Strategies to Improve Drug Use Educational: to inform or persuade Managerial: to structure or guide decisions Regulatory: to restrict or limit decisions Framework for Changing Drug Use Practices

Managerial Strategies 1 GOAL: to structure or guide decisions Changes in Selection, Procurement, Distribution essential drugs lists morbidity-based quantification kit system distribution Changes Aimed at Prescribers utilization review (audit) and feedback diagnostic and treatment guidelines structured drug order forms peer group monitoring Framework for Changing Drug Use Practices

Managerial Strategies 2: GOAL: to structure or guide decisions Changes Aimed at Dispensers allowing generic substitution improved labeling course of therapy packaging Changes in Economic Incentives patient cost-sharing revolving drug funds cost controls Framework for Changing Drug Use Practices

Standard Treatment Guidelines STG’s lead prescribers to most cost-effective treatments Particularly useful for low level workers Can be used for training, examinations and audit Used for procurement Framework for Changing Drug Use Practices

Prescribing Audits plus "Feedback" to Prescriber Establish Criteria & Guidelines for Review AUDIT (COLLECT DATA ON) PRESCRIBING · Comparison with Guidelines · Comparison with Peers NOTIFY PRESCRIBERS OF RESULTS · Individuals or Groups · Letters or Patient Notes or in Person Framework for Changing Drug Use Practices

Regulatory Options GOAL: To Restrict Decisions Market Controls Limiting Drug Registration Banning Previously Registered Drugs Rx - only to OTC Controlling Content in Drug Advertising Prescribing and Dispensing Controls Limiting Drugs Supplied in Public Sector Restricting Specific Drugs to Higher Levels of Care Required Generic Prescribing Allowing Generic Substitution Limits on Number or Quantity of Drugs per Patient Framework for Changing Drug Use Practices