1. Promoting Rational Drug Use in the Community What influences drug use by consumers

2. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 2 Objectives To be able to:  Identify various factors which influence drug use by consumers  Recognise relative importance of the factors with respect to efforts to promote rational drug use by consumers

3. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 3 The session  Various factors which influence drug use by consumers  by level of influence  related both to environment and behaviour  provides a basis to analyse problems  to be used in the development of interventions

4. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 4 Layers of influence  the family level  the community  the health service institution  the national level  the international level

5. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 5 The family level  perceived need for drugs  ideas about efficacy and safety  uncertainty - poly-pharmacy  division of drug consumption roles  cost of medicines  literacy level  the power of medicines

6. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 6 Perceived safety and efficacy  related to colour, taste and shape of medicines  related to dosage form  depends on compatibility between medicine and the person  depends on cause of illness  related to past experiences  new medicines perceived to be better

7. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 7 Gender roles and medicines Philippines  mothers buy  mothers give to children  neighbours or relatives give advice  husband not consulted generally Pakistan  fathers buy  mothers give to children  men have information about medicines and tell wives how to use them

8. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 8 The community level  local drug-use culture  drug supply system  community information channels

9. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 9 Town Clinics (2%) Hospital (1%) Doctors (7%) Drugstores (35%) Household stocks and free-clinics (8%) Neighbourhood stores (40%) Neighbours and relatives (5%) Neighbourhood MEDICINES (n=1324) Community drug distribution Source: Hardon A (1991). Confronting ill health: medicines, self-care and the poor in Manila

10. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 10 The health institution level  utilisation of health service  quality of health worker prescribing  quality of communication during consultation  quality of medicine dispensing  regular supply of medicines  cost of medicines

11. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 11 Extent to which health worker advice is sought  Thailand: 7% of 1755 episodes (rural)  Philippines: 8% of 1411 episodes (urban) 20% of 422 episodes (rural infants)  Pakistan: 56% in NGO-PHC area, 48% in controls (rural)  Ghana: 42% in urban, 43% in rural

12. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 12 The national level  Implementation of essential drugs policy  Drug promotion  Drug costs, financing and reimbursement policies  Advocacy by consumer and patient organizations  Health communication on medicines in school curricula, and in TV and radio programmes

13. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 13 Drug promotion  Industry expenditure on marketing: research = 2 : 1  In fact 35% of sales revenues for drug marketing  Commercial drug info : public funded drug info = 50 : 1 (UK)  Drug promotion emphasises benefit, often lacking information on risks

14. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 14 WHO ethical criteria on drug promotion (adopted in 1988)  consistent with national health policy  contains reliable claims  contains no omission which can lead to health risks  should not be designed to disguise its real nature

15. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 15 Ethical criteria adoption:  WHO (1988): ethical criteria only adopted in 17 out of 42 national drug policies  Australia (1995): only 29% of 140 advertisements to the public contain warnings or cautions about health risks

16. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 16 OTC advertising: IOCU study  238 OTC ads in 11 countries reviewed (1994)  most ads do not comply with WHO ethical criteria  75% do not mention side-effects nor contraindications

17. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 17 Increase in promotion towards consumers  prescription drugs are increasingly registered as OTC drugs  before patient was ignorant and prescriber the target, now consumer is target as “expert” in need of info.  direct to consumer advertising of prescription drugs increases  increase in promotion of life style drugs

18. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 18 Top DTCA expenditures  137 million US$ on Claritin  93 million US$ Viagra*: to treat impotence/improve sexual performance  75 million US$ on Xenical*: to reduce weight  57 million US$ on Zyrtec  45 million US$ on Zyban*: to quit smoking *life-style drugs

19. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 19 The international level  Implementation of multilateral agreements affecting drugs  Health consequences of global trade agreements  Donor support for essential drugs programmes  Global consumer advocacy  The Internet

20. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 20 Zyban: Information from the Internet  Nicotine-free ZYBAN is a prescription- strength medicine  ZYBAN is the first nicotine-free pill approved to help you quit smoking  You start taking ZYBAN and continue to smoke  ZYBAN is priced lower than other smoking cessation therapy

21. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 21 Activity tasks  Participants should have read the case studies prior to session  Appoint a rapporteur and facilitator  Facilitator should check if case study has been read. If not, allow for time  The facilitator guides the discussion  Answer discussion questions  Rapporteur reports in plenary

22. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 22 DTCA discussion questions  Make an inventory of the ways in which prescription drugs are promoted to consumers in the Philippines  Discuss use of Viagra by young men as aphrodisiac. What factors influence it?  Define possible solutions to this misuse  Discuss pros and cons of DTCA in the Philippines

23. WHO What influences drug use by consumers Promoting Rational Drug Use in the Community 23 Discussion questions: drugs used as abortifacients  What medicines are used as abortifacients in the Philippines  What are health risks?  What factors determine this misuse?  What can be done to discourage this misuse?