NTA Level 5 • Semester 1 • PST05105

Introduction to Irrational Use of Medicines

Rational Use of Medicines • Source Session/Topic 2

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Session 2: Introduction to Irrational Use of Medicines

Total Session Time: 120 Minutes

Prerequisites

• None

Students Learning Tasks

By the end of this session students are expected to be able to:

• Give over view of irrational medicines use

• Identify types of irrational Medicines use

• Describe dispenser’s influence on irrational use of medicines

• Describe prescriber’s influence on irrational use of medicines

• Give reasons for irrational use of medicines to continue

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

• Handout 2.1:Factors underlying irrational Use of Medicines

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (05Minutes)

READ or ASK students to read the learning objectives and clarify

ASK students if they have any questions before continuing.

STEP 2: Introduction to Irrational Use of Medicines (20Minutes)

Irrational use of medicines:

• Is the use of medicines in a way that is not compliant with rational use,

this incorrect use may take the form of overuse, underuse and misuse of

prescription or non-prescription medicines

Irrational use of medicines is a serious public health problem worldwide

and can be seen as:

• Use of too many medicines per patient

• Inappropriate use of antimicrobials, often in inadequate dosage and

insufficient duration;

• Overuse of injections when oral medication would be more appropriate;

• Failure to prescribe in accordance with clinical guidelines including

standard treatment guidelines and prescribing policy; and

• Inappropriate self-medication, often of prescription-only medicines.

STEP 3: Types of Irrational Medicines Use Based on Prescribing Practice (30

Minutes)

|Activity: Small Group Discussion ( 05 minutes) |

|DIVIDE students into small manageable groups |

|ASK students to discuss on the following question |

|Give types of irrational medicine use base on prescribing practice |

|ALLOW students to discuss for 10 minutes |

|ALLOW few groups to present and the rest to add points not mentioned |

|CLARIFY and SUMMARIZE by using the contents below |

The following are some types of irrational use of medicines based on

prescribing practices that observed in health institutions:

• Under-prescribing;

• Over-prescribing

• Incorrect prescribing or dispensing

• Extravagant prescribing

• Multiple prescribing

• Poly-pharmacy

• Under-prescribing:

o Occurs when needed medications are not prescribed and the dosage

prescribed is inadequate

• Over-prescribing:

o Occurs when the prescribed drug is not needed by the patient and the

quantity of drug dispensed is too much for current course of treatment

• Incorrect prescribing or dispensing:

o Occurs when prescribing the wrong drug, dispensing the wrong drug due

to the prescription being prepared improperly and adjustments are not

made for existing medical, genetic, environmental or other conditions

• Extravagant prescribing:

o Occurs when prescribing a more expensive branded drug when there is a

less expensive generic drug of good quality available and treating the

patient symptomatically instead of treating the serious illness, hence

making the patient use a lot of his funds.

• Polypharmacy

o The use of too many medicines per patient when more than one medicine

is used unnecessarily to treat same condition.

STEP 4: Dispenser’s Influence on Irrational Use of Medicines (20 Minutes)

The dispenser plays a crucial role in the therapeutic process, on the other

hand:

• Dispensing quality may be affected by training and supervision the

dispenser has received and the medicine information available to the

dispenser.

• A shortage of dispensing materials and short dispensing time caused by

heavy patient load may also have an adverse impact on dispensing.

• As with prescribers, dispensers, especially private drug sellers, may

have a financial incentive to dispense irrationally.

• Drug sellers in retail outlets are rarely trained and there is little

knowmonitoring or supervision.

• Low status of dispensers affects the quality of dispensing.

Dispensing characteristics that lead to Irrational Medicine Use are:

• Incorrect interpretation of the prescription

• Retrieval of wrong medicines/ingredients

• Inaccurate counting, compounding, or pouring

• Inadequate labelling

• Unsanitary procedures packaging:

o Poor-quality packaging materials

o Odd package size, which may require repackaging

o Unappealing package

Pharmaceutical personnel promoting irrational use of medicines by: –

• Recommending prescription medicines even though the law does not permit

it.

• When recommending Over-The-Counter (OTC) medicines, he may

recommend/provide:

o Irrational medicines and combinations.

o Inappropriate dosage.

o Improper medicine for a particular condition.

o Insufficient or inappropriate information about the medicines,

dosages, timing set leading to improper dosing by the patient.

• By being tempted to stock and push/recommend medicines that are costly,

or those which offer better schemes/profit margins, but compromise on

genuine need and rationality.

• By following/copying prescribing patterns similar to those of physicians.

• By passing on misleading information from pharmaceutical

companies/medical representatives to clients.

