Medicine Information to promote RUM

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Medicine Information to promote RUM

• Nani Sukasediati
• EDM- WCO Indonesia

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Outline

• Rational use of medicine (RUM)
• Factors and strategies related to RUM
• Information and education in RUM
• WHO Ethical Criteria

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• 1.
• Rational Use of Medicine

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Rational/Quality/Prudent Use

• Patients receive medications appropriate to their
  clinical needs, in doses that meet their own
  individual requirements, for an adequate period
  of time, at the lowest cost to them and their
  community
• Therapeutically sound medicines used by the
  health professionals and cost effective
• Principles
• correct
• Cost-effective
• Evidence based quality, safety, efficacy
• - Comply to the guideline

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RATIONAL USE/QUALITY USE/PRUDENT USE OF MEDICINES
IN GPP
Review of c p
distribution
Nursing care
Use of med
Patient care
Pharmaceutical care
Managing Medicine supply
Implement of c p
procurement
Identify drug problem
Medical care
selection
Dev. of care plan
Rational use of medicines
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• Medicines should not be seen as a chemical
• But a chemical plus information for its correct
  use
• (RD WHO Searo, 2nd ICIUM 2004)

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• 2.
• Factors and strategies
• related to RUM

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Factors influencing medicines use
Information
training
ROLE MODEL
EXPIRED DATE
Information
availability
Prescribers
Supply
Finance
reliability
Medicine use
Training
Culture
Patient
dispenser
Consultation time
Supervision
behavior
Information
INFO
workload
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STRATEGY TO PROMOTE RUM
EDUCATION MANAGERIAL/FINANCING REGULATION/
POLICIES
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• 3.
• Information and education
• to promote RUM

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WHO 12 key interventions ? RUM

• Est. multidisciplinary national body to
  coordinate policy on medicines use (Dir. of
  Promoting RUM, MoH)
• Use of STG
• National EDL
• Est. D/PTC in hospital and district
• Incl. problem based pharmacotherapy training in
  undergraduate curricula
• CPD as licensure requirement CPD PUKA.ppt
• Supervision, audit, feedback
• Independent information on medicines
• Public education on medicines
• Avoidance of conflicting financial incentives
• Use appropriate and enforced regulation
• Sufficient govt expenditure availability med
  and staff

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Education
Community empowerment CBIA
Approach
Training for Health provider
HCs
hospital
Advocacy LG U
MODULES Promoting RUM
Monitoring, supervision
Technical assistant

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Education on medicines

• Main targets
• Community / consumers, lay person. Significant
  portion and leverage
• Health professionals CPD, basic curricula
• Decision maker advocacy on financing, LGU
  health expenditure

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Consumers/Layman education of RUM

• Knowledgeable ?
• Awareness, alert ?
• Skilled in selection and decision?
• Changing habit and behavior ?
• ? better use of medicine

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Education methods for layman

• Written passive
• Posters, banners, leaflets
• Booklet
• Articles (magazine, newspapers)
• Oral
• Lectures (passive)
• Discussion groups, interactive discussion
  (active)
• Media passive and active
• TV, films
• Radio spot, jingle,
• Video
• Traditional media (puppet show, street plays)

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CBIA Cara Belajar Ibu Aktif

• Format small discussion group
• Method interactive discussion, presided by
  tutor
• Participants mothers/woman belongs to civil
  society, religious group
• Discussion objects medicines stored in their
  household, medicines at their surrounding
• Purpose enhance their skill in selection
  medicine through understanding the API and its
  benefit.

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Health professionals MTP (QIMC)

• Adult learning process
• Self initiative learning process

• Follow quality improvement management cycle

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• 4.
• WHO Ethical Criteria
• for Medicine Promotion 1988

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WHO report 2005

• Irrational use of AM greatest contribution to
  AM resistant
• Pneumonia, disentry, gonorrhoe, hopsitals
  infection 70-90 to first line AM
• The more we use them, the more we lose them
  (Strama).
• 2,3-7m hepatitis B C cases and 160 ths new
  cases HIV using 15b injection/year. 50 are not
  in steril condition
• ADR 4-10 in patients in developing countries.

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• 2/3 world pop have access to medicines, half of
  them are prescribed incorrect
• 50 medicines in the world, are being prescribed,
  dispensed, and sold incorrect. and 50 of
  patients use it inappropriate
• WHO Promotion budget on RUM 0,2 2,3b (02-03)
  vs global sales promotion of precription drugs
  282,5b (00)

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Summary of studies in Indonesia

• Suryawati, 1997
• Permenkes 386/1994 ttg periklanan
• Spot survey
• 69 tdk menyebut bhn aktif
• 29-36 indikasi tdk benar
• 20 menulis informasi produsen
• 31 memberi informasi menyesatkan

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• Regulation of medicine promotion
• In 2004, 89 countries (46, WHO survey)
  reported that they regulated drug promotion
• Often delegated to industry self-regulation
• Few resources for example, in Canada less than
  1 full-time dedicated staff person, no fines or
  sanctions since 1978

Pills, Politics and Practice 25 YEARS OF
PROMOTING PEOPLE-CENTRED MEDICINES POLICY
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• WHO Ethical Criteria for Medicinal Drug
  Promotion, 1988
• First international ethical standard
• Aim is to support rational drug use, public
  health
• Specific types of information must be provided in
  advertising
• Promotion should not take advantage of concern
  for health
• Should not be disguised as education or science
• Generally, direct-to-consumer advertising of
  prescription
• drugs should not be allowed.

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Objective

• The main objective is to support and encourage
  the improvement of health care through the
  rational use of drugs.
• - WHO Ethical Criteria for Medicinal Drug
  Promotion

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Criteria

• Ethical criteria varies among society, should
  lay the foundation for proper behavior concerning
  promotion of medicines, consistent with
  truthfulness and righteousness, should assist in
  judging if promotional practice are in within the
  acceptable ethical standards

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Criteria

• Applicability and implementation Promotion
  general principles for ethical standard, do not
  constitues legal obligation
• Promotion all informations, persuasive
  activities by manufactures, and distributors, the
  effect of which to induce prescription, supply,
  purchase and/or use of medicine
• available in the country, scientific/evidence
  based
• comparison should be factual
• Advertising appropriate language, should help
  people make rational decision
• Free samples on OTC to public promotional
  difficult to justify
• Information for patients leaflets, package
  inserts, booklets

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• Medical representative
• Free samples of prescription medicine
• Symposia and other scientific meeting
• PMS and Dissemination information
• Promotion of exported medicines

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n102 internal medicine residents Am J Med 2001
110551
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n102 internal medicine residents Am J Med 2001
110551
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Summary

• Empowerment in medicine use is the key issues to
  promote RUM through cross cut community
• 3 target groups of information and education
  consumers/lay person, health providers/professiona
  ls, decision makers.
• Particular methods of empowerment has been
  developed
• How to disseminate the method of CIE

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Thank You
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