Download rational drug use programme

RATIONAL USE OF DRUGS
Haryana State Health Resource Centre
PHARMACEUTICAL MANAGEMENT CYCLE
Selection
Use
Management
Support
Procurement
Distribution
Policy, Regulations, Laws
INSTANCES OF IRRATIONAL USE
PRESCRIPTION LEVEL
 Use of Cap Amoxi+ Clox- combination is irrational
(Reasons-same class, no increase in spectrum and
dose schedule is different)

Annual Consumption in 2010-11 is Rs 49.66 Lacs
(5th largest ).

Ciplox 500mg is the topmost Antibiotic (Rs74.6
lacs) on verge of developing resistance.

Levoflox should not be used indiscriminately in
chest infections as it is a 2nd line ATT
INSTANCES OF IRRATIONAL USE
DISPENSING LEVEL
 Use of Tinidazole 300mg is used while 500mg
has nil consumption (Taken from monthly drug
consumption report)
(300mg is inadequate dose for adult patients)

Substitution of doctor’s prescription
Substitution of Nimuslide with
Diclofinac/Brufen which can cause Angiodema
in prone patients
INSTANCES OF IRRATIONAL USE
PATIENT LEVEL
 Iron causes gastric irritation and change in
stool color
 Metronidazole causes taste alteration
 This can reduce compliance and may lead to
incomplete treatment
 Simply giving information of common side
effects can improve compliance and better
treatment outcome
EXAMPLES OF IRRATIONAL USE

Poly pharmacy

Misuse of antibiotics

Overuse of injections

Under-use of drugs for chronic illnesses like HT,
Epilepsy, Depression, BA,COPD
WHY RATIONAL USE OF MEDICINES?
 Problems:
 Ineffective
treatment
 Increased financial burden
 Wastage of resources
 Side effects of drugs leading to increase in
disease burden
 Drug resistance especially antibiotic resistance
(public health problem)
 e.g. Amoxicillin & Cloxacillin (as described
earlier)
WHAT IS RATIONAL USE OF MEDICINES?

The rational use of medicines requires that
patients receive medicines appropriate to
their clinical needs, in doses that meet
their own individual requirements, for an
adequate period of time, and at the lowest
cost to them and the community
(WHO 1988)
8
TOOLS TO PROMOTE RDU

Essential Medicine List (EML)

Drug Formulary

Standard Treatment Guidelines

Trainings to doctors and paramedical staff

Prescription Audit

Drug Utilization Studies
STEPS TOWARDS RDU

Preparation of Standard Treatment Guidelines
(STGs)

Updating the Essential Medical List based on
the STGs

Preparation of Drug Formulary

Prescription Audit & Drug use studies
STANDARD TREATMENT GUIDELINES
“Systematically developed statements
to help practitioners or prescribers
make decision about appropriate
treatments for specific clinical
conditions.”
ADVANTAGES OF STGS
Pt Level : Optimal drug treatment
 Prescriber Level: Guidance to prescribers
 Policy Level:

 Revision
of EML
 Demand estimation
 Per capita consumption
 Budget allocations
 Rationalize Procurement of drugs
DRAFTING OF STG

Workshop was held on RDU & STGs
Specialists from each specialty from all distt.
 Sensitized about need of RDU & STGs
 STGs of Haryana state based on local disease profile

Formation of a State Level Committee headed
by The DGHS is being formed.
 Civil Surgeons should ensure maximum feed
back to this committee so that STG is a made
with participation of all as full participation will
help in proper implementation

PRESCRIPTION AUDIT
A tool for monitoring and evaluation of drug
management system
 Availability & Use of drugs
 Rational / irrational
 Why ,Why, Why, Why, Why to get to the bottom
 Not fault finding exercise
 Hand holding at each level (Prescriber,
dispenser and patient)

Diagnosis
H/o previous drug intake
H/o allergy to any drug
H/o BA, HT, Jaundice, DM
Out of list abbreviations
Handwriting
No. of drugs prescribed
Drug name & of first or second choice
Irrational drugs or drug combinations
Dose of drug/drugs
Dosage form
Dose frequency
Duration of treatment
Signature of doctor,
Drug drug interaction
Prescription cost
Recorded or not
Recorded or not
Recorded or not
Recorded or not
Used or not
Clear or not
Brand or Generic
Adequate or not
Adequate or not
Adequate or not
Adequate or not
Present or not
Considered or not
THANK YOU