Essential Medicine List Concept and Rational Use

of Medicine For BNS 1st YearDr. Pravin Prasad

1st Year Resident, MD Clinical PharmacologyInstitute of Medicine, Maharajgunj, Kathmandu1st December, 2015 (Mangsir 14, 2072), Tuesday

General Pharmacology

Objectives Introduction to Clinical Pharmacology Terminologies and abbreviations used in Pharmacology Drug Nomenclature• Essential Drug Concept• Rational use of Drugs

Essential Medicine(Drug) Concept• “Those drugs that satisfy the priority of healthcare needs of the

population” – World Health Organization• Selection on the basis of:• Public health relevance• Evidence on efficacy and safety• Comparative cost effectiveness

Essential Medicine Concept• Should be available within the context of functioning health systems:• At all times• In adequate amounts• In appropriate dosage forms• With assured quality, and• With adequate information• At an affordable price to individual and community

Essential Medicine Concept• Includes• Drug name• Dosage forms• Dosage strength• Indications ??

• Includes single formulations• Fixed drugs are included only if its efficacy is proven to be higher

• Anti-Tubercular Agents• Anti-Malarial Agents

• Drugs listed as Main List and Complementary List

Essential Medicine Concept• First Model List of Essential Drugs by WHO in 1977 AD• Current Edition – 19th Edition, April 2015 (Amended August 2015)• Separate List for Paediatric Population – 5th Edition (2015)

• Nepal’s Essential Medicine List:• National List of Essential Medicines• Current Edition: 2011, 4th • No separate list for paediatric population• Modified for different level of health facilities • 368 medicines

Objectives Introduction to Clinical Pharmacology Terminologies and abbreviations used in Pharmacology Drug Nomenclature Essential Drug Concept• Rational use of Drugs

Rational Use of Medicines (Drugs)• The rational use of drugs requires that patients receive medications

appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, and at the lowest cost to them and their community.

WHO conference of experts Nairobi 1985

• So, what would you understand by Irrational use of Medicines?• Irrational or non-rational use is the use of medicines in a way that is not

compliant with rational use as defined above.

Why Rational Use is Important??Irrational Use has various harms as follows: Ineffective & unsafe treatment

over-treatment of mild illness inadequate treatment of serious illness

Increased morbidity (Adverse Drug Events, prolonged illness) and mortality

Distress, harm and cost burden to patient and community as a whole

Increased drug resistance

Why medicines are used irrationally??• Lack of information• Role models – Teachers or seniors• Lack of diagnostic facilities/Uncertainty of diagnosis – medicine for all

possible causes • Demand from the patient• Patient load• Promotional activities of pharmaceutical industries• Drug promotion and exaggerated claim by companies• Defective drug supply system & ineffective drug regulation

Influences over choosing treatment options

Irrational Use: Few examples• Injudicious use of antimicrobials: Antibiotics in Viral fever and diarrhea• Unnecessary combinations• Use of drugs not related to diagnosis• Incorrect route• Incorrect dosing – under or overdose• Incorrect duration – prolong or short term use• Unnecessary use of expensive medicines• Unsafe use of corticosteroids• Polypharmacy

Moving towards Rational Use…

Educational StrategiesTraining for Providers• Undergraduate education• Continuing in-service medical

education (seminars, workshops)• Face-to-face persuasive

outreach e.g. academic detailing• Clinical supervision or

consultation

Printed Materials• Clinical literature and

newsletters• Formularies or therapeutics

manuals• Persuasive print materials

Media-Based Approaches• Posters• Audio tapes, plays• Radio, television

Managerial StrategiesChanges in selection, procurement, distribution to

ensure availability of essential drugs• Essential Drug Lists, morbidity-based quantification, kit systems

Strategies aimed at prescribers• targeted face-to-face supervision with audit, peer group monitoring,

structured order forms, evidence-based standard treatment guidelines

Dispensing strategies • course of treatment packaging, labelling, generic substitution

Economic StrategiesAvoid perverse financial incentives • prescribers’ salaries from drug sales• insurance policies that reimburse non-essential drugs or incorrect

doses • flat prescription fees that encourage polypharmacy by charging the

same amount irrespective of number of drug items or quantity of each item

Regulatory StrategiesDrug registrationBanning unsafe drugs - but beware unexpected results• Substitution of a second inappropriate drug after banning a first inappropriate

or unsafe drug

Regulating the use of different drugs to different levels of the health sector e.g.• Licensing prescribers and drug outlets• Scheduling drugs into prescription-only & over-the-counter

Regulating pharmaceutical promotional activities

Abbreviation Play time!!

That will be all for today!!• Next class we will be discussing about:• Routes of Drug Administration

• Assignments for you….. Posters making• Use A4 papers• Don’t get stressed - its something you have been doing

• Thank you!