Essential drug list
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Transcript of Essential drug list
Essential Drug List & Rational Use of Drug
Presented By- Santu M.Pharm (p’cology) ISCP Moga.
The concept of essential medicines
A limited range of carefully selected essential drugs leads to
Better health care
Better drug management
Lower costs
Definition of essential medicines
Essential medicines are those that satisfy the priority health care needs of the population at all time.
Essential medicines
History of the WHO Model List of Essential Drugs
1977 First Model list published, ± 200 active substances
List is revised every two years by WHO Expert Committee
April 2003 revised Model list contains 315 active substances
2007, a separate list for children up to 12 years was included.
Latest, The 18th edition for adults and the 4th edition for children were released in April 2013
Number of countries with a national list of essential medicines
National Essential Drugs List
< 5 years (127)> 5 years (29)No NEDL (19)Unknown (16)
156 countries with EDL
1/3 within 2 years
3/4 within 5 years
Full description of essential drugs(Expert Committee Report, April 2002)Definition: Essential medicines are those that satisfy the priority health care needs of the populationSelection criteria: Essential medicines are selected with due regard to disease prevalence, evidence on efficacy and safety, and comparative cost-effectivenessPurpose: Essential medicines are intended to be available within the context of functioning health systems at all times, in adequate amounts, in the appropriate dosage forms, with assured quality, and at a price the individual and the community can afford. Implementation: The implementation of the concept of essential medicines is intended to be flexible and adaptable to many different situations; exactly which medicines are regarded as essential remains a national responsibility.
The Essential Medicines Target
S S
All the drugsin the world
Registered medicines
National list ofessential medicines
Levels of use
Supplementaryspecialistmedicines
CHWdispensary
Health center
Hospital
Referral hospital
Private sector
National List of Essential Medicines of India
The first National List of Essential Medicines of India was prepared and released in 1996.
The list was subsequently revised in 2003. 2011, publication of revised list containing 348 drugs. In comparison to NLEM 2003, number of medicines deleted
is 47 and 43 medicines was added. 3 category included P→ Primary S → Secondary T → Tartiary
o P,S,T containing 181 drugso S,T containing 106 drugso T containing 61 drugs.
The WHO Model List of Essential Medicines is amodel product, model process and public health tool
Model product: list of essential drugs with information
Core list: minimum drug needs for a basic health care system, listing the most cost-effective drugs for priority conditions (selected on the basis of burden of disease and potential for safe and cost-effective treatment).
Complementary list: essential drugs for priority diseases which are cost-effective but not necessarily affordable or for which specialised health care facilities may be needed; and essential drugs for less frequent diseases
Seven steps to get a new medicine onthe WHO Model List of Essential Drugs
1. Identification of public-health need for a medicine2. Development of the medicine; phase I - II - III trials3. Regulatory approval in a number of countries
> Effective and safe medicine on the market4. More experience under different field circumstances; post-marketing
surveillance5. Price indication for public sector use6. Review by WHO disease programme; define comparative
effectiveness and safety in real-life situations, comparative cost-effectiveness and public health relevance
> Medicine included in WHO treatment guideline7. Submission to WHO Expert Committee on Essential Drugs
> Medicine included in WHO Model List
PROCESS ADOPTED FOR REVISION OF NLEM India (2011)
National List of Essential Medicines 2003
(Base document)
Consultation meetings with Experts
Deliberation on Evidence based criteria for addition and deletion of
medicines from the NLEM
Therapeutic area wise group discussion
(Group composition: Clinicians, Pharmacologists, Pharmacists,
Scientists and Regulators)
REVISION PROCESS contd…
Presentation by groups in open house discussion
Deliberations/ discussion and reasoning for additions/
deletions/modifications
Draft recommendations for NLEM
Consideration and adoption of NLEM by the Core
Committee
Resource Materials: WHO Model List of Essential
Medicines 2010, WHO model formulary,
National Formulary of India 2010 (Pre print Version),
Textbooks of Pharmacology, Internal Medicine,
Drug compendia, Indian Pharmacopoeia,
Internet facility
Resource Support: Scientists, Senior Residents,
Junior Residents and PhD Scholar of Dept of
Pharmacology, AIIMS, New Delhi
Content of EDL 1 Anaesthetics 1.1 General anaesthetics and oxygen 1.2 Local anaesthetics 1.3 Preoperative medication and sedation for short-term procedures
2 Medicines for pain and palliative care 2.1 Non-opioids and non-steroidal anti-inflammatory drugs (NSAIDs) 2.2 Opioid analgesics 2.3 Medicines for other common symptoms in palliative care
3 Antiallergics and medicines used in anaphylaxis 4 Antidotes and other substances used in poisonings 4.1 Non-specific 4.2 Specific
5 Anticonvulsants/antiepileptics 6 Anti-infective medicines 6.1 Antihelminthics 6.2 Antibacterials 6.3 Antifungal medicines 6.4 Antiviral medicines 6.5 Antiprotozoal medicines
