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Course Title: Clinical Pharmacy-III

Topic: Rational Prescribing of drug II

Ms. Anum Hanif

Lecturer
Faculty of Pharmacy
Hajvery University (HU)
 Learning Outcomes

• Students will learn in this lecture about:

1. Understand the adverse impacts of inappropriate use of drugs
2. Identify factors that influence the behaviour of prescribers in
choosing specific medication therapies.
3. How to sampling to the study of drug use
 PROBLEMS OF IRRATIONALE DRUG USE:
IRRATIONAL PRESCRIBING:
May be regarded as "pathological" prescribing, where
the rational prescribing criteria are not fulfilled.
Common patterns of irrational prescribing, may,
therefore be manifested in the following forms:
1. The use of drugs when no drug therapy is indicated,
e.g., antibiotics for viral upper respiratory infections.
2. The use of the wrong drug for a specific condition
requiring drug therapy, e.g. tetracycline in childhood
diarrhoea requiring ORS
3. The use of drugs with doubtful/unproven efficacy, e.g., the
use of anti-motility agents in acute diarrhea.
4. The use of drugs of uncertain safety status, e.g., use of
dipyrone (Baralgan, etc.), Failure to provide available,
safe, and effective drugs, e.g., failure to vaccinate against
measles or tetanus, failure to prescribe ORS for acute
diarrhea,
5. The use of correct drugs with incorrect administration,
dosages, and duration, e.g., the use of IV metronidazole
when suppositories or oral formulations would be
appropriate.
6. The use of unnecessarily expensive drugs, e.g.
the use of a third generation, broad spectrum
antimicrobial when a first-line, narrow
spectrum, agent is indicated.
7. Some examples of commonly encountered
inappropriate prescribing practices in many
health care settings include:
• Overuse of antibiotics and anti-diarrheal for
non-specific childhood diarrhoea,
8. Indiscriminate use of injections, e.g., in malaria treatment.
9. Multiple drug prescriptions,
10. Excessive use of antibiotics for treating minor ARI acute
respiratory infection
11. Minerals and tonics for malnutrition.
12. Consumers may have a very different perspective as what is
rational. The drug use is complex and varies from country to
country. Drugs may be imported or manufactured locally. The
drugs may be used in hospitals or health centres, by private
practitioners and often in a pharmacy or drug shop where OTC
preparations are sold.
In some countries all drugs are available over the counter! Finally,
the public includes very wide range of people with differing
knowledge, beliefs and attitudes about medicines.
 INDICATORS OF DRUG USE

Introduction
PURPOSE OF DRUG USE INDICATORS:
• The main purpose of this manual is to define a limited number of
objective measures that can describe the drug use situation in a
country, region or individual health facility.
• Such measures, or indicators, will allow health planners,
managers and researchers to make basic comparisons between
situations in different areas or at different times.
• Also, when an intervention is undertaken to improve
aspects of drug use, the indicators can be used to
measure impact. Indicators can also serve as simple
supervisory tools to detect problems in performance
by individual providers or health facilities.
• The indicators can be quickly and efficiently used in
many settings to assess potential problems in drug
use, and to prioritize and focus subsequent efforts to
correct these problems.
 TYPES OF INDICATORS
These drug use indicators were developed to be used as
measures of performance in
Three general areas related to the rational use of drugs
in primary care:
• Pharmaceutical prescribing practices by health
providers;
• Key elements of patient care, covering both clinical
consultation and pharmaceutical dispensing.
• Availability of facility-specific factors which support
rational use, such as key essential drugs and minimum
pharmaceutical information.
 CORE DRUG USE INDICATORS:

• Group 1: prescribing indicators

• Group 2: patient care indicators
• Group 3: health facility indicators
GROUP 1: PRESCRIBING INDICATORS
• The indicators of prescribing practices measure the
performance of health care providers in several key
dimensions related to the appropriate use of drugs.
• The indicators are based on the practices observed in a
sample of clinical encounters taking place at outpatient
health facilities for the treatment of acute or chronic
illness.
• These encounters can be observed retrospectively,
from data recorded in historical medical records, or
they can be observed prospectively, from a group of
patients attending the clinic on the day the data are
collected.
Group 2 Patient Care Indicator
• In order to understand the way drugs are used it is important to
consider what take places at the health facilities from both the
provider and the patient. It address the key aspects of what
patient experience at health facilities.
• The time that prescriber and dispensers spend with each patient
sets important limits on the potential quality of diagnosis and
treatment. A proper evaluation of quality of care should assess
the content of interaction between patient and health worker.
Group 3: health facility indicators
• The ability to prescribe drugs rationally is influenced by many
features of the working environment.
• Two particularly important components are an adequate supply
of essential drugs and access to unbiased information about
these drugs.
 SAMPLING TO STUDY DRUG USE

• Sampling is a process by which we study a small part of a

population to make judgments about the entire population.
• Sampling involves the selection of a number of study units
from a defined study population.
• A sampling unit is the thing that is sampled, may be a person,
a health facility, a prescription, or another such unit.
• A study population, sometimes called the reference
population, is the collection of all possible study units. Again,
this population may be people, health facilities, prescriptions
or other such units.
 SAMPLING TO STUDY DRUG USE

• Sampling frame is a list of all of the available units in the

study population. If a complete listing is available, the
sampling frame is identical to the study population.

• A representative sample has all the important characteristics

of the population from which it is drawn.
Learning Outcomes
Students will learn in this lecture about:
• Problems related to irrational drug use
• Indicators of drug use
• Core indicators of drug use
• Sampling to study drug use
1. Students you can ask any
question regarding this
lecture.
2. Google Classroom discussion
board.