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(2001; 12 pages) [French] [Spanish]
Rational use: Action at all levels of care
Irrational drug use typically involves the wrong drug given in the wrong dose or for the wrong duration. Escalating health care costs in many countries, a growing range of pharmaceutical treatments for individual conditions, and the increasing threat of antimicrobial resistance are now magnifying the impacts of such irrational use, making therapeutically sound and cost-effective use of drugs by health workers and consumers both medically and economically necessary.
Support to individual countries in rational selection and use of drugs was given to Afghanistan, Armenia, Egypt, Georgia, several states in India, Kyrgyzstan, Mongolia and Tajikistan in particular.
In Armenia and Georgia, substantial efforts have been put into improving drug prescribing practices by introducing problem-based pharmacotherapy, clinical and social pharmacy teaching into the medical and pharmacy curricula at both undergraduate and continuing education levels, and development and use of standard treatment guide-lines for priority diseases in primary and hospital care. Generic drug prescribing is now strongly promoted through essential drug lists and formularies at all health care levels, and pilot hospital pharmacies have substantially strengthened their function as providers of drug information.
In Tajikistan, WHO worked with the National Pharmaceuticals Taskforce to improve drug use in particular. Also with WHO assistance, the Directorate for Rational Use of Drugs was established in the Ministry of Health of Oman.
While work was under way on revising WHO treatment guidelines (Box 10), an open consultative process was also being undertaken to propose changes to the revision process of the WHO Model List of Essential Drugs.
Box 10: WHO treatment guidelines revised and to be linked to Model List of Essential Drugs
Covering the world’s major diseases, WHO’s treatment guidelines are used to develop national and institutional treatment protocols and essential drugs lists, training programmes and drug supply systems. A total of 192 treatment guidelines were evaluated and summarized. The summaries will be made available on the WHO web-site, as a CD-ROM and in hard copy. Additionally, a database of WHO recommended drug treatments, drug treatment guidelines and drugs recommended in WHO treatment guidelines was created - to help systematize WHO’s treatment recommendations - and standard procedures and a checklist for developing WHO treatment guidelines formulated. Links between the WHO Model List of Essential Drugs, WHO treatment guidelines and the WHO Model Formulary are also being strengthened.
Courses, workshops and regional coordination continued to be important means of developing rational use skills. Courses to promote rational drug use were held in Nigeria and Indonesia in collaboration with the International Network on Rational Use of Drugs (INRUD). In Kazakhstan, Kyrgyzstan and Uzbekistan, rational drug use courses were held for family medicine teachers. Drug selection workshops were held in Peru (for pharmacy and therapeutics committee representa-tives) and Sudan.
Additionally, the drug evaluation and selection capacity of the pharmacy and therapeutics committee responsible for promoting rational drug use in 12 of Colombia’s 34 provinces was strengthened. The first version of a manual on establishing and running drug and therapeutics committees was also produced.
Other workshops included national rational drug use training and advocacy work-shops in Kuwait, Pakistan, Somalia and Sudan. A national workshop to improve ongoing supervision and monitoring of drug use and drug supplies was also held in Cambodia.
In the European region, rational use was promoted via cross-country collaboration. Health professionals from Ministries of Health and health insurance institutions from 20 countries of Western and Central and Eastern Europe met to compare national approaches to rationalizing drug use through formulary and guidelines development, innovative use of drug information and information technology, and local structures for prescribing support. Direct country support was provided to Armenia, Croatia, Kazakhstan, Kyrgyzstan, the Russian Federation, Tajikistan, Turkmenistan and Uzbekistan for developing formularies and standard treatment guidelines. Also in the European region, the EuroPharmForum network of pharmaceutical associations and the Regional Office for Europe now consists of 33 country members, and implements disease management and health promotion projects through community pharmacies.
Much activity also took place around the problem of antimicrobial resistance (AMR). An interdisciplinary group on AMR consisting of different programmes was established in the Western Pacific Regional Office, and also in the Eastern Mediterranean Regional Office.
In terms of promoting rational use among households, consumers and patients, new training modules on public education in rational drug use in the community were tested at a first international two-week course in Thailand.
Developed by WHO and the University of Amsterdam, the course taught participants how to: identify and prioritize community drug use problems; choose and develop appropriate intervention strategies and communication channels; pre-test materials; evaluate impact; and fundraise and network for support and sustainability (Figure 4).
Figure 4: Steps in an effective communication intervention to promote more appropriate drug use by consumers
Development and implementation of community-based intervention projects to promote more rational use of antibiotics for infectious diseases at household level also continued as part of an initiative with several universities and NGOs.