncertain safety status, e.g., use of Baralgan, Nimesulide, Mosapride, etc. • Failure to provide available, safe, and effective drugs, e.g., failure to vaccinate against measles or tetanus, failure to prescribe ORS for acute diarrhoea • The use of correct drugs with incorrect administration, dosages, and duration, e.g., the use of IV metronidazole when suppositories or oral formulations would be appropriate. • The use of unnecessarily expensive drugs, e.g. the use of a third generation, broad spectrum antimicrobial when a first-line, narrow spectrum agent is indicated.

21. Overuse of antibiotics and antidiarrhoeals for non-specific childhood diarrhea, • Indiscriminate use of injections, e.g., in malaria treatment, • Multiple drug prescriptions, • Excessive use of antibiotics for treating minor ARI. • Minerals and tonics for malnutrition. • Consumers may have a very different perspective as what is rational.

22. The drug use system is complex and varies from country to country. Drugs may be imported or manufactured locally. The drugs may be used in hospitals or health centers, by private practitioners and often in a pharmacy or drug shop where OTC preparations are sold. In some countries all drugs are available over the counter. • Finally, the public includes a very wide range of people with differing knowledge, beliefs and attitudes about medicines.

23. Factors that have led sudden realization for rational drug use: ●Drug Explosion ●Efforts to prevent the development of resistance ●Growing awareness ●Increased Cost of Treatment ●Consumer Protection Act

24. Reasons for Irrational drug use: 1).Lack of information 2).Faulty and inadequate training, education of medical and nursing students. 3).Poor communication between health professionals & patients 4).Lack of diagnostic facilities/Uncertainity of diagnosis 5).Demand from the patients 6).Defective supply system & ineffective drug regulations 7).Promotional activities of pharmaceutical industries

25. Impact of Inappropriate Use of Drugs • The impact of this irrational use of drugs can be seen in many ways: • Reduction in the quality of drug therapy leading to increased morbidity and mortality • Ineffective & unsafe treatment • Exacerbation and prolongation of the illness • Waste of resources leading to reduced availability of other vital drugs and increased costs

26. Impact of Inappropriate Use of Drugs • Distress and harm to the patient • Increased risk of unwanted affects such as adverse drug reactions and the emergence of drug resistance, e.g., malaria or multiple drug resistant tuberculosis • Increase the cost of treatment • Psychosocial impacts, such as when patients come to believe that there is "a pill for every ill". This may cause an apparent increased demand for drugs.

27. So, for Rational Use of Drugs • Appropriate: • indication • drug • dosage & administration, • patient, and • information

28. Requirement for rational drug use • Adequate diagnosis : For a correct diagnosis to be made, the prescriber must have adequate knowledge and motivation, private examination facilities, and sufficient time to take a history, perform an examination, and explain to the patient the diagnosis and treatment. Correct prescribing : To prescribe correctly, the prescriber must know which drug to prescribe for which diagnosis or complaint and when treatment without drugs is appropriate. Appropriate dispensing : For correct dispensing to occur, the dispenser must be trained, have adequate time, have the necessary materials (containers, labels), and have a dispensary where it is possible to communicate with patients. Patient adherence to treatment (compliance) : Patient adherence to treatment is dependent on understanding and acceptance of the treatment; this results from effective communication between prescriber, dispenser and patient.

29. Right Drug for Right Person at Right Time in Right Dose..........Thank you