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Problems of Irrational DrugProblems of Irrational DrugUseUse
Problems of Irrational Drug Use 2
Problems of Irrational Dru g Use:Problems of Irrational Dru g Use:ObjectivesObjectives
•• Identify magnitude and nature of inappropriateIdentify magnitude and nature of inappropriatedrug utilizationdrug utilization
•• Understand the adverse impacts ofUnderstand the adverse impacts ofinappropriate use of drugsinappropriate use of drugs
•• Describe factors which influence the decision-Describe factors which influence the decision-making processmaking process
•• Identify factors which influence the behavior ofIdentify factors which influence the behavior ofprescribers and patientsprescribers and patients
•• Discuss specific medication use problemsDiscuss specific medication use problems
Problems of Irrational Drug Use 3
What is Rational Use of Dru gs?What is Rational Use of Dru gs?
The rational use of drugs requires that patients receive medicinesThe rational use of drugs requires that patients receive medicinesappropriate to their clinical needs, in doses that meet their own individualappropriate to their clinical needs, in doses that meet their own individual
requirements, for an adequate period of time, and at the lowest cost torequirements, for an adequate period of time, and at the lowest cost tothem and the community.them and the community.
(WHO 1988)(WHO 1988)
●● Appropriate indication Appropriate indication●● Appropriate drug Appropriate drug●● Appropriate administration, dosage, and duration Appropriate administration, dosage, and duration●● Appropriate patient Appropriate patient●● Appropriate patient information Appropriate patient information●● Appropriate evaluation Appropriate evaluation
Problems of Irrational Drug Use 4
Irrational Use of Dru gs = Patholo gyIrrational Use of Dru gs = Patholo gyof Prescribin gof Prescribin g
•• The use of drugs when no drug therapy is indicatedThe use of drugs when no drug therapy is indicated
•• The use of wrong drugs for a specific conditionThe use of wrong drugs for a specific conditionrequiring drug therapyrequiring drug therapy
•• The use of drugs with doubtful or unproven efficacyThe use of drugs with doubtful or unproven efficacy
•• The use of drugs of uncertain safety statusThe use of drugs of uncertain safety status
•• Failure to prescribe available, safe, & effective drugsFailure to prescribe available, safe, & effective drugs
•• Incorrect administration, dosages, or durationIncorrect administration, dosages, or duration
Problems of Irrational Drug Use 5
Examples of Common InappropriateExamples of Common InappropriatePrescribin g PracticesPrescribin g Practices
•• The overuse of antibiotics and antidiarrheals forThe overuse of antibiotics and antidiarrheals fornonspecific childhood diarrheanonspecific childhood diarrhea
•• Indiscriminate use of injections for malariaIndiscriminate use of injections for malaria•• Multiple or over-prescriptionMultiple or over-prescription•• Use of antibiotics for mild, non-bacterialUse of antibiotics for mild, non-bacterial
infection, e.g., URIinfection, e.g., URI•• Tonics and multivitamins for malnutritionTonics and multivitamins for malnutrition•• Unnecessary use of expensiveUnnecessary use of expensive
antihypertensivesantihypertensives
Problems of Irrational Drug Use 6
Components of the Dru g UseComponents of the Dru g UseSystemSystem
Drug ImportsDrug ImportsLocalLocal
ManufactureManufacture
HospitalHospital or or HealthHealth CenteCente rr
Private Physician orPrivate Physician or Other PractitionerOther Practitioner Pharmacist orPharmacist or
Drug TraderDrug Trader
The DrugThe Drug SupplySupply ProcessProcess
Provider andProvider and Consumer BehaviorConsumer Behavior
Illness PatternsIllness Patterns
++
PublicPublic
Problems of Irrational Drug Use 7
Factors Underlyin g IrrationalFactors Underlyin g IrrationalUse of Dru gsUse of Dru gs
•• inefficientinefficientmanagementmanagement
•• non-availabilitynon-availabilityof requiredof requireddrugsdrugs
Drug SupplyDrug SupplyDrug Supply
•• availability ofavailability ofunsafe drugsunsafe drugs
•• informalinformalprescribersprescribers
•• etc.etc.