[pic]

STEP 5: Prescriber’s Influence on Irrational Use of Medicines (20 Minutes)

Prescriber can be affected by internal and external factors such as:

• He or she may have received inadequate training either pre-service or in-

service, or his or her prescribing practices may have become outdated

because of a lack of continuing education and a poor supervisory system.

• Prescribing role models who are imitated may not prescribe rationally.

Objective information on medicines may be lacking, and the information

provided by supplier representatives may be unreliable.

• Temptation can be strong to generalize inappropriately about the

effectiveness or side effects of medicines on the basis of limited

personal experience.

• Externally, a heavy patient load and pressure to prescribe from peers,

patients, and pharmaceutical company representatives all complicate

prescribing decisions.

• Profit may affect a prescriber’s choice if the prescriber’s income is

dependent on medicine sales.

Prescriber’s Characteristics that Lead to Irrational Medicine Use are:

• Inadequate examination of patient

• Incomplete communication between patient and prescriber

• Lack of documented medical history

• Inadequate laboratory Resources which lead to incomplete patient

examinations.

Handout 2.1: Factors Underlying Irrational Use of Medicines

|Patients |Drug misinformation |

| |Misleading beliefs |

| |inability to communicate problems |

| |Patient demands/expectations |

|Prescribers |Lack of education and training. |

| |Inappropriate/poor role models. |

| |Lack of objective/inadequate drug |

| |information. |

| |Generalization of limited experience. |

| |Misleading beliefs about drug efficacy. |

| |Marketing pressures and lucrative |

| |offers/financial interest |

| |Pressure to prescribe |

| |Heavy patient load |

|Dispenser |Poor training |

| |Financial interest |

| |No supervision |

| |Shortage of dispensing materials |

| |Patient load |

|Health Supply system |Unreliable supply |

| |Medicine shortages. |

| |Supplying expired medicines. |

| |Inefficient management |

| |Supplying substandard or counterfeit |

| |medicines |

| |Supplying wrong medicines |

|Pharmaceutical industry |Over promotion – Promotional activities |

| |through advertisements or medical |

| |representatives) |

| |Misleading claims. |

| |Large number of preparations |

|Drug regulation |Availability of non-essential medicines.|

| |Presence of non-formal /informal |

| |prescribers (Quacks). |

| |Lack of regulation enforcement. |

| |Sluggish judiciary. |

| |Absence of Essential drug list |

| |Absence of standard treatment guidelines|

STEP 6: Reasons for Irrational Use of Medicine to Continue (15Minutes)

|Activity: Brainstorming (10 Minutes) |

|Ask students to brainstorm on the following question: |

|Why does irrational use of medicines continue? |

|ALLOW few students to respond? |

|WRITE their responses on the flip chart/ board |

|CLARIFY and SUMMARISE by using the content below |

Very few countries regularly monitor drug use and implement effective

nation-wide interventions this is because:

• They have insufficient funds or personnel

• They lack of awareness about the funds wasted through irrational use

• There is insufficient knowledge concerning the cost-effectiveness of

interventions

• They do not bear the cost of irrational use

STEP 7: Key Points (05 Minutes)

• Health professionals have a responsibility to ensure that the right drug

is prescribed, dispensed and taken.

• Prescriber’s characteristics that lead to Irrational Medicine Use are

inadequate examination of patient, incomplete communication between

patient and prescriber and lack of documented medical history.

• Dispensing characteristics that lead to irrational medicine use are:

incorrect interpretation of the prescription, retrieval of wrong

medicines/ingredients, inaccurate counting, compounding, or pouring,

inadequate labeling, unsanitary procedures

• Improving drug use improves the quality of care and frequently lowers

cost.

STEP 8: Evaluation (05 Minutes)

• What is irrational use of medicines

• What are the types of irrational use of medicines?

• List reasons for irrational use of medicines to continue

References:

Dean, B., Schachter, M., Vincent, C, Barber, N (2002).Lancet: Causes of

prescribing errors in hospital inpatients: a prospective study.

359:1373–8. 7

Dean, B., Vincent, C, Schachter, M., Barber, N (2005).Drug Saf:The

incidence of prescribing errors in hospital inpatients: an overview of

the research methods.. 28:891–900.

Knudsen, P., Herborg, H., Mortensen, A,R., Knudsen, M., Hellebek, A

.(2007). QualSaf Health Care:Preventing medication errors in community

pharmacy: root-cause analysis of transcription errors.16:285–290.

Lesar, T.S., Briceland, L., Stein, D, S. (1997). JAMA:Factors related to

errors in medication prescribing.. 277:312–317.

Rees, J. A., Smith, I., & Watson, (2012) J. Pharmaceutical practice (5th

ed.). London, United Kingdom: Churchill Livingstone

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