Many DTCs do not function. The way to address this is very similar to starting up a DTC from scratch. Often DTCs do not function because there is:
• lack of awareness of drug use problems or interest to address these problems
• lack of awareness of what a DTC could do to address drug use problems
• lack of time or reward for members to undertake any DTC activities
• no mandate or support from senior authority.
Just as with changing medicine use problems, the first step is to quantify the problem and understand why it exists. Only after this can solutions be found. Therefore, if staff are unaware of medicine use problems, demonstrate the problems and their underlying causes. If DTC members are not active, find out why. Perhaps DTC members are not given sufficient reward for their effort and you need to find suitable incentives - this will mean gaining the support of the senior administration. Perhaps DTC members have a conflict of interest and do not want to be active. In such a case, you would need to gain senior support for introducing regulations concerning conflict of interest in DTC members. Finding such support is likely to require evidence of drug misuse, for example the unnecessary cost of using a more expensive branded product which is no more effective or safe than a cheaper alternative.
If a DTC has ceased to function because a specific issue cannot be resolved, for example a decision about a formulary medicine, investigate whether all the appropriate steps had been taken. If not, tackle the problem again following an agreed set of steps (as suggested in this manual). If all the correct steps had been followed, or could not be followed because of reasons beyond your control, then leave this problem and choose a simpler one to solve first. Resolve the simpler problems before tackling the more complex ones.