RATIONAL USE OF

MEDICINE
Presented by: Steven Egili (Bsc, BPharm, PharmD)
Moderator:pharm. Okafor
AtUBTH PHRMACY DEPt
Definition
“The rational use of drugs requires that patients
receive medications appropriate to their clinical
needs, in doses that meet their own individual
requirements for an adequate period of time, and at
the lowest cost to them and their community”
(WHO, 1985)
Rational Use of Medicine (RUM)
• The aim of any pharma-management system is to deliver the
correct medicine to the patient
• Appropriate selection, procurement, and distribution are
precursors to RUM.
• RUM fulfils following criteria;
• Appropriate indication
• Appropriate medicine
• Appropriate dosage
• Correctly dispensed
• Appropriately informed patients
• Patient adherence
 Examples of Irrational Use of
Medicine (IUM)
• Poly Pharmacy Average no. of medicines per
prescription
• Unnecessary medication/ no medicine needed
Antibiotics misuse (RTIs)
• Wrong Medicine Less than 40% patients are treated
according to STGs
• Ineffective Medicine/ Medicine with doubtful
efficacy Multivitamins, Tonics
• Unsafe Medicines Anabolic steroids for athletes and
as appetizers for children
Examples continues..
• Underuse of available effective medicine No
therapy for mental disorders ORT for diarrhoea
• Incorrect use of medication Incomplete antibiotic
therapy
Factors Causing IUM
• 1) INTERNATIONAL LEVEL Drug promotion and
marketing Misleading, biased, scientifically
inaccurate Encourage over use High cost Market
dynamics Invest more in developed countries
• 2) NATIONAL LEVEL Weak Laws and Regulations
Poor quality medicines Poor HRM Economic status
Factors Causing IUM
• 3) HEALTH SYSTEMS LEVEL Unreliable suppliers
Poor planning of the drug needs Poor infrastructure
for storage Poor information management systems
Lack of monitoring and supervision
• 4) PRESCRIBERS LEVEL Lack of information and
training Outdated prescribing practices Heavy
patient load Pressure from pharma-industries
(Conflict of interest)
Factors Causing IUM
• 5) DISPENSING LEVEL Lack of qualification and
training Heavy patient load
• 6) PATIENTS & COMMUNITY LEVEL Non adherence
Cultural beliefs Accessibility Affordability Education
Availability
Adverse Impact of IUM
• Impact of Quality of Medicine Therapy and Medical
Care
• Impact on Antimicrobial Resistance
• Impact on Cost
• Psychosocial Impact
Vicious CircleLeadingto IUM
Intervention Strategies to Improve
Medicine Use
• EDUCATIONAL STRATEGIES:
• Training of prescribers Formal education In-service
education (CME) Supervisory visits
• Printed materials Clinical literature Treatment
guidelines & formularies
• Others Patient education Influence opinion leader
• MANAGERIAL STRATEGIES:
• Monitoring supervising & feedback D & TC Health
survey teams Government inspectors Self
assessment
• Selection procurement & distribution Limited
procurement list Drug use review Regional drug
committees
• Prescribing and dispensing approaches Structured
medicine order forms Diagnostic and treatment
guidelines Course of therapy packaging
• ECONOMIC STRATEGIES
• Price setting Capitation based budgeting
Reimbursement and user fees Insurance
• REGULATORY STRATEGIES
• Medicine registration Limited medicine lists
Prescribing restrictions Dispensing restrictions
Developing a Strategy
• There are six steps to develop a strategy to promote
RUM given as;
• Identify the problem and recognize the need for
action
• Identify underlying causes and motivating factors
• List possible interventions
• Assess recourses available for action
• Choose intervention(s) to test
• Monitor the impact and restructure the intervention
Core Policies to Promote RUM
• 1) A mandated multi-disciplinary national body to
coordinate medicine use policies
• 2) Clinical guidelines
• 3) Essential medicines list based on treatments of choice
• 4) Drugs and therapeutics committees in districts and
hospitals
• 5) Problem-based pharmacotherapy training in
undergraduate curricula
• 6) Continuing in-service medical education as a licensure
requirement
• 7) Supervision, audit and feedback
• 8) Independent information on medicines
• 9) Public education about medicines
• 10) Avoidance of perverse financial incentives
• 11) Appropriate and enforced regulation
• 12) Sufficient government expenditure to ensure
availability of medicines and staff
Thank you for listetening