[e-drug] How can we promote rational use of medicines? (15)

["Dr.S.Gopal Krishnan" <drsgopal@gmail.com>]

E-DRUG: How can we promote rational use of medicines? (15)
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Dear e-druggers, hope this short write up on the concept of rational use of
drugs will help to understand it better for all levels of health care
professionals.

*Rational Use of Drugs, an overview.*
                                                         *
Dr.S.Gopalakrishnan*

Medicines are to be used in appropriate and safe way and only when needed. A policy on rational use of drugs is an extremely important part of a national drug policy. Its aim is to contribute to the health of the country's population by improving the use of medicines by health workers and consumers, and by encouraging the activities of governments, industry and the media in support of rational use of drugs.

Drugs are an integral part of the health profession. The selection and use
of the right drug in an appropriate manner is a challenge and difficult task for the prescribers. Drugs should be used only when it is really needed.

Rational use of drugs means sensible or reasonable use of drugs. It is
defined as the appropriate use of drugs, when it is really needed, in
appropriate strength, dosage and duration which will have a beneficial
effect on the consumer.

*The requirements of rational use of drugs will be fulfilled, if the process of prescribing is appropriately followed.*

1. Steps in defining the patient's problems (diagnosis).
2. Defining effective and safe treatment (drugs and non-drug options).
3. Selecting appropriate drugs, dosage and duration.
4. Writing a good prescription.
5. Giving patients, adequate information.
6. Planning to evaluate treatment responses.

* *

*The rational prescribing should meet the criteria like *

1. appropriate indication,
2. appropriate drugs,
3. appropriate patient,
4. appropriate information  **
5. monitoring*.*

Unfortunately in real practice, prescribing patterns do not always conform
to these criteria and can be classified as "inappropriate" or "irrational"
prescribing i.e. pathological prescribing.

* *

*The impact of the irrational use of drugs can be seen in many ways.*

1. Reduction in the quality of drug therapy leading to increased
morbidity and mortality

2. Waste of resources leading to reduced availability of other vital
drugs and increased costs.

3. Increased risks of unwanted effects such as adverse drug reactions
and emergence of drug resistance.

4. Psychosocial impact, such as when patients come to know that there is a "pill for every ill", it may cause an apparent increased demand for drugs.

* *

*Action to promote rational use of drugs.*

* *

1. *Educational approaches*

Education and training of health professionals and health workers form a
major strategy to achieve rational drug use. Education should start at the undergraduate level itself.

2. *Managerial action*

Prescribing and dispensing can be improved managerially by audit and
feedback, structured drug order forms, standard diagnostic and treatment
guidelines, packaging in quantities required for a course of therapy and
mandatory consultation or justification.

3. *Regulatory interventions:*

Regulatory intervention can be rapidly effective but can have unintended
impacts. Thus they should be used with caution.

4. *Combining actions:*

Interventions of different categories should be combined either simultaneously or sequentially. Such combinations have synergistic impact
when evaluated.

Public education in the appropriate use of drugs is needed because, without it people lack the skill and knowledge they require to make informed decisions about how to use drugs. However, public education is frequently treated as marginal activity. There is a need to increase the
priority given to public education.

Drugs have a potential for harm as well as benefit that makes them different from other commodities. Their promotion and sale required
special control. Hence, the main aim of promotional activities of drugs is
to support and encourage the improvement of health care through the rational use of drugs. It is one of the essential elements in achieving quality of health and medical care for patients and the community.

Rational use of drugs in our health care delivery system requires resources, knowledge and skills among the prescribers and dispensers. Only by providing objective information, continuing education and training in good prescribing practices and pharmaco-epidemiology, the essence of propagating the need for essential drugs and rational use of drugs in health care delivery system can be achieved.

Dr.S.Gopalakrishnan
Associate Professor
Asian Institute of Medicine, Science and Technology
Kedah, Malaysia
drsgopal@gmail.com