E-drug: Generic prescription & rational use of drugs (cont)
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Dear Ruwan,
Here are some definitions:
The Rational Use of Drugs requires that "patients received 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 1987, Conference of experts on the
rational use of drugs, Nairobi: Report on the rational use of drugs,
WHO Geneva.
Essential drugs are "those drugs that satisfy the health care needs of the
majority of the population; they should therefore be available at all times
in adequate amounts and in appropriate dosage forms. WHO has developed a
model list of essential drugs that can be adapted in different countries
according to need". WHO 1999, The use of essential drugs: ninth report of
the WHO expert committee, WHO Technical report series 895, WHO Geneva.
Standard Treatment Guidelines, protocols and prescribing policies are
"systematically developed statements to help practitioners or
prescribers to make decisions about appropriate treatments for
specific clinical
conditions", Managing Drug Supply, 1997, 2nd edition, Management
Sciences for Health in collaboration with World Health Organisation,
published by Kumarian Press inc., 14 Oakwood Ave, West Hartford,
Connecticut 06119-227, USA. ISBN: 1-56549-047-9
A formulary manual "contains summary drug information on a selected
number of drugs. It is drug-centred and the information is usually
organised in therapeutic groups". Managing Drug Supply 1997.
"Generic drugs are usually cheaper than their brand names counterparts,
making their use rational from a cost stand-point" provided that the
bio-equivalence is the same as for the brand product. Managing Drug
Supply, 1997.
"Generic substitution is the "dispensing of a product that is generically
equivalent to the prescribed product, with the same active ingredients in
the same dosage form, and identical in strength, concentration and route of
administration". Managing Drug Supply, 1997.
I suggest that you acquire a copy of Managing Drug Supply, 1997, as it will
give you comprehensive information on all aspects of drug use, including
rational drug use and methods to promote more rational drug use. Below is
some summarised information from chapters 28-33.
Strategies to change drug use should only be undertaken after the scale of
the problem has been "assessed and quantified" and "the reasons for the
problem behaviour...investigated...and understood". The main types of
intervention used to change behaviour include:
(1) education strategies based on information and persuasion e.g. training
(2) managerial strategies based on guiding decision making e.g. essential
drug list
(3) regulatory strategies based on limiting prescriber/consumer decisions
e.g. banning drugs
Interventions should be "carefully selected with regard to efficacy,
feasibility for implementation in the existing system and cost" and their
impact evaluated. "Programs to ensure rational use of drugs should be an
integral part of health and medical care services. The responsibility for
promoting rational use of drugs belongs to decision-makers, administrators
and clinicians".
Another useful sources of information on improving the use of medicines
include:
Laing R.O, Hogerzeil H.V, Ross-Degnan D, (2001), "Ten recommendations
to improve the use of medicines in developing countries", Health
Policy and
Planning, Vol.16(1), pp.13-20.
The WHO website: http://www.who.int/medicines which contains, under
the section on rational use, (1) CD Rom training materials on
promoting the rational use of drugs, and
(2) presentations from the international conference on improving the use of
medicines in Thailand in 1997.
Good luck with your workshop
Kathy
Kathy Holloway,
Medical Officer for Policy Access and Rational Use,
Department of Essential Drugs and Medicines Policy,
World Health Organisation, 20 Avenue Appia, Geneva CH-1211.
Tel: +41 22 791 2336; Fax: +41 22 791 4167
email: hollowayk@who.int
[For Managing Drug Supply email is erc@msh.org
website is http://www.msh.org/ BS]
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