Problems of Irrational Drug Use - WHO archivesarchives.who.int/prduc2004/rducd/Acrobat_Files/VA_Acrobat_Files/3... · Problems of Irrational Drug Use 7 Factors Underlying Irrational

1

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


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


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


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


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


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


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


Activity 1Activity 1

Meaning of Appropriate UseMeaning of Appropriate Use


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


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


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


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


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


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


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


SudanSudan

IndonesiaIndonesia

ZimbabweZimbabwe

TanzaniaTanzania

NigeriaNigeria

NepalNepal

EcuadorEcuador

GuatemalaGuatemala

Eastern CaribbeanEastern Caribbean

GhanaGhana

CameroonCameroon


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











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











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


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


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


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


MalawiMalawi

TanzaniaTanzania

NigeriaNigeria

NepalNepal

EcuadorEcuador

CameroonCameroon

GhanaGhana


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


Activity 2Activity 2

Identifying a Priority ProblemIdentifying a Priority Problem


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.

Documents

Problems of Irrational Drug Use - WHO archivesarchives.who.int/prduc2004/rducd/Acrobat_Files/VA_Acrobat_Files/3... · Problems of Irrational Drug Use 7 Factors Underlying Irrational