(2002; 6 pages) [French] [Spanish]
Assessing the problem of irrational use
To address irrational use of medicines, prescribing, dispensing and patient use should be regularly monitored in terms of:
• the types of irrational use, so that strategies can be targeted towards changing specific problems;
• the amount of irrational use, so that the size of the problem is known and the impact of the strategies can be monitored;
• the reasons why medicines are used irrationally, so that appropriate, effective and feasible strategies can be chosen. People often have very rational reasons for using medicines irrationally. Causes of irrational use include lack of knowledge, skills or independent information, unrestricted availability of medicines, overwork of health personnel, inappropriate promotion of medicines and profit motives from selling medicines.
There are several well-established methods to measure the type and degree of irrational use. Aggregate medicine (drug) consumption data can be used to identify expensive medicines of lower efficacy or to compare actual consumption versus expected consumption (from morbidity data), Anatomical Therapeutic Classification (ATC)/Defined Daily Dose (DDD) methodology can be used to compare drug consumption among institutions, regions and countries. WHO drug use indicators (Box 1) can be used to identify general prescribing and quality of care problems at primary health care facilities.
Focused drug use evaluation (drug utilization review) can be done to identify problems concerning the use of specific medicines or the treatment of specific diseases, particularly in hospitals, The qualitative methods employed in social science, (e.g. focus group discussion, in-depth interviews, structured observation and structured questionnaires), can be used to investigate the motives underlying irrational use, The data collected can then be used to design appropriate interventions and to measure the impact of those interventions on medicines use.
WHO, with partners, runs several international courses on how to measure medicines use and implement interventions to promote more rational use of medicines (Box 2).
Box 1 Selected WHO/INRUD* drug use indicators for primary health care facilities (WHO, 1993)
Patient Care Indicators:
Complementary Drug Use Indicators:
* International Network for the Rational Use of Drugs
Box 2 Training courses related to the rational use of medicines
For further details email: firstname.lastname@example.org or visit the WHO medicines website: http://www.who.int/medicines/
• Promoting the rational use of drugs (medicines), in collaboration with the International Network for the Rational Use of Drugs (INRUD) coordinated by Management Sciences for Health, USA. This course teaches the investigation of medicine use in primary health care and how to promote rational use of medicines by providers.
• Promoting rational drug (medicine) use in the community, in collaboration with the University of Amsterdam, The Netherlands. This course teaches the investigation of medicine use in the community, and how to promote rational use of medicines by consumers.
• Drugs and therapeutics committees, in collaboration with the Rational Pharmaceutical Programme coordinated by Management Sciences for Health, USA. This course teaches methods for evaluating medicine utilization and how to promote rational use of medicines in hospitals and districts.
• Problem-based pharmacotherapy teaching, in collaboration with Groningen University, The Netherlands, the University of Cape Town, South Africa, the University of La Plata, Argentina (in Spanish) and the National Centre for Pharmacovigilance, Ministry of Health, Algiers, Algeria (in French). This course teaches a problem-based approach to rational prescribing based on WHO's Guide to Good Prescribing.
• Pharmacoeconomics, in collaboration with the University of Newcastle, Australia. This course teaches how to do economic evaluation in medicine selection.
• Drug (medicine) policy issues for developing countries, in collaboration with Boston University, USA. This course teaches about general medicines policy including aspects relating to promoting more rational use of medicines.
• ATC/DDD methodology for medicine consumption, in collaboration with the WHO Collaborating Centre for Drug Statistics Methodology. This course provides an introduction to the application of ATC/DDD methodology in measuring medicine consumption.