Drug RegulationDrug RegulationDrug Regulation
•• promotionpromotion•• misleadingmisleading
claimsclaims
IndustryIndustryIndustry
•• lack of educationlack of educationand trainingand training
•• lack of druglack of druginformationinformation
•• heavy patient loadheavy patient load•• pressure topressure to
prescribeprescribe•• generalization ofgeneralization of
limited beliefslimited beliefs•• misleading beliefsmisleading beliefs
about efficacyabout efficacy
PrescribersPrescribersPrescribers•• drugdrug
misinformationmisinformation
•• misleadingmisleadingbeliefsbeliefs
•• inability toinability tocommunicatecommunicateproblemsproblems
PatientsPatientsPatients
Problems of Irrational Drug Use 8
Impact of InappropriateImpact of InappropriateUse of Dru gsUse of Dru gs
ReducedReducedquality ofquality oftherapytherapy
••morbiditymorbidity••mortalitymortality
Waste ofWaste ofresourcesresources Risk ofRisk of
unwantedunwantedeffectseffects
••patients rely onpatients rely onunnecessary drugsunnecessary drugs
Psycho-socialPsycho-socialimpactsimpacts
••Reduced availabilityReduced availability••increased costincreased cost
••adverse reactionsadverse reactions••bacterial resistancebacterial resistance
Problems of Irrational Drug Use 9
Activity 1Activity 1
Meaning of Appropriate UseMeaning of Appropriate Use
Problems of Irrational Drug Use 10
Drugs per Case by A ge Group:Drugs per Case by A ge Group:E. Java & W. Kalimantan, Indonesia, 1987E. Java & W. Kalimantan, Indonesia, 1987
OneOne3%3%
TwoTwo14%14%
ThreeThree27%27%
FourFour26%26%
FiveFive17%17%
SixSix ++13%13%
OneOne1%1%
TwoTwo9%9%
ThreeThree29%29%
FourFour35%35%
FiveFive19%19%
SixSix + +6%6%
Under 5Under 5 Five & OverFive & Over
Problems of Irrational Drug Use 11
All CasesAll Cases DiarrheaDiarrhea RespResp ..DisDis .. SkinSkin G.I.G.I. MusculoskelMusculoskel .00
11
22
33
44
55
# Drugs per Case# Drugs per Case
Under FiveUnder FiveFive & OverFive & Over
Drugs Per Case B y DiagnosisDrugs Per Case B y DiagnosisE. Java & W. Kalimantan, Indonesia, 1987E. Java & W. Kalimantan, Indonesia, 1987
Problems of Irrational Drug Use 12
NoneNone12%
OneOne56%
TwoTwo29%
Three/MoreThree/More3%
NoneNone35%
OneOne36%
TwoTwo27%
Three/MoreThree/More2%
5 & Over 5 & Over Under 5 Under 5
% Of Patients Receivin g% Of Patients Receivin gAntibioticsAntibioticsE. Java & W. Kalimantan, Indonesia, 1987E. Java & W. Kalimantan, Indonesia, 1987
Problems of Irrational Drug Use 13
NoneNone56%
OneOne34%
Two or MoreTwo or More10%
NoneNone26%
OneOne
54%
Two or MoreTwo or More20%
Under 5Under 5 5 & Over 5 & Over
% Of Patients Receiving Injections% Of Patients Receiving InjectionsE. Java & W. Kalimantan, Indonesia, 1987E. Java & W. Kalimantan, Indonesia, 1987
Problems of Irrational Drug Use 14
AntibioticsAntibiotics AnalgesicAnalgesic Cough/ColdCough/Cold AntihistAntihist .. OthersOthers00
0.20.2
0.40.4
0.60.6
0.80.8
11
1.21.2
1.41.4
Average # of Drugs Per CaseAverage # of Drugs Per Case
Under Five Under Five Five & Over Five & Over
ARI Treatment PatternARI Treatment PatternE. Java & W. Kalimantan, Indonesia, 1987E. Java & W. Kalimantan, Indonesia, 1987
Problems of Irrational Drug Use 15
Other Dru g Use ProblemsOther Dru g Use Problems
•• Incorrect treatment of malariaIncorrect treatment of malaria
–– incorrect use of chloroquin injectionincorrect use of chloroquin injection
•• Poor compliance with TB therapy Poor compliance with TB therapy
–– causes treatment failure and resistantcauses treatment failure and resistantorganismsorganisms
•• Underuse of effective drugs Underuse of effective drugs
–– hypertensionhypertension
–– depressiondepression
•• Hospital drug use problems Hospital drug use problems
–– antibiotic misuse for surgical prophylaxisantibiotic misuse for surgical prophylaxis
Problems of Irrational Drug Use 16
YemenYemenUgandaUganda
SudanSudanMalawiMalawi
IndonesiaIndonesiaBangladeshBangladesh
ZimbabweZimbabweTanzaniaTanzania
NigeriaNigeriaNepalNepal
EcuadorEcuadorGuatemalaGuatemala
Eastern CaribbeanEastern CaribbeanJamaicaJamaica
GhanaGhanaCameroonCameroon
El SalvadorEl Salvador
00 11 22 33 44 55
Average Number of DrugsAverage Number of Drugs
