E-DRUG: How can we promote rational use of medicines? (5)
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Dear E-Druggers;
in response to Dr Holloways request for comments on questions to promote rational use of medicines, I respectfully provide the following:
The definition of rational use of medicines 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. Implicitly this means that rational use of medicines is to achieve an outcome of health maintenance or improvement in individuals and in the community in a sustainable manner. Logically therefore, the purpose of the whole supply chain management sector is to achieve rational use of essential good quality medicines for a safe health maintenance or improvement outcome. To facilitate understanding for planning and implementing interventions to promote rational use of medicines therefore requires an analysis of poor or unsafe procedures at all stages of the medical supplies management sector, as compared to a limited approach to improve prescription of and consumer use of those medicines.
There is no shortage of data from developed and developing countries, that
provides detail of non-rational practices in the (mis) management of the
medicines sector, including examples of poor quality of manufacture, increased counterfeiting, selection of products un- related to reducing disease burden, inefficient procurement, poor quality of storage, ineffective and/or inappropriate distribution, questionable prescription, unprofessional dispensing, unethical marketing practices, lack of security and unhealthy consumption of medicines practices. The data are possible indicators that senior health systems managers in government, the professions, and community are only partially convinced about the specific management requirements for medicines (and medical supplies) that are vital to result in their safe and rational use for health improvement. This lack of conviction, can in turn lead to a prevailing indifference to the potential for global adverse public health outcomes that can and do result from non-rational management and poor use of medicines practices.
It is important to determine the risks that hinder rational use of medicines. The risks are certainly not limited to poor prescription and poor use of medicines by consumers. Indeed so many potent medicines including anti-infective agents are not prescribed by competent authorised persons but are freely available and sold by unskilled retailers. There are different examples where consumer use of medicines are more rational than what is prescribed.
Other factors that directly or indirectly adversely affect the achievement of rational use of medicines are limitations in, or absence of appropriate
country specific policies, laws or enforcement of the law, inadequate health care education or non-disciplined behaviour by key stakeholders
(administrators, practitioners and consumers) in medical supply chain
management. Rational medicines use is severely compromised wherever there is not collective acceptance or support for the unique and disciplined management practices required to assure the human right for access to good quality essential medicines and professional support for effective use of that medicine. The protection of this human right requires a disciplined sectoral focus by government and health care professionals, to establish and enforce local specific minimum standards for medical supply management infrastructure, human resources and systems that do result in overall safe and rational behaviour in the management of medicines for a healthy outcome.
Phillip Passmore PhD;
Manager ANTARA Medical Supplies Management Sub-program;
NTT Province Indonesia.
Adjunct Senior Lecturer, Curtin University of
Technology, School of Pharmacy Western Australia.
psmint@iinet.net.au