RUD useful references;

1
RUD useful references

• Rational Drug Use Consumer Education and
  Information
• Estimating Drug Requirements A Practical Manual
  
• Public Education in Rational Drug UseReport of
  an Informal Consultation. Geneva, 23-26 November
  1993
• Rational Use of Drugs in the South-East Asia
  RegionReport of an Intercountry Consultative
  Meeting. New Delhi, 7-11 June 1993
• Producing National Drug and Therapeutic
  Information -- The Malawi Approach to Developing
  Standard Treatment Guidelines
• Clinical Pharmacology. The European Challenge
• The Rational Use of Drugs.Report of the
  Conference of Experts. Nairobi, 25-29 November
  1985
• The Use of Essential Drugs.Eighth Report of the
  WHO Expert Committee(including the Tenth Model
  List of Essential Drugs)
• WHO Drug Information
• International Nonproprietary Names (INN) for
  Pharmaceutical SubstancesLists 1-73 of Proposed
  INN and Lists 1-35 of Recommended INNCumulative
  List No. 9
• International Nonproprietary Names (INN) for
  Pharmaceutical Substances Names for Radicals and
  Groups, Comprehensive List July 1997
• Guidelines on the Use of International
  Nonproprietary Names (INN) for Pharmaceutical
  Substances

2
RUD useful references (cont.)

• The Use of Common Stems in the Selection of
  International Nonproprietary Names (INN) for
  Pharmaceutical Substances, March 1999
• WHO Model Prescribing Information Series
• WHO Model Prescribing Information Drugs Used in
  the Treatment of Streptococcal Pharyngitis and
  Prevention of Rheumatic Fever
• WHO Model Prescribing Information Drugs Used in
  HIV-Related Infections
• WHO Model Prescribing Information Drugs Used in
  Leprosy
• WHO Model Prescribing Information Drugs Used in
  Skin Diseases
• WHO Model Prescribing Information Drugs Used in
  Parasitic DiseasesSecond edition
• WHO Model Prescribing Information Drugs Used in
  Sexually Transmitted Diseases and HIV Infection
• WHO Model Prescribing Information Drugs Used in
  Anaesthesia

3
Challenges

• Despite the growing body of knowledge on rational
  use interventions, numerous studies have
  documented the continuing widespread irrational
  prescribing of drugs.
• injection therapy can also be an example of
  irrational drug use.
• knowledge alone is not enough to change
  behaviour, and that complex and multifaceted
  solutions are needed.
• Many new drugs and second-line drugs are very
  expensive and accordingly unaffordable for many
  governments and consumers.

4
Challenges (cont.)

• Drugs and therapeutics committees may have
  difficulty to run in situations where Medical and
  pharmacy training is still very traditional with
  much emphasis on drug knowledge and very little
  on public health, prescribing skills, drug
  management and patient care.
• Influence of pharmaceutical representatives
• Doctors often gets visits from these
  representatives introducing new drugs or
  reminding doctors of their products.
• Doctors should stick to the principles of
  rational prescribing.

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Expected outcomes for 2000-2003

• Development of national standard treatment
  guidelines and essential drugs lists
• Support for problem-based and skill-based
  in-service training programmes 
• Drugs and therapeutics committees established and
  operating effectively
• International technical guidelines and standards
  on traditional medicine expanded

6
Rational Drug Use by Consumers

• Establishing effective drug information
  systems to provide independent and unbiased drug
  information -- including on traditional medicine
  -- to the general public and to improve drug use
  by consumers

7
Progress

• An extensive review by WHO of public education on
  drugs provided valuable insight into strategies
  used, and their strengths and weaknesses (Public
  Education in Rational Drug Use A Global Survey).
  
• WHO guide to investigating drug use in the
  community has contributed to a growing body of
  knowledge on consumer understanding, attitudes
  and practices regarding drug use. (How to
  Investigate Drug Use in Communities).
• Support independent sources of drug information.
  Experiences with independent drug bulletins are
  being shared with developing countries through
  networks such as the International Society of
  Drug Bulletins.
• Development of drug information centres. These
  are important source of independent drug
  information. Linking these centres
  electronically contributes to sharing of
  information and experience.

8
Challenges

• The consumer takes the final decision about
  whether and where to seek health care, what
  medicine is actually taken , how much and when,
  and from what source. These decisions are
  influenced by knowledge, culture, drug promotion
  and personal finances.
• Independent drug information and public education
  about drug use are complicated and costly and
  have always been underserved and underfunded.
  They also tend to be organized by NGOs thus with
  informal networks and objective evaluation of
  interventions and publication of the results are
  not easily arranged.
• Lack of independent drug information and advice.
  Worldwide, some 50 of people fail to take their
  medicines correctly. Part of the problem is that
  self-medication is widespread.
• Purchases of drugs in certain localities take
  place in the private sector, where prescribing
  and selling functions are often combined. Profit
  motives and pressure to please the patient can
  lead to over-treatment of mild illnesses, overuse
  of injections and misuse of anti-infective drugs.
  

