[e-drug] ICIUM 2004 recommendations and presentations online

["E-drug" <e-drug@healthnet.org>]

E-DRUG: ICIUM 2004 recommendations and presentations online
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The web site of the Second International Conference on Improving Use of Medicine (ICIUM 2004) is now available through www.icium.org

A wonderful new resource has now been made available thanks to some excellent work by colleagues from Thailand, Boston and Geneva. The website has all the conference material from ICIUM2004 freely available to view or download and use. Amongst the many treasures are:

- All abstracts and PowerPoint slides from all posters, and oral presentations 
- Selected videos of oral presentations presented on the first or last day
- Summaries of conference recommendations, both  overall and topic-related
- A list of those who attended and contributed.

You may access files of oral presentations from the daily conference agenda, search for poster presentations by track, or search for poster or oral presentation files by entering a text word from the title or an author's or a presenter's last name in the search box.

In addition to an overall summary of the key conference policy recommendations, all of ICIUM 2004's consensus recommendations concerning policy implementation and priority research have been organized under 25 individual topic headings (such as Tuberculosis, Malaria, HIV, AMR, private pharmacies etc). These recommendations summarize what we know about improving the use of medicines in non-industrialized settings.  We hope that they will be widely promulgated among policymakers and form the basis for applied research programs on medicines use in the coming five years.

Enjoy!

The ICIUM Organizing Committee

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[The main ICIUM recommendations are reproduced here FYI]
http://mednet3.who.int/icium/icium2004/icium2004_policy_program_rec.asp
  
Policies and Programs to Improve Use of Medicines: Recommendations from ICIUM 2004 

As part of a global effort to improve the use of medicines, 472 leading policy makers, researchers, and other stakeholders representing 70 countries gathered in Chiang Mai, Thailand, in April 2004 for the Second International Conference on Improving Use of Medicines (ICIUM 2004).  Evidence presented made it clear that misuse of medicines continues to be widespread and has serious health and economic implications, especially in resource poor settings.  However, effective solutions for some serious medicines problems already exist.  Participants called upon governments to implement policies and programs in the priority areas listed below.  (Detailed recommendations are available at www.icium.org). 

The conference highlighted the need to move from small scale research projects to implementing large scale programs that achieve public health impacts. Many promising and successful interventions were presented at ICIUM, yet global progress is confined primarily to demonstration projects.  There are few reports of effective national efforts to improve the use of medicines on a large scale and in a sustainable manner. Thus a major research gap is to answer the question “How do we achieve large scale and sustained improvements within health systems?”

Countries should implement national medicines programs to improve medicines use. 
·        Data from Lao PDR, Kyrgyzstan, and Oman show that systematic implementation of a comprehensive national medicines policy improves medicines use.  Implementation should be based on local evidence; should cover both the private and public sector, should include interventions on multiple levels of the health care system; and should be long-term since implementation takes time, continued stakeholder commitment, and adequate human resources.    

·        Broad-based insurance systems covering essential medicines for the poor can be developed in low income settings.  Countries should strengthen efforts to develop and extend insurance systems, and they can use these insurance systems to leverage better prescribing, more cost-effective use by consumers, and lower prices from industry.  

·        Generic prescribing and dispensing policies can dramatically decrease the cost of medicines to consumers and health programs.  They must be accompanied by programs to assure medicines quality.  

·        Although challenging, policies to separate prescribing and dispensing are feasible to implement and can result in lower costs to consumers and programs and improved use of medicines.    

·        In settings where patients share in the cost of care, policies can be structured to promote more appropriate use. Charging fees per full course of medicines results in higher quality than charging per unit or per visit.  

·        Prices are a major determinant of access to medicines.  A new standardized methodology allows countries to measure prices and affordability of essential medicines.  All countries should measure essential medicines prices, rationalize policies that determine price, and monitor comparative price information over time.  

Successful interventions should be scaled up to national level in a sustainable way.  
·        One exciting finding presented at ICIUM 2004 is the efficacy of 3-day antibiotic therapy for childhood pneumonia, the major killer of children in developing countries. Short-course antibiotic therapy is effective for non-severe pneumonia, costs less, increases adherence, causes fewer side effects, and decreases the emergence of resistant bacteria. 

·        Multifaceted coordinated interventions, rather than single interventions, are more effective in changing prescribing by both public and private sector providers.  Interventions should be based on detailed analyses of existing problems and must take into account financial incentives.  Evidence from Sweden demonstrates that a nationwide, multifaceted intervention can improve antibiotic use and contain antimicrobial resistance.  Intervention strategies should be tailored to local needs and may include media campaigns, treatment guidelines, and individual and group feedback on practice.  

·        Misuse of medicines in hospitals remains problematic. However, data from Indonesia, Cambodia, and Lao PDR show that a structured quality improvement process improves use of medicines in hospitals and can be transferred across countries.    

·        Countries should monitor impacts when scaling up interventions to improve use of medicines.  In particular, they should use valid indicators to monitor the long-term impacts on equity of access to medicines, quality of care, affordability, and cost. This will allow countries to evaluate program success and refine approaches based on evidence.  

Interventions should address medicines use in the community. 
·        In many countries, most medicines are purchased in pharmacies and other retail drug shops, often without input from a trained medical provider.  Several interventions involving outreach, peer process, regulatory enforcement, and incentives have shown short-term success in improving practice in this setting.  Working with professional and trade associations, countries should develop sustainable programs to measure and improve quality of retail pharmacy practice.

·        Poor adherence to therapy contributes to the emergence and rapid spread of resistance. Resistance to conventional drugs has been observed in patients with respiratory infections, malaria, diarrheal diseases, tuberculosis, sexually transmitted infections, and HIV/AIDS.  As global programs expand access to therapies for HIV, malaria, and tuberculosis, countries must implement systems to insure adherence as an integral part of treatment programs and monitor the emergence of resistance to treatments.  

·        Another exciting finding at ICIUM 2004 was that children can be effective change agents to improve community medicines use.  Countries should consider school-based education programs that involve children as a way for key messages to reach parents.  

·        Pharmaceutical promotion has negative effects on prescribing and consumer choice.  Voluntary methods to regulate promotion have been shown to be ineffective.  Countries should regulate and monitor the quality of drug advertising and of industry promotional practices, and enforce sanctions for violations.

·        Complementary and alternative medicines (CAM) often play a significant role in meeting individuals’ needs for affordable essential medicines.  However, countries should review all of their policies concerning the quality, safety, and efficacy of CAM.  

Evidence is still lacking about how to improve use of medicines for chronic conditions, including mental health problems, in resource poor settings.  Given increasing prevalence worldwide, there is an urgent need to evaluate how medicines are currently used to treat chronic conditions and how to promote more cost-effective long-term use.