7 Antimigraine medicines 7.1 For treatment of acute attack 7.2 For prophylaxis etc,……………………………………….
Contents…. Hormones, other endocrine medicines and cont Immunologicals Ophthalmological preparations Vitamins and minerals Medicines for diseases of joints Ear, nose and throat medicines in children Cardiovascular medicines Antiparkinsonism medicines Diagnostic agents Diuretics Gastrointestinal medicines
etc…………………………
State EDL (Punjab)
Rational use of drugs
Rational use of Drug 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
correct drug
appropriate indication
appropriate drug considering efficacy, safety, suitability for the patient, and cost
appropriate dosage, administration, duration
no contraindications
correct dispensing, including appropriate information for patients
patient adherence to treatment
Examples of Irrational Drug use
Prescribing drugs of no proven value. Prescribing empirically. Unnecessary prescribing for self limiting
conditions. Over dosing and under dosing. Prescribing costly drugs. Using injections when oral drugs would sufficient.
Why does irrational use continue?
Very few countries regularly monitor drug use because…
They have insufficient funds. They lack of awareness. There is insufficient knowledge of concerning the
cost-effectiveness of interventions.
Many Factors Influence Use of Medicines
Treatment Choices
Prior Knowledge
HabitsScientific Information
Relationships
With Peers
Influenceof Drug
Industry
Workload & Staffing
Infra-structure
Authority & Supervision
Societal
Information
Intrinsic
Workplace
Workgroup
Social &Cultural
Factors
Economic &
Legal Factors
Overview of Rational use of Drug
Strategies to Improve Use of Drugs
Economic: Offer incentives
– Institutions– Providers and patients
Managerial: Guide clinical practice
– Information systems– Drug supply / lab capacity
Regulatory: Restrict choices
– Market or practice controls– Enforcement
Educational: Inform or persuade
– Health providers– Consumers
Use of Medicine
s
Educational StrategiesGoal: to inform or persuade Training 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 strategies Goal: to structure or guide decisions
Changes 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 strategies:
Goal: to offer incentives to providers an consumers
Avoid perverse financial incentives
Regulatory strategiesGoal: to restrict or limit decisions
Drug registration Banning 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
PHARMACIST’S ROLE
A) Drug Selection : The selection and range of drugs should be
based on the essential drug concept. Strict inventory control and cost effective
procurement should be practiced. Procure the most cost effective drugs in the right
quantities. Select reliable suppliers of high quality products. Ensure timely delivery. Achieve the lowest possible total cost.
B) Inventory control : Monitoring of drug stocks and
minimizing out of stock. Restrict the number and brands of
drugs. Drugs with overdue expiry dates should
not be dispensed or stored. All the drugs required to health facility
should be kept in stock.
C) Information and education Interact with other healthcare
professionals and inform them about new drugs and availability of drugs.
Suitable programes should be evolved to raise awareness of ADR.
Patient should be counseled.
D) Pharmaceutical care : This aims to optimize the patients health
related quality of life and achieve positive and cost effective clinical outcomes.
An evidence based approach must be adopted.
Pharmacists must collect subjective information regarding the patient’s health.