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“The rational use of medicines 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)
The rational use of medicines depends upon
- Correct diagnosis
- Correct medicine
- Appropriate indication
- Appropriate medicine as regards efficacy, safety, suitability for the patient and cost
- Appropriate dosage, administration and duration
- Contraindications
- Correct dispensing, including appropriate information for patients
- Patient adherence to treatment
Strategies to promote the rational use of medicines may include:
- Identification of the problem
- Noting of trends in the prescribing and use of medicines
- Developing evidence based standard therapeutic guidelines
- Formularies (hospital lists , national list, other lists)
- Drugs and therapeutics committees (DTCs)
- Independent information on medicines through bulletins, leaflets, articles, media etc
- Educational strategies to inform health providers and health professionals
- Public education about medicines so that consumers are well informed
- Managerial strategies to guide clinical practice through information systems, formularies, therapeutic guidelines, medicines supply etc.
- Regulation of medicines in terms of Prescription only Medicines (PoM) and Over the Counter (OTC) medicines
- Regulation of the promotion and advertising of medicinal products
- Appropriate and enforced medicines regulation
The impact on medicines use can be greater and long-term if various interventions are put together in a package which is implemented in a co-ordinated way and sustained over a period of time.
Therapeutic guidelines and protocols based on an up-to-date formulary, are critical to promoting the rational use of medicines, as they aim to indicate the best care options based on the rigorous research, selection, synthesis and interpretation of evidence.
Very often, the only information about medicines that the health professionals receive is provided by the pharmaceutical industry and may be biased. Therefore, the provision of independent, unbiased information is essential. This information must be free from any influence or conflicts of interest and based on good research and sound evidence. Information on the medicinal products available on the Maltese market may be found in the Summary of Product Characteristics (SPCs) and Patient Information Leaflets (PIL) available on the Medicines Authority website.
People often lack sufficient knowledge about the risks and benefits of using medicines and when and how to use them. This leads to the loss of the needed and expected clinical outcome, and to the development of side-effects. This is true for the prescription only medicines (PoM) as well as medicines bought over the counter (OTC) and administered without the advice of a health professional.
Medicines regulation with regards to registration, prescribing, dispensing, licensing, pharmacovigilance, advertising, labeling etc, and its enforcement can lead to an improvement in the rational use of medicines. However, education of both the public and health professionals is crucial to decrease the influence that cultural beliefs and social factors have on the rational pharmaceutical health care.
“Monitoring medicine use and using the collected information to develop, implement and evaluate strategies to change inappropriate medicine use behaviour are fundamental to any national programme to promote the rational use of medicines. A mandated national body to co-ordinate all activities and sufficient government funding are critical to success” - (WHO Policy Perspectives on Medicines - Promoting rational use of medicines: core components, 2002)
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