1 Problems of Problems of Irrational Drug Use Irrational Drug Use
Dec 30, 2015
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Problems of Irrational Problems of Irrational Drug UseDrug Use
Problems of Irrational Drug Use 2
Problems of Irrational Drug Use:Problems of Irrational Drug Use:ObjectivesObjectives
• Identify magnitude and nature of inappropriate Identify magnitude and nature of inappropriate drug utilizationdrug utilization
• Understand the adverse impacts of Understand the adverse impacts of inappropriate 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 of Identify factors which influence the behavior of prescribers and patientsprescribers and patients
• Discuss specific medication use problemsDiscuss specific medication use problems
Problems of Irrational Drug Use 3
What is Rational Use of Drugs?What is Rational Use of Drugs?
The rational use of drugs requires that patients receive medicines The rational use of drugs requires that patients receive medicines appropriate to their clinical needs, in doses that meet their own individual 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 requirements, for an adequate period of time, and at the lowest cost to them and the community.them and the community.
(WHO 1988)(WHO 1988)
Appropriate indicationAppropriate indication Appropriate drugAppropriate drug Appropriate administration, dosage, and durationAppropriate administration, dosage, and duration Appropriate patientAppropriate patient Appropriate patient informationAppropriate patient information Appropriate evaluationAppropriate evaluation
Problems of Irrational Drug Use 4
Irrational Use of Drugs = Pathology Irrational Use of Drugs = Pathology of Prescribingof Prescribing
• 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 condition The use of wrong drugs for a specific condition requiring 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 Inappropriate Examples of Common Inappropriate Prescribing PracticesPrescribing Practices
• The overuse of antibiotics and antidiarrheals for The overuse of antibiotics and antidiarrheals for nonspecific 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-bacterial Use 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 expensive Unnecessary use of expensive
antihypertensivesantihypertensives
Problems of Irrational Drug Use 6
Components of the Drug Use Components of the Drug Use SystemSystem
Drug ImportsDrug ImportsLocalLocal
ManufactureManufacture
HospitalHospital or or HealthHealth CenteCenterr
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 Underlying Irrational Use Factors Underlying Irrational Use of Drugsof Drugs
• inefficient inefficient managementmanagement
• non-availability non-availability of required of required drugsdrugs
Drug SupplyDrug SupplyDrug SupplyDrug Supply
• availability of availability of unsafe drugsunsafe drugs
• informal informal prescribersprescribers
• etc.etc.
Drug RegulationDrug RegulationDrug RegulationDrug Regulation
• promotionpromotion• misleading misleading
claimsclaims
IndustryIndustryIndustryIndustry
• lack of education lack of education and trainingand training
• lack of drug lack of drug informationinformation
• heavy patient loadheavy patient load• pressure to pressure to
prescribeprescribe• generalization of generalization of
limited beliefslimited beliefs• misleading beliefs misleading beliefs
about efficacyabout efficacy
PrescribersPrescribersPrescribersPrescribers• drug drug
misinformationmisinformation
• misleading misleading beliefsbeliefs
• inability to inability to communicate communicate problemsproblems
PatientsPatientsPatientsPatients
Problems of Irrational Drug Use 8
Impact of InappropriateImpact of InappropriateUse of DrugsUse of Drugs
Reduced Reduced quality of quality of therapytherapy
•morbiditymorbidity•mortalitymortality
Waste of Waste of resourcesresources Risk of Risk of
unwanted unwanted effectseffects
•patients rely on patients rely on unnecessary drugsunnecessary drugs
Psycho-social Psycho-social impactsimpacts
•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 Age Group:Drugs per Case by Age 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 CasesDiarrheaDiarrhea Resp.Dis.Resp.Dis. SkinSkin G.I.G.I. MusculoskelMusculoskel.00
11
22
33
44
55
# Drugs per Case# Drugs per Case
Under FiveUnder Five
Five & OverFive & Over
Drugs Per Case By DiagnosisDrugs Per Case By DiagnosisE. Java & W. Kalimantan, Indonesia, 1987E. Java & W. Kalimantan, Indonesia, 1987
Problems of Irrational Drug Use 12
NoneNone12%
OneOne
56%
TwoTwo
29%
Three/MoreThree/More3%
NoneNone35%
OneOne36%
TwoTwo27%
Three/MoreThree/More2%
5 & Over5 & Over Under 5Under 5
% Of Patients Receiving % Of Patients Receiving AntibioticsAntibioticsE. 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 & Over5 & 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 Antihist.Antihist. 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 FiveUnder Five
Five & OverFive & Over
ARI Treatment PatternARI Treatment PatternE. Java & W. Kalimantan, Indonesia, 1987E. Java & W. Kalimantan, Indonesia, 1987
Problems of Irrational Drug Use 15
Other Drug Use ProblemsOther Drug Use Problems
• Incorrect treatment of malariaIncorrect treatment of malaria– incorrect use of chloroquin injectionincorrect use of chloroquin injection
• Poor compliance with TB therapyPoor compliance with TB therapy– causes treatment failure and resistant causes treatment failure and resistant
organismsorganisms• Underuse of effective drugsUnderuse of effective drugs
– hypertensionhypertension– depressiondepression
• Hospital drug use problemsHospital 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 per Average Number of Drugs per PatientPatientPublic 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
% Receiving Antibiotics% Receiving 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
% Receiving Injections% Receiving 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 (mins)Average Consultation Time (mins)
Average Consultation TimeAverage Consultation TimePublic Sector Drug Use Indicator Studies 1990-1993Public Sector Drug Use Indicator Studies 1990-1993
Problems of Irrational Drug Use 21
TanzaniaTanzania
NigeriaNigeria
NepalNepal
Eastern CarribeanEastern Carribean
GhanaGhana
00 5050 100100 150150 200200
Average Dispensing Time (seconds)Average Dispensing Time (seconds)
Average Dispensing TimeAverage Dispensing 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 Knowing Drug Dosing% Patients Knowing Drug DosingPublic 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 Key Drugs in Stock% of Key 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 therapeutic Drug use is the end of the therapeutic consultation.consultation.
• Health professionals have a responsibility to Health professionals have a responsibility to ensure 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 to Methods exist to measure drug use and to change practices.change practices.
• Improving drug use improves the quality of Improving drug use improves the quality of care and frequently lowers cost.care and frequently lowers cost.