NTA Level 5 • Semester 1 • PST05105

Factors Hindering Promotion of Rational Use of Medicine

Rational Use of Medicines • Source Session/Topic 9

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Session 9: Factors Hindering Promotion of Rational Use of Medicine

Total Session Time: 120 minutes

Prerequisites

• None

Students Learning Tasks

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

• Give overview of factors hindering promotion of rational use of

medicine

• List factors hindering promotion of rational use of medicine

• Explain Factors hindering promotion of rational use of medicine

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

SESSION OVERVIEW

SESSION CONTENTS

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

READ or ASK students to read the learning objectives and clarify

ASK students if they have any questions before continuing.

STEP 2: Introduction to Factors Hindering Promotion of Rational Use of

Medicine (15 Minutes)

• Promoting the correct and appropriate use of medicinal products is

the main goal of pharmaceutical personnel activities.

• The pharmaceutical personnel activities can be summarized as

following: consulting, selection of drugs, drug information,

formulation and preparation, drug use studies and research,

pharmacokinetics/ therapeutic drug monitoring, clinical trials,

pharmacoeconomy, dispensing & administration, teaching & training.

• The aims of these activities are to maximize rational use of

medicines, clinical effect of medicines, to minimize the risk of

treatment-induced adverse events and to minimize the expenditures for

pharmacological treatments for the national health systems and for

the patients

STEP 3: Types of Factors Hindering Promotion of Rational Use of Medicine

(30 Minutes)

|Activity: Buzzing (10 minutes) |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

|What are the factors hindering promotion of rational use of Medicine? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

|WRITE their response on the flip chart/board |

|CLARIFY and SUMMARIZE by using the content below |

The following are the factors hindering promotion of rational use of

Medicine

• Poor communication between professionals and patients/clients

• Lack of objective information

• Inadequate public education

• Cost of medicines

• Proliferation of brands

• Prescribing errors

• Defective drug supply system and ineffective drug regulation

• Promotional activities of pharmaceutical industries

STEP 4: Explanation of Factors Hindering Promotion of Rational Use of

Medicine (60 Minutes)

The subsequent are the explanations of factors hindering promotion of

rational use of medicine

Poor communication between professionals and consumers

• Communication between professionals and patients is fundamental to the

improvement of rational use of medicines by patients.

• The following information should be provided to patients: the name of the

medicine, the purpose for which the medicine is being taken, dose,

frequency of use, and duration of use.

• The adverse effects due to medicines for chronic disease like cancer and

HIV/AIDS should be explained clearly to patient to avoid confusion and

irrational use of medicines.

• The shortage of qualified health personnel in public health facilities

has resulted in inadequate labelling of medications by prescribers and

dispensers, and in insufficient time spent by them to inform the patients

on how to take the medicine.

Lack of objective information

• The pharmaceutical market has been saturated by medical representatives

whose aim is to achieve higher sales for the companies they represent.

• These sales professionals have become the principal source of information

for many

Prescribers and dispensers despite the fact that the information they

provide is geared towards promoting the sales of pharmaceutical

companies.

• The essential medicines list, standard treatment guidelines, national

drug policies

are often good sources of literature on medicines use, but these

reference materials are not widely disseminated.

• Media can play a key role in raising awareness on problems with drugs and

publicizing serious health hazards related to drugs; however the media

has at times been used by pharmaceutical companies to covertly promote

their medicines.

• The existence of counterfeits has sometimes been used to discredit

generic products by some media houses as a result consumers end up with

mixed reactions on the use of generics and irrational use of medicines.

Inadequate public education

• Developing countries have ineffective public education programmes.

The most important sources of information for consumers about medicines

are

Doctors; followed by the pharmaceutical personnel, then nurses and other

healthcare personnel.

• Medical professionals must not only know the correct information to

convey, but the skill and the time to do it well, However, skill and time

are scarce resources.

• Patients may not be aware of the kind of information they need or what

questions they should ask, so there is a significant, general educational

challenge.

• The emergence of HIV/AIDS and other chronic diseases has exacerbated the

problem since there are higher patient numbers but fewer of them are able

access the medicines they require.

• In the event that the prescribed medicines are dispensed, the HIV/AIDS

patients

go back home but most of them do not get regular outpatient support to

encourage them to take the medicines.

• A successful patient follow up mechanism has been put in place in many

countries to encourage the rational use of TB medicines; unfortunately no

similar mechanisms have been designed at the international and national

level for other diseases.

Cost of medicines

• In economic terms, inappropriate use has led to the wastage of limited

resources and to non-availability of essential medicines where they may

be needed.

• Most of the people live below poverty line as a result: many patients who

go to public health facilities or private sectors for treatment often go

back home without getting the medicines they need which lead the

situations where a family ends up sharing medicines that were prescribed

to treat one person – a classic example of irrational use of medicines.

• Some sections of the population have developed a misconception that the

expensive medicines are more effective than the cheaper generic versions.

• Middle class patients in developing countries that may have the

purchasing power to buy medicines often have limited knowledge on the use

of medicines and therefore sometimes end up pressurizing the prescribers

and dispensers for the expensive branded medicines in preference to

cheaper generics which are just as effective.

Proliferation of brands

• Irrational drug use is directly related to the number of brands on the

market and to their promotion.

• Many medicines are variations of prototype drugs and offer no therapeutic

advantage over drugs already available.

Prescribing errors

• Some doctors are rarely use the prescription form approved by the

Ministry of Health for writing medicine prescriptions rather they use

form-notebooks, known as blanks, which are distributed by pharmaceutical

representatives, so as to receive a share of the profits made by the

pharmaceutical representatives.

o Prescription without dose indication is also a common prescribing

error. For instance, a Prescription may give only the name of the

preparations without indicating the dose, the turnout form or the mode

of application.

o Children’s prescriptions errors are areas where many errors are likely

to occur, the prescribing of drugs which are contraindicated in

children or which should not be prescribed to children below a certain

age is a common mistake. For instance: Famotidin is prescribed to

younger children in doses of a half and a quarter pill daily. However

it is not advisable to prescribe the drug to children less than 16

years old.

• Defective drug supply system & ineffective drug regulation: Absence of a

well organized drug regulatory authority (TFDA) and presence of large

numbers of drugs in the market leads to irrational use of drugs.

• Promotional activities of pharmaceutical industries: The lucrative

promotional programs of various pharmaceutical industries influence the

drug prescribing and dispensing which lead irrational use of medicines.

STEP 6: Key Points (05 minutes)

• The shortage of qualified health personnel coupled with inadequate staff

time in public health facilities has resulted in inadequate labelling of

medications by prescribers and dispensers

• Medical professionals must not only have the information to convey, but

the skill and the time to do it well

• Day-to- day tests and regular analysis of prescriptions would reform the

treatment and reduce the risk of adverse reactions which appear as a

result of misuse of the preparations.

• It is necessary to resume cooperation of family physicians and

pharmaceutical personnel regarding correct and efficient drugs

prescribing, this cooperation would reform treatment.

STEP 7: Evaluation (05 minutes)

• List factors hindering promotion of rational use of Medicine?

• What are the promotional activities of pharmaceutical industries that

hinder rational use of medicine

References:

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

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

Velo, G, P., &Minuz, P. (2009). British Journal of Clinical Pharmacology:

Medication errors: prescribing faults and prescription errors. 67:6

http://www.med.rug.nl/pharma/who-cc/ggp/homepage.html.Published by:

WHO/EDM, WHO; 1994

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