Irrational Use Of Drugs

Problems of
Irrational Drug Use

Session Guide

Problems of Irrational Drug Use

Session Guide

PURPOSE AND CONTENT

IN BOTH THE DEVELOPED AND THE DEVELOPING WORLD, MEDICALLY INAPPROPRIATE, INEFFECTIVE, AND ECONOMICALLY INEFFICIENT USE OF PHARMACEUTICALS COMMONLY OCCURS IN HEALTH CARE FACILITIES. THE COSTS OF SUCH IRRATIONAL DRUG USE ARE ENORMOUS IN TERMS OF BOTH SCARCE RESOURCES ANDTHE ADVERSE CLINICAL CONSEQUENCES OF THERAPIES THAT MAY HAVE REAL RISKS BUT NO OBJECTIVE BENEFITS.

This session will sensitize participants to the reality of medication misuse in the developing world, drawing on existing examples as well as inappropriate prescribing patterns in their own countries. In addition to providing an overview of problem areas in medication use, this session will alsoidentify some of the more important causes that underlie such misuse. To improve the quality and efficiency of drug therapy, it is necessary to have a thorough understanding of the existing patterns of therapy, the magnitude of the ways in which such therapy departs from optimal practice, and the factors (clinical, psychological, political, economic, and cultural) that underlie these patterns.OBJECTIVES

THIS SESSION WILL DEVELOP YOUR ABILITY TO—

1. Identify the magnitude and nature of inappropriate drug utilization.
2. Understand the adverse impacts of inappropriate use of drugs.
3. Describe the factors that influence the clinical decision-making process in drug use.
4. Identify factors that influence the behavior of prescribers and patients.
5. Relate these issues tospecific medication use problems.

PREPARATION

1. READ THE SESSION NOTES.
2. Prepare a list of medication use problems to be referred to in the Activities section that follows.

FURTHER READINGS

LAING RO. RATIONAL DRUG USE: AN UNSOLVED PROBLEM. TROP DOCT. 1990; 20:101–3.

Avorn J, Harvey K, Soumerai, SB et al. Information and education as determinants of antibiotic use. Rev Infect Dis.1987; 9(S3):S286–96.

Vance MA, Millington WR. Principles of irrational drug therapy. Int J Health Serv. 1986;16(3):355–61.

Quick JD, Foreman P, Ross-Degnan D, et al. Where Does the Tetracycline Go?: Health Center Prescribing and Child Survival in East Java and West Kalimantan, Indonesia. Boston: Management Sciences for Health, October 1988.

Ross-Degnan, D, Laing RO, Quick, JD et al. Astrategy for promoting improved pharmaceutical use: The International Network for Rational Use of Drugs. Soc Sci and Med. 1992 35 (11) 1329–41.
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SESSION NOTES

BACKGROUND

MEDICALLY INAPPROPRIATE, INEFFECTIVE, AND ECONOMICALLY INEFFICIENT USE OF PHARMACEUTICALS IS COMMONLY OBSERVED IN HEALTH CARE SYSTEMS THROUGHOUT THE WORLD, ESPECIALLY IN DEVELOPING COUNTRIES. HOWEVER, VARIOUS FORMS OFINAPPROPRIATE PRESCRIBING OFTEN REMAIN UNNOTICED BY THOSE WHO ARE INVOLVED IN HEALTH SECTOR DECISION MAKING OR DELIVERY OF HEALTH SERVICES. THIS PROBLEM WILL USUALLY COME TO THE ATTENTION OF HEALTH DECISION MAKERS OR MANAGERS WHEN THERE IS AN ACUTE SHORTAGE OF PHARMACEUTICAL BUDGET THAT REQUIRES ACTION FOR COST-EFFICIENCY.

Promoting appropriate use of drugs in the health care system is needed notonly because of the financial reasons with which policy makers and managers are usually most concerned. Appropriate use of drugs is also one essential element in achieving quality of health and medical care for patients and the community. Obviously, quality of care is of concern to practitioners. Actions or intervention programs to promote the appropriate use of drugs should, therefore, becontinuously implemented and systematically incorporated as an integral part of the health care system.

This session serves as an introduction to the entire issue of Promoting Rational Use of Drugs in developing countries. The definition of rational use will be discussed, and a description of irrational drug use will build on that definition, with common examples highlighted. The session addresses...