9
Expected outcomes for 2000-2003

• Effective systems of drug information that are
  accessible to all health workers and the general
  public, through provision of training material
  and regional and national training courses, and
  technical support to international networks of
  drug information centres.
• Public education in rational drug use and
  consumer empowermentthrough operational
  research, and development and provision of new
  training materials and courses.

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Activities in Japan

• April 1998 Japanese version of P-Drug manual
• 28 Oct. 98 13th Fujigoko Clinical
  Pharmacological Conference
• 10 Oct. 98 P-Drug Network (P-Net-J) founded
• 15 Oct. 98 P-Net-J website founded
  (http//p-drug.UMIN.ac.jp)
• 6 Dec. 98 1st P-Drug Workshop Hamamatsu,
  Shizuoka (Facilitator Hans Hogerzeil)
• 1 Apr. 99 P-Net-J Regulation
• 27-29 Aug. 99 2nd P- Drug Workshop, Hieizan,
  Shiga (Facilitator K. Kafle)
• 9-11 Aug. 99 3rd P-Drug Workshop, Machida, Tokyo
  (Facilitator K. Barnes)
• 30 Sep. 2000 7th Course for Certified Clinical
  Pharmacologist by J-CPT
• 11 Nov. 2000 6th Meeting of Japanese Society for
  Pharmacoepidemiology (Symposium)
• 16 Nov. 2000 10th Meeting of Japanese Society
  for Clinical Psychopharmacology (Plenary lecture)
• 18th Feb. 2001 20th Meeting of Japanese Society
  of Oral Therapeutics and Pharmacology (Plenary
  lecture)
• ? 2001 4th P-Drug Workshop

12
RUD in Malaysia

• Drug regulation (MOH/Pharmaceutical
  division/NPCB/DCA)
• RUD meeting in Sarawak 1995 with WHO involvement
  (?first)
• Bi-Regional Working Group Meeting on Hospital
  Pharmaceutical Therapeutic Committee and Drug
  Information Service13 - 15 October 1999, Penang,
  Malaysia
• PRUD workshop in Kuala Lumpur August 2001
• Scientific meetings of professional Societies and
  Associations MSPP
• USM
• National Poison Centre (and Drug information)
• RUD teaching in School of Medical Sciences USM.
• Research and Ethical Committee
• Pharmacy and Therapeutics Committee
• DIU/DUC
• Clinical Trial Unit
• Regular Therapeutic Update Seminars

13
Examples of regional activities by NGOs incl.
associations

• First Asian CPT Conference, Yokyakarta,
  Indonesia, 1993
• ICIUM- 1-4 April 1997, Chiengmai, Thailand
• Padang, Indonesia 9-21 Oct. 2000 Training
  Course on Promoting Rational Drug Use
• Kuala Lumpur, August 2001- Workshop on Rational
  Pharmacotherapy
• Manila, Philippines 19-28 Oct. 2001-1st Asian
  Course in Problem-based Pharmacotherapy Teaching

14
Other Centres of activity worldwide

• Newcastle Australia
• Boston USA
• Gronigen Netherlands
• Cape Town South Africa
• Individual efforts in respective countries

N.B It is important that the educational
activities are conducted to the right target
group, eg. Medical teachers, prescribers,
decision makers in family. School children has
been shown to be effective in dissemination of
information.
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WHO model (Guide to Good Prescribing)

Process of Rational Prescribing
Define the patients problem
Specify the Therapeutic objective
Verify whether your P-Treatment is suitable for
this patient
Start the Treatment
Give information, instructions and warnings
Monitor and stop treatment
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WHO model (Guide to Good Prescribing)
Process of Rational Prescribing Rahmans
modification
Define the patients problem (after careful
evaluation)
Specify the Therapeutic objective
Management Plan (Pharmacological and
Non-pharmacological)
Choose and verify P-Drug
Write Prescription
Give information, instructions and warnings
Execute Treatment
Cont./stop treatment
Review treatment
Monitor and stop treatment
17

•  Do The right things right (K-action)
• 5 rights' of medication 
• right patient
• right drug
• right dose
• right route
• right frequency

18
In conclusion

• It is our duty to provide health
• care for mankind through rational
• approach and providing rational
• management as part of overall
• rational patient care.

19
Doctors must not say Dont tell me what to do  
20
 No. of physicians in the U.S.
70,000 Accidental death caused by physicians per
year 120,000 ð     accidental death per
physicians 0.171 (source U.S. Dept. of
Health and Human Services) cf. No. of gun owners
in the U.S. 80,000,000 No. of accidental gun
death per year 1500 No. of accidental gun death
per gun owner 0.0000188 Statistically doctors
are approximately 9000 more dangerous than gun
owners.

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Summary

• Drugs need to be used rationally
• Irrational use of drugs is occurring
• Definition of rational use of drugs need to
  consider national, economic and socio-cultural
  background in respective community
• Efforts to promote RUD is worldwide
• Focus of activities should be at international,
  national, prescribers and consumers level
• There are many challenges in tackling irrational
  use of drugs
• Cooperation among parties involved in promotion
  of RUD including pharmaceutical industry should
  be strengthened
• Doctors must maintain the noble status of their
  profession

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• ARIGATO GOZAIMAS