Average Number of Drugs perAverage Number of Drugs perPatientPatientPublic Sector Drug Use Indicator Studies 1990-1993Public Sector Drug Use Indicator Studies 1990-1993
Problems of Irrational Drug Use 17
SudanSudan
IndonesiaIndonesia
ZimbabweZimbabwe
TanzaniaTanzania
NigeriaNigeria
NepalNepal
EcuadorEcuador
GuatemalaGuatemala
Eastern CaribbeanEastern Caribbean
GhanaGhana
CameroonCameroon
El SalvadorEl Salvador
JamaicaJamaica
00 2020 4040 6060 8080 100100% Generic% Generic
% Prescribed as Generics% Prescribed as GenericsPublic Sector Drug Use Indicator Studies 1990-1993Public Sector Drug Use Indicator Studies 1990-1993
Problems of Irrational Drug Use 18
YemenYemenUgandaUganda
SudanSudanMalawiMalawi
IndonesiaIndonesiaBangladeshBangladesh
ZimbabweZimbabweTanzaniaTanzania
NigeriaNigeriaNepalNepal
EcuadorEcuadorGuatemalaGuatemala
Eastern CaribbeanEastern CaribbeanJamaicaJamaica
GhanaGhanaCameroonCameroon
El SalvadorEl Salvador
00 2020 4040 6060 8080 100100% of encounters receiving antibiotics% of encounters receiving antibiotics
% Receivin g Antibiotics% Receivin g AntibioticsPublic Sector Drug Use Indicator Studies 1990-1993Public Sector Drug Use Indicator Studies 1990-1993
Problems of Irrational Drug Use 19
YemenYemenUgandaUganda
SudanSudanMalawiMalawi
IndonesiaIndonesiaBangladeshBangladesh
ZimbabweZimbabweTanzaniaTanzania
NigeriaNigeriaNepalNepal
EcuadorEcuadorGuatemalaGuatemala
Eastern CaribbeanEastern CaribbeanJamaicaJamaica
GhanaGhanaCameroonCameroon
El SalvadorEl Salvador
00 2020 4040 6060 8080 100100
% of encounters receiving injections% of encounters receiving injections
% Receivin g Injections% Receivin g InjectionsPublic Sector Drug Use Indicator Studies 1990-1993Public Sector Drug Use Indicator Studies 1990-1993
Problems of Irrational Drug Use 20
MalawiMalawi
IndonesiaIndonesia
TanzaniaTanzania
NigeriaNigeria
NepalNepal
00 11 22 33 44 55 66 77
Average Consultation Time (Average Consultation Time ( minsmins ))
Avera ge Consultation TimeAvera ge Consultation TimePublic Sector Dru g Use Indicator Studies 1990-1993Public Sector Dru g Use Indicator Studies 1990-1993
Problems of Irrational Drug Use 21
TanzaniaTanzania
NigeriaNigeria
NepalNepal
EasternEastern Carribean Carribean
GhanaGhana
00 5050 100100 150150 200200
Average Dispensing Time (seconds)Average Dispensing Time (seconds)
Avera ge Dispensin g TimeAvera ge Dispensin g TimePublic Sector Drug Use Indicator Studies 1990-1993Public Sector Drug Use Indicator Studies 1990-1993
Problems of Irrational Drug Use 22
MalawiMalawi
IndonesiaIndonesia
BangladeshBangladesh
TanzaniaTanzania
NigeriaNigeria
NepalNepal
Eastern CaribbeanEastern Caribbean
GhanaGhana
00 2020 4040 6060 8080 100100% patients w/ dosing knowledge% patients w/ dosing knowledge
% Patients Knowin g Drug Dosin g% Patients Knowin g Drug Dosin gPublic Sector Drug Use Indicator Studies 1990-1993Public Sector Drug Use Indicator Studies 1990-1993
Problems of Irrational Drug Use 23
MalawiMalawi
TanzaniaTanzania
NigeriaNigeria
NepalNepal
EcuadorEcuador
CameroonCameroon
GhanaGhana
El SalvadorEl Salvador
GuatemalaGuatemala
JamaicaJamaica
00 2020 4040 6060 8080 100100% of key drugs in stock% of key drugs in stock
% of Ke y Drugs in Stock% of Ke y Drugs in StockPublic Sector Drug Use Indicator Studies 1990-1993Public Sector Drug Use Indicator Studies 1990-1993
Problems of Irrational Drug Use 24
Activity 2Activity 2
Identifying a Priority ProblemIdentifying a Priority Problem
Problems of Irrational Drug Use 25
ConclusionConclusion
•• Drug use is the end of the therapeuticDrug use is the end of the therapeuticconsultationconsultation
•• Health professionals have a responsibility toHealth professionals have a responsibility toensure that the right drug is prescribed,ensure that the right drug is prescribed,dispensed and taken.dispensed and taken.
•• Methods exist to measure drug use and toMethods exist to measure drug use and tochange practices.change practices.
•• Improving drug use improves the quality ofImproving drug use improves the quality ofcare and frequently lowers cost.care and frequently lowers cost.
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