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IRRATIONAL DRUG USE

Problems of Irrational Drug Use

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Problems of Irrational Drug
Use:
Objectives

• Identify magnitude and nature of
inappropriate drug utilization
• Understand the adverse impacts of
inappropriate use of drugs
• Describe factors which influence the
decision-making process
• Identify factors which influence the
behavior of prescribers and patients
• Discuss specific medication use
problems
Problems of Irrational Drug Use

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for an adequate period of time. dosage. and duration Appropriate patient Appropriate patient information Appropriate evaluation Problems of Irrational Drug Use 3 . and at the lowest cost to them and the community. (WHO 1988)       Appropriate indication Appropriate drug Appropriate administration.What is Rational Use of Drugs? The rational use of drugs requires that patients receive medicines appropriate to their clinical needs. in doses that meet their own individual requirements.

safe.Irrational Use of Drugs = Pathology of Prescribing • The use of drugs when no drug therapy is indicated • The use of wrong drugs for a specific condition requiring drug therapy • The use of drugs with doubtful or unproven efficacy • The use of drugs of uncertain safety status • Failure to prescribe available. & effective drugs • Incorrect administration. or duration Problems of Irrational Drug Use 4 . dosages.

. e.Examples of Common Inappropriate Prescribing Practices • The overuse of antibiotics and antidiarrheals for nonspecific childhood diarrhea • Indiscriminate use of injections for malaria • Multiple or over-prescription • Use of antibiotics for mild. non-bacterial infection.g. URI • Tonics and multivitamins for malnutrition • Unnecessary use of expensive antihypertensives Problems of Irrational Drug Use 5 .

Components of the Drug Use System Local Manufacture Drug Imports The Drug Supply Process Provider and Consumer Behavior + Hospital or Health Center Center Private Physician or Other Practitioner Illness Patterns Pharmacist or Drug Trader Public Problems of Irrational Drug Use 6 .

• inefficient management • nonavailability of required drugs Problems of Irrational Drug Use 7 .Factors Underlying Irrational Use of Drugs Patients Patients • drug misinformati on • misleading beliefs • inability to communicate problems Industry Industry Prescribers Prescribers • lack of education and training • lack of drug information • heavy patient load • pressure to prescribe • generalization of limited beliefs • misleading beliefs about efficacy • promotion • misleading claims Drug DrugSupply Supply Drug DrugRegulation Regulation • availability of unsafe drugs • informal prescribers • etc.

Impact of Inappropriate Use of Drugs Reduced quality of therapy •morbidity •mortality Waste of resources Risk of unwanted effects •Reduced availability •increased cost •adverse reactions •bacterial resistance Problems of Irrational Drug Use Psycho-social impacts •patients rely on unnecessary drugs 8 .

2007 Three 27% Three 29% Two 14% Two 9% One 1% One 3% Six + 6% Six+ 13% Four 26% Four 35% Five 19% Five 17% Under 5 Five & Over Problems of Irrational Drug Use 9 . Kalimantan. Indonesia. Java & W.Drugs per Case by Age Group: E.

Skin G. Kalimantan. Musculoskel.Drugs Per Case By Diagnosis E. 2007 # Drugs per Case 5 4 3 Under Five Five & Over 2 1 0 All Cases Diarrhea DiarrheaResp.Dis. Indonesia.I. Musculoskel Problems of Irrational Drug Use 10 . Java & W.

% Of Patients Receiving Antibiotics E. Indonesia. Java & W. Kalimantan. 2007 None 35% One 56% None 12% Three/More 3% Three/More 2% One 36% Two 27% Two 29% Under 5 Problems of Irrational Drug Use 5& Over 11 .

Kalimantan. 2007 None 56% None 26% One 54% Two or More 10% Two or More 20% One 34% Under 5 5 & Over Problems of Irrational Drug Use 12 . Indonesia.% Of Patients Receiving Injections E. Java & W.

2 1 Under Five Five & Over 0.ARI Treatment Pattern E.6 0. Kalimantan.8 0.4 1.2 0 Antibiotics AnalgesicProblems Cough/Cold Antihist. 2007 Average # of Drugs Per Case 1. Others of Irrational Drug Use 13 .4 0. Java & W. Indonesia.

Other Drug Use Problems • Incorrect treatment of malaria – incorrect use of chloroquin injection • Poor compliance with TB therapy – causes treatment failure and resistant organisms • Underuse of effective drugs – hypertension – depression • Hospital drug use problems – antibiotic misuse for surgical prophylaxis Problems of Irrational Drug Use 14 .

Average Number of Drugs per Patient Public Sector Drug Use Indicator Studies 2000-2003 Yemen Uganda Sudan Malawi Indonesia Bangladesh Zimbabwe Tanzania Nigeria Nepal Ecuador Guatemala Eastern Caribbean Jamaica Ghana Cameroon El Salvador 0 1 2 3 4 5 Average Number of Drugs Problems of Irrational Drug Use 15 .

% Prescribed as Generics Public Sector Drug Use Indicator Studies 2000-2003 Sudan Indonesia Zimbabwe Tanzania Nigeria Nepal Ecuador Guatemala Eastern Caribbean Ghana Cameroon El Salvador Jamaica 0 20 40 60 80 100 % Generic Problems of Irrational Drug Use 16 .

% Receiving Antibiotics Public Sector Drug Use Indicator Studies 2000-2003 Yemen Uganda Sudan Malawi Indonesia Bangladesh Zimbabwe Tanzania Nigeria Nepal Ecuador Guatemala Eastern Caribbean Jamaica Ghana Cameroon El Salvador 0 20 40 60 % of encounters receiving antibiotics Problems of Irrational Drug Use 80 100 17 .

% Receiving Injections Public Sector Drug Use Indicator Studies 2000-2003 Yemen Uganda Sudan Malawi Indonesia Bangladesh Zimbabwe Tanzania Nigeria Nepal Ecuador Guatemala Eastern Caribbean Jamaica Ghana Cameroon El Salvador 0 20 40 60 % of encounters receiving injections Problems of Irrational Drug Use 80 100 18 .

Average Consultation Time Public Sector Drug Use Indicator Studies 2000-2003 Malawi Indonesia Tanzania Nigeria Nepal 0 1 2 3 4 5 6 7 Average Consultation Time (mins) Problems of Irrational Drug Use 19 .

Average Dispensing Time Public Sector Drug Use Indicator Studies 2000-2003 Tanzania Nigeria Nepal Eastern Carribean Ghana 0 50 100 Average Dispensing Time (seconds) Problems of Irrational Drug Use 150 200 20 .

% Patients Knowing Drug Dosing Public Sector Drug Use Indicator Studies 20002003 Malawi Indonesia Bangladesh Tanzania Nigeria Nepal Eastern Caribbean Ghana 0 20 40 60 % patients w/ dosing knowledge Problems of Irrational Drug Use 80 100 21 .

% of Key Drugs in Stock Public Sector Drug Use Indicator Studies 2000-2003 Malawi Tanzania Nigeria Nepal Ecuador Cameroon Ghana El Salvador Guatemala Jamaica 0 20 40 60 80 100 % of key drugs in stock Problems of Irrational Drug Use 22 .

• Health professionals have a responsibility to ensure that the right drug is prescribed. • Methods exist to measure drug use and to change practices. dispensed and taken. • Improving drug use improves the quality of care and frequently lowers cost. Problems of Irrational Drug Use 23 .Conclusion • Drug use is the end of the therapeutic consultation.