21. INTRODUCTION TO RATIONAL DRUG USE

The topic includes two important concepts: 1) Essential Medicines and 2) Rational Drug Use (RDU). Together, these principles ensure safe, effective and affordable treatment for the community.

Essential Medicines

Definition

According to WHO, essential medicines are those that meet the priority healthcare needs of a population. These medicines must be available, affordable, safe and effective.

Selection Criteria

Essential medicines are selected based on:

  • Public health needs (disease patterns in the region)
  • Evidence of efficacy and safety
  • Cost-effectiveness
  • Available treatment facilities
  • Skill level of healthcare staff
  • Ease of administration and patient acceptability

Importance of Essential Medicines

  • Must be available at all health facilities in adequate quantities
  • Should be in appropriate dosage forms with assured quality
  • Should have proper information and be affordable
  • Cover 80–90% of common healthcare needs

Essential Medicine List (EML)

An EML is a limited list of carefully chosen core medicines. It ensures better healthcare, cost control, easier procurement and simpler storage.

Advantages of Having an EML

  • Reduces deaths caused by treatable diseases when essential drugs are available
  • Makes procurement and storage easier
  • Ensures better quality control
  • Helps doctors and pharmacists develop strong clinical knowledge of commonly used drugs
  • Ensures treatment follows standard guidelines

Disadvantages of EML

  • Some doctors feel their freedom to prescribe is restricted
  • Pharmaceutical companies oppose limited lists for commercial reasons
  • EML is often (incorrectly) seen as a “list for the poor”

Rational Use of Drugs (RDU)

Definition

Rational drug use means prescribing the right drug for the right disease, in the right dose, for the right duration, at the lowest cost and with proper patient counselling.

Factors That Lead to Irrational Drug Use

  • Self-medication without proper diagnosis
  • Easy access to medicines without prescription
  • Advice from friends or peers
  • Desire to avoid visiting a doctor

Common Types of Irrational Drug Use

  • Polypharmacy: Using too many medicines unnecessarily
  • Inappropriate antibiotic use: wrong dose, wrong duration, using for viral infections
  • Overuse of injections: when oral medicines would work
  • Inappropriate self-medication
  • Not following Standard Treatment Guidelines (STGs)

Strategies to Improve Rational Drug Use

Improving rational use requires continuous monitoring, training and supervision.

1) Managerial Strategies

  • Use of STGs (Standard Treatment Guidelines)
  • Prescription audits for feedback
  • Encouraging use of EML medicines

2) Economic Strategies

  • Insurance reimbursement only for approved/EML-listed drugs
  • Pharmaceutical companies offer competitive pricing to get included on lists

3) Regulatory Strategies

  • Restricting who can prescribe what
  • Licensing of doctors and pharmacists
  • Drug scheduling and banning of unsafe drugs
  • Regulation of pharmaceutical promotions

4) Educational Strategies

  • Training healthcare providers
  • Use of formularies and unbiased drug information
  • Patient counselling by pharmacists

National Strategies to Promote RDU (WHO Recommendations)

  • Set up national bodies to monitor medicine policies
  • Develop evidence-based STGs
  • Create and update national EML
  • Establish Drug & Therapeutics Committees (DTCs)
  • Include problem-based pharmacotherapy in medical education
  • Mandatory continuing medical education (CME)
  • Provide unbiased drug information sources
  • Conduct drug audits and provide feedback
  • Educate the public about medicines
  • Remove incentives that cause irrational prescribing
  • Ensure adequate government funding for medicine availability

Role of Pharmacist in Promoting Rational Drug Use

  • Member of DTC: helps select essential medicines and prepare EML
  • Drug procurement: ensures high-quality medicines from reliable suppliers
  • Drug storage: prevents stock-outs, maintains proper storage conditions
  • Dispensing: ensures correct dispensing and prevents errors
  • Patient education: counselling improves adherence
  • Pharmacovigilance: monitors and reports ADRs
  • Drug information service: provides unbiased, updated drug information
  • Pharmaceutical care: pharmacist takes responsibility for patient’s drug-related needs

Detailed Notes:

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