Principles of Rational Medicines Use

(Drug management cycle and drug use cycle)

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Dr. Hindum Lanyero

Introduction to �Essential Medicines and health Supplies Management cycle

Topic Areas

Purpose of essential medicines and health supplies management system

Quality monitoring

Procurement

Quantification

• Consumption
• Morbidity data
• Adjusted consumption
• Service-level projection

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Objectives

By the end of this session, you will be able to:

Describe the purpose of a Essential Medicines and Health Supplies (EMHS) management system

Introduce the Medicines Management Cycle

Describe the components of the EMHS management system and how they are interlinked

Describe the four different methods of quantification

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Purpose of EMHS Management System

An efficient supply management system ensures that the:

Right medicines of the

Right quality (not expired), in the

Right quantities (amount) are available at the

Right place, at the

Right time, and at the

Right cost

Goal: Safe, effective, quality, and affordable medicines and health supplies are consistently available

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EMHS Management Cycle

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QA

EMHS Management Cycle

Selection – Based on Essential medicines, supplies and Lab items list and level of care

Quantification and Procurement- Involves quantification and prioritization based on available budget. The procurement process follows prescribed guidelines

Distribution Inventory and stores management- Involves Ordering, Receipt, Recording, Storage and Issuing (transportation) of the commodities at national level and facility level

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EMHS Management Cycle………

Rational Drug Use Involves rational prescribing, proper dispensing and ensuring appropriate use by patients and clients

Management Support System- The whole cycle rests on crosscutting support systems that Includes the human resource, funds, M and E systems that collects, analyses data on logistics management.

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Methods of Quantification

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First choice for procurement forecasts

Relies on reliable inventory records

Uses projected medicine costs for costing

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Appropriate for new programs, e.g., COVID 19

Data on population and patient attendances

Actual or projected incidence of problem

Standard treatment guidelines

Projected medicine costs

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Disadvantages

Morbidity not available or accurate

Standard treatment guidelines may not be followed

Requires accurate information on the population and morbidity as well as clinic attendance; uses standard treatment guidelines to project needs

Most complex (calculations) and time-consuming of the four methods

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Used when consumption and morbidity methods are unreliable

Extrapolate from consumption data from another region

Adjust for losses

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Estimate budget needs

Utilization of service level and facility type

Average medicine cost per attendance

Disadvantages: variable facility use, attendance, treatment patterns, supply system efficiency

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Reconcile Needs and Funds

Compare the estimated cost from quantification with the funds available

Reduce quantities or range of items

Look for alternative funding for other items

Approve the purchase

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Procurement Cycle

Determine quantities needed (quantification)

Reconcile needs and �funds

Review medicine selection

Choose procurement method

Locate and select suppliers

Specify contract terms

Make payments

Monitor order status

Receive and check medicines

Distribute medicines

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Cycle for development of procurement plans at HF level in Ugandan context

Key Points

Effective procurement results in obtaining the right medicines in the right quantities at the right time and at the lowest possible purchase price

Quantification is essential and, if done properly, will prevent waste and stock-outs

Understanding the problems associated with tools will help improve the quantification process

Proper management of stock cards is paramount

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Principles of Rational Medicines Use

Medicines and Health Supplies Management

Topic Areas

• Rational medicines use
• Appropriate medicines use
• Common inappropriate prescribing practices
• Irrational use of medicines

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Session Objectives

By the end of the session you will be able to:

• Define appropriate and rational medicines use (RMU)
• Describe the medicines use process
• Provide examples of inappropriate prescribing practices
• Describe factors underlying irrational use of medicines
• Discuss the impact of inappropriate medicines use
• Explain ways to promote rational medicines use

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What is Rational Medicine Use?

Rational use of medicines requires that patients receive medicines 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 the community. (WHO 1985)

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Criteria for RMU

• Appropriate indication. The decision to prescribe medicine(s) is based entirely on a medical rationale and the therapy is an effective and safe treatment.
• Appropriate medicine. The selection of the medicine is based on efficacy, safety, suitability, and cost considerations.
• Appropriate patient. No contraindications exist, the likelihood of adverse reactions is minimal, and the medicine is acceptable to the patient.
• Appropriate patient information. Patients are provided with relevant, accurate, important, and clear information regarding their conditions and the medication(s) prescribed.
• Appropriate evaluation. Anticipated and unexpected effects of the medications are appropriately monitored and interpreted.

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The Medicines Use Process

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Diagnosis / Follow-up

Prescribing

Dispensing

Adherence

Irrational Use of Medicines

• Use of medicines when no drug therapy is indicated
• Use of incorrect medicines for a specific condition
• Use of medicines with doubtful or unproven efficacy
• Use of medicines of uncertain safety
• Failure to prescribe available, safe, and effective medicines
• Incorrect administration, dosages, or duration

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Examples of Common Inappropriate Prescribing Practices

• Not adhering to standard treatment guidelines
• Prescribing medicines for an incorrect duration
• Using the wrong combination of medicines
• Giving incorrect dosage forms, e.g., stavudine 40 mg instead of 30 mg
• Prescribing many types of medicines (i.e., a pill for �every symptom) or polypharmacy

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We Can’t Find Anything Wrong with You....

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I Want An Injection, Doctor . . .

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Factors Underlying Irrational Use of Medicines

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Irrational Use of Medicines: �Diagnosis Problems

• Inaccurate diagnosis due to poor communication between prescriber and patient
• Lack of appropriate prescriber skills impedes proper diagnosis, e.g., no physical examination of the patient
• Excessive workload means less time to assess patient condition
• Lack of basic diagnostic equipment and tests�

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Irrational Use of Medicines: �Prescribing Problems

• Prescribe expensive medicines when cheaper ones can do the same work
• Incorrect selection of medicines for a patient’s condition, e.g., antidiarrheal medication for simple diarrhea when ORS would work
• Prescribing several medicines when a few would do
• Prescribing medicines for non-drug conditions �(self-limiting disease)

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Irrational Use of Medicines:�Dispensing Problems

• Incorrect interpretation of prescription
• Incorrect quantity dispensed
• Inadequate/incorrect labelling
• Incorrect/insufficient dispensing information
• Unsanitary practices: contamination of medications

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Irrational Use of Medicines: �Packaging Problems

• Poor quality of packaging material: packaging must protect medicines against heat and humidity
• Inadequate container size when repackaging medications

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Irrational Use of Medicines: �Compliance Problems

Causes of poor compliance—

• Improper labelling
• Inadequate instructions
• Treatment that does not consider the patient’s socioeconomic conditions and cultural factors

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Impact of Inappropriate Use of Medicines

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Promotion of RMU (1)

Improve consultation time by:

• Taking a complete history of the patient’s illness. Identify the main reason the patient came to the clinic
• Perform a physical examination relevant to the patient’s symptoms
• Do lab tests relevant to the patient’s complaints

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Promotion of RMU (2)

Improve dispensing practices by—

• Recruiting and training competent personnel
• Organizing the dispensing area so that it allows for efficient work flow
• Verifying the quantity of medicine that is being dispensed to a patient
• Giving correct and adequate instructions to the patient
• Providing appropriate dispensing tools

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Promotion of RMU (3)

Improve compliance by—

• Labelling appropriately
• Asking for the patient’s feedback to verify his/her understanding of the treatment
• Taking into consideration local beliefs and customs that influence use of medicines when prescribing and dispensing

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Key Points

• All issues and questions need to be discussed and answered before the medicine is taken
• Health professionals have the responsibility to ensure that the right medicine is prescribed, dispensed, and taken
• Improving medicines use improves the quality of care and often lowers costs

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