INRUDINRUD

International Network for International Network for Rational Use of DrugsRational Use of Drugs

“Better health through research”

INRUD is a cooperative international venture to address INRUD is a cooperative international venture to address in an in an innovative wayinnovative way the problem of inappropriate use of the problem of inappropriate use of drugs, with an drugs, with an interdisciplinaryinterdisciplinary approach. approach.

By using a network approach, it is hoped that By using a network approach, it is hoped that effective effective and realisticand realistic policy and program options to improve policy and program options to improve rational use of drugs can be identified.rational use of drugs can be identified.

IndonesiaIndonesia

NigeriaNigeria

GhanaGhana

ZimbabweZimbabweTanzaniaTanzaniaUgandaUganda

PhilippinesPhilippinesThailandThailand

Inauguration: 1990Inauguration: 1990

NepalNepal

BangladeshBangladesh

Support Groups:Support Groups:MSH (Arlington), Drug Policy Group-Harvard (Boston), WHO-EDM MSH (Arlington), Drug Policy Group-Harvard (Boston), WHO-EDM IHCAR (Stockholm), Clinical Pharmacology-University of Newcastle (Australia), IHCAR (Stockholm), Clinical Pharmacology-University of Newcastle (Australia),

Strategy Strategy An An interdisciplinaryinterdisciplinary focus, linking clinical and social science; focus, linking clinical and social science; Activities originating from Activities originating from country-basedcountry-based core group of individuals core group of individuals

representing MOH, universities, NGOs, and private sector institutions;representing MOH, universities, NGOs, and private sector institutions; Belief in the importance of Belief in the importance of sharing relevant experiencessharing relevant experiences and in and in technical technical

cooperationcooperation among participant individuals; among participant individuals; Emphasis on understanding Emphasis on understanding behavioral aspects of drug usebehavioral aspects of drug use, particularly , particularly

the beliefs and motivations of providers and consumers;the beliefs and motivations of providers and consumers; Promotion of Promotion of well-designed researchwell-designed research studies to understand these studies to understand these

behavioral factors, leading to behavioral factors, leading to reproducible interventionsreproducible interventions to improve drug to improve drug use;use;

Development of Development of useful tools for researchuseful tools for research, including standard research , including standard research methodologies, simplified sampling and data collection strategies, and methodologies, simplified sampling and data collection strategies, and user-accessible computer software. user-accessible computer software.

Factors influencing drug Factors influencing drug useuse

Informational & marketing:Informational & marketing:Unbiased information Unbiased information Influence of industryInfluence of industry

Work environment:Work environment:Workload & staffingWorkload & staffingDrug availabilityDrug availabilityInfrastructureInfrastructure

Provider-patient Provider-patient interactions:interactions:Cultural beliefsCultural beliefsPatient demandsPatient demands

Characteristics of Characteristics of providers:providers:

Knowledge deficitsKnowledge deficitsAcquired habitsAcquired habits

DRUG USEDRUG USE

Social structure of Social structure of providers:providers:

Peer norms & RelationPeer norms & RelationAuthority, PowerAuthority, Power

INRUDINRUD framework - framework - for changing drug use for changing drug use problemproblem

FORMATIVE FORMATIVE STUDIESSTUDIES

INTERVENTIONINTERVENTIONSTUDIESSTUDIES

FOLLOW-UPFOLLOW-UP

1. Define problems with drug use patterns1. Define problems with drug use patterns2. Identify motivating factors, underlying causes2. Identify motivating factors, underlying causes

3. List possible interventions3. List possible interventions4. Choose intervention (s) to test4. Choose intervention (s) to test5. Conduct controlled study of intervention (s)5. Conduct controlled study of intervention (s)

IMPLEMENIMPLEMENTTCost-effective Cost-effective interventions interventions on larger scaleon larger scale

REVISE & RESTUDYREVISE & RESTUDYPartially effective or Partially effective or costly interventionscostly interventions

DROPDROPIneffective, Ineffective, uneconomicaluneconomicalinterventionsinterventions

IGD to reduce IGD to reduce inappropriate injection inappropriate injection useuse

0%

20%

40%

60%

80%

100%Control(12 HCs)

IGD (12 HCs)

MonthMonth

IGDIGD DisseminationDisseminationof IGD resultsof IGD results

Implementation of Implementation of other district-wide other district-wide RDU programRDU program

Source: Long-term impact of small group interventions, Santoso et al., 1996Source: Long-term impact of small group interventions, Santoso et al., 1996

Significant reduction of Significant reduction of inappropriate injections: 1987-inappropriate injections: 1987-19991999

0%

20%

40%

60%

80%

100%

1987 Dec'97 Jul'98 Oct'98 Mar'99

pharmacy

public hospital

private hospital

health center

Source: Evaluation of NDP implementation, Ministry of Health of Indonesia, 1999Source: Evaluation of NDP implementation, Ministry of Health of Indonesia, 1999

Courses on Promoting Courses on Promoting Rational Drug UseRational Drug Use

PRDU Course participants 1990-2000PRDU Course participants 1990-2000

600 from 41 countries600 from 41 countries

International Conference on Improving the Use of MedicineInternational Conference on Improving the Use of Medicine(ICIUM) Chiangmai, 1-4 April 1997(ICIUM) Chiangmai, 1-4 April 1997

Jointly sponsored by: Jointly sponsored by:

WHO-DAP, INRUD, USP, The ARCH ProjectWHO-DAP, INRUD, USP, The ARCH Project Presentations of research projects related to promoting rational Presentations of research projects related to promoting rational

drug use (published & unpublished)drug use (published & unpublished) Evaluation on the achievement so farEvaluation on the achievement so far Summary and recommendation:Summary and recommendation:

– Best research methodology: RCT, time seriesBest research methodology: RCT, time series

– Small-group interventions for behavioral aspect of drug useSmall-group interventions for behavioral aspect of drug use

– Lots have been done for public primary health careLots have been done for public primary health care

– Few have been done for private sector, hospital setting, and chronic Few have been done for private sector, hospital setting, and chronic diseasesdiseases

http://www.who.http://www.who.intint/programmes/dap/icium//programmes/dap/icium/

What What INRUDINRUD offers?offers?

Sharing knowledge and experience on Sharing knowledge and experience on research methodology, effective research methodology, effective strategies to improve drug use strategies to improve drug use problemsproblems

PRDU CoursePRDU Course INRUD NewsletterINRUD Newsletter ConsultancyConsultancy