PHM-Exch> Fwd: Rational Use of Medicines

[Claudio Schuftan]

From: David Legge <D.Legge at latrobe.edu.au>



  RATIONAL USE OF MEDICINES, Chapter 14 in THE WORLD MEDICINES SITUATION
2011

Kathleen Holloway
Department of Essential Medicines and Pharmaceutical Policies, WHO, Geneva
Liset van Dijk
University of Utrecht, the Netherlands

http://www.who.int/medicines/areas/policy/world_medicines_situation/WMS_ch14_wRational.pdf


SUMMARY

   - Irrational use of medicines is an extremely serious global problem that
   is wasteful
   and harmful. In developing and transitional countries, in primary care
   less than 40%
   of patients in the public sector and 30% of patients in the private
   sector are treated in
   accordance with standard treatment guidelines.
    - Antibiotics are misused and over-used in all regions. In Europe, some
   countries are
   using three times the amount of antibiotics per head of population
   compared to other
   countries with similar disease profiles. In developing and transitional
   countries, while
   only 70% of pneumonia cases receive an appropriate antibiotic, about half
   of all acute
   viral upper respiratory tract infection and viral diarrhoea cases receive
   antibiotics
   inappropriately.
    - Patient adherence to treatment regimes is about 50% worldwide and
   lower in
   developing and transitional countries, where up to 50% of all dispensing
   events are
   inadequate (in terms of instructing patients and/or labelling dispensed
   medicines).
   n Harmful consequences of irrational use of medicines include unnecessary
   adverse
   medicines events, rapidly increasing antimicrobial resistance (due to
   over-use of
   antibiotics) and the spread of blood-borne infections such as HIV and
   hepatitis B/C
   (due to unsterile injections) all of which cause serious morbidity and
   mortality and
   cost billions of dollars per year.
    - Effective interventions to improve use of medicines are generally
   multi-faceted. They
   include provider and consumer education with supervision, group process
   strategies
   (such as peer review and self-monitoring), community case management
   (where
   community members are trained to treat childhood illness in their
   communities
   and provided with medicines and supervision to do it) and essential
   medicines
   programmes with an essential medicine supply element. Printed materials
   alone
   have little effect and for guidelines to be effective they need to be
   accompanied by
   reminders, educational outreach and feedback.


   - Less than half of all countries are implementing many of the basic
   policies needed
   to ensure appropriate use of medicines, such as regular monitoring of
   use, regular
   updating of clinical guidelines and having a medicine information centre
   for
   prescribers or drug (medicine) and therapeutics committees in most of
   their hospitals
   or regions.
    - The second International Conference on Improving Use of Medicines in
   2004 and
   World Health Assembly Resolution WHA60.16 in 2007 recognized the
   difficulty of
   promoting rational use of medicines in fragmented health systems. They
   recommend
   a cross-cutting health system approach and the establishment of national
   programmes
   to promote rational use of medicines, which would require much more
   investment
   than governments and donors have so far been willing to give
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