1. Rational Use of Drug Ali Abad hospital April 12 th, 2005

2. PLAN  Main Concepts-Definitions  Problems of Irrational Use of Drugs  Programmation Chart: 3 approaches Change prescribing habitsChange prescribing habits Improve knowledge of doctors and pharmacistsImprove knowledge of doctors and pharmacists Improve drug managementImprove drug management

3. GENERIC MEDICINE

4. Generic Medicine  What is it? ICD: International Common Denomination Same active ingredient, same dosage, same route of administration Same therapeutic effect

5. Generic Medicine  Why using generics? Less expensive to produce Easier to buy Easier to use

6. Generic Medicine  How using generics? Packing when the patient submits the presciption to the pharmacist Pre-packing

7. ESSENTIAL DRUG

8. Essential Drug  What is it? Medicines which cover the most urgent needs for the population

9. Essential drug  Why using essential drugs? Good benefit-risk ratio Efficacity proved Safe use

10. Essential Drug  How using it? Following standardized guidelines

11. ESSENTIAL DRUG LIST

12. EDL Specific for each country, according to its priorities in the health policy. Specific for each country, according to its priorities in the health policy. Limited number and types of drugs available at each level of health services Limited number and types of drugs available at each level of health services In Afghanistan, list established by the BPHS; it consists of 237 medicines and items of medical material, available at 4 levels In Afghanistan, list established by the BPHS; it consists of 237 medicines and items of medical material, available at 4 levels

13. EDL Type of HF Number of medicines available Total Number of items HP1524 BHC4876 CHC80120 DH84137

14. STANDARD TREATMENT GUIDELINES

15. STG A systematically developped collection of statements designed to assist prescribers decisions about appropriate health care for specific clinical circumstances

16. Definition of RUD The Rational Drug Use requires that patients receive medicines appropriate to their clinical needs, in doses that meet their individual requirements, for an adequate period of time, and at the lowest cost to them and the community. WHO, 1998 WHO, 1998

17. Surveys about RUD Prescribing indicators Average number of drugs/encounter % of encounters with ≥1 ATB % of encounters with ≥1 injection % of drugs prescribed from EDL Patients Care indicators % of drugs actually dispensed % of drugs adequally labeled Patients’ knowledge of correct dosage Facility indicator Availability of key drugs

18. Results

19. PROBLEMS OF IRRATIONAL USE OF DRUGS

20. CAUSES

21. From the prescriber Lack of knowledge about diagnosis, therapeutics Lack of knowledge about diagnosis, therapeutics Acquired habits Acquired habits False beliefs about illness and drugs False beliefs about illness and drugs Economic motivations Economic motivations

22. Between patient and prescriber Patient’s demand: lack of knowledge, family pressure Patient’s demand: lack of knowledge, family pressure Quality of communication Quality of communication

23. Work Environment Influence of drugs availability Influence of drugs availability Availability of diagnosis services Availability of diagnosis services Lack of space Lack of space Workload Workload Availability of female staff Availability of female staff

24. HOW IMPROVING RATIONAL USE OF DRUGS?

25. By changing prescribing habits Standardization of therapeutic schemes Standardization of therapeutic schemes Audits: prescription control sheet Audits: prescription control sheet

26. By improving knowledge of doctors and pharmacists Specific trainings Specific trainings Printed educational material: Printed educational material:  Therapeutic manuals (guidelines, EDL)  Clinical litterature (Salamati magazine)  Posters (most frequently used drugs dosages, tables of dilution, preparation and storage of antiseptic solutions...)

27. Improving the dispensation to the patient (1/1) Possibility of packaging by advance Correct labeled packets: Name of the patient Name of the patient Name and dosage of the drug Name and dosage of the drug Schedule and duration Schedule and duration

28. Improving the dispensation to the patient (1/2) Explanations and advice to the patient:  How and when to take the treatment  Potential side effects, in which case he must stop  Advise not to take other medication at the same time if not compatible  When he must come back if no improvment