E-drug: Rational use of drugs (cont)
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Following on from Foppe's comments, I wonder if the term 'rational drug use'
needs rethinking (although it so widely used and known this may not be worth
the effort).
As there are many different reasons that drive consumers to use drugs and
prescribers to prescribe drugs, it is very difficult to objectively describe
drug use as rational or irrational.
I am thinking that the focus has shifted from irrational drug use,
irrational consumers, and irrational prescribers to the many factors that
influence prescribing, and how we can improve decision making, prescribing
and drug use, and the things competent prescribers and consumers should know
and do.
Although the criteria for optimal drug use may be universally accepted in
some circumstances, often they are not clear, lack a strong evidence base,
are broadly disputed or even not near definition. In addition, drug use
operates in a complex environment, and while criteria for optimal use may be
defined in one context, they may not be equally valid in a slightly
different context. In this situation, where decision making is loaded with
uncertainties, the environment in which prescribing occurs has a powerful
influence.
Putting this in a quality improvement paradigm might be valuable - how we
can improve the quality of drug use? Donabedian described seven attributes
of health care which define its quality which could also be applied to drug
use:
1. Efficacy: the ability of care, at its best, to improve health
2. Effectiveness: the degree to which attainable health improvements are
realised
3. Efficiency: the ability to obtain the greatest health improvement at the
lowest cost
4. Optimality: the most advantageous balancing of costs and benefits
5. Acceptability: conformity to patient preferences regarding accessibility,
the patient-practitioner relation, the amenities, the effects of care, and
the cost of care
6. Legitimacy: conformity to social preferences concerning all of the above
7. Equity: fairness in the distribution of care and its effects on health
(Donabedian A. The seven pillars of quality. Archives Of Pathology And
Laboratory Medicine 1990;114(11):1115-8.)
Regards
Jonathan Dartnell
Therapeutic Guidelines
Level 2, 55 Flemington Rd, North Melbourne, VIC 3051, Australia
Tel: 03 9326 9959 Fax: 03 9326 5632
website: http://www.tg.com.au
"Jonathan Dartnell" <jdartnell@tg.com.au>
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