Starting or Strengthening a Drug Bulletin - A Practical Manual
(2005; 165 pages) View the PDF document
Table of Contents
View the documentPreface
View the documentHow the manual was produced
View the documentAbout ISDB
View the documentExecutive summary
Open this folder and view contents1. Introduction
Open this folder and view contents2. Rational use of medicines
Open this folder and view contents3. What are drug bulletins?
Close this folder4. Defining aims, target and type of bulletin
View the document4.1 Principles
View the document4.2 What is already available?
View the document4.3 Information on drug utilisation helps you choose topics
View the document4.4 Defining and refining the aims of the bulletin
View the document4.5 Who are the readers?
View the document4.6 What type of information is needed?
Open this folder and view contents5. Planning resources
Open this folder and view contents6. Planning bulletin production: schedules and timing
Open this folder and view contents7. The editorial process
Open this folder and view contents8. Reviewing a new drug: is it a therapeutic advance?
Open this folder and view contentsAnnexe to Chapter 8: Evaluating harm
Open this folder and view contents9. Design and production
Open this folder and view contents10. Dissemination
Open this folder and view contents11. Organizational and legal issues
Open this folder and view contents12. Evaluating quality and usefulness
Open this folder and view contents13. Partnership and collaboration
Open this folder and view contents14. Keeping records and creating a memory
Open this folder and view contentsAppendix: Electronic sources of information

4.3 Information on drug utilisation helps you choose topics

Any bulletin that is intended to change prescribing must be informed by knowledge of what is being prescribed and what the problems are. These problems may range from use of a less than ideal drug because the best drug is unavailable, to overuse of expensive drugs for simple problems. The quality of data available will vary greatly. Some countries have good records of all drug prescriptions, but few collect information about the indications for prescribing.

Where prescription data are collected, it is often the trends in utilisation that are the most interesting to monitor. For example, in many countries the use of selective serotonin re-uptake inhibitors (SSRIs) for depression has increased greatly even though it remains unclear when they should be preferred to older and cheaper antidepressants. Figure 4.1 shows an example from the Italian bulletin Dialogo sui Farmaci, which has access to drug utilisation data, showing the growth in use of atypical antipsychotic drugs in recent years.

Changes in prescribing can signal problems, as may reports of adverse drug reactions or interactions. It may also be possible to discover what proportion of hospital admissions are due to problems with medication, for example overdose or failure to take necessary drugs.

Laboratory data can also be useful, for example an increase in resistant bacteria may imply the over use of broad-spectrum antibiotics.

Assuming patients have access to necessary medicines, various utilisation problems may be encountered:

• using a drug with no therapeutic effect, e.g. most tonics;

• prescribing a drug when it is not indicated (and its use is pointless, e.g. it is not effective);

• prescribing a drug which does not cure a condition that should be cured, e.g. prescribing an anti-ulcer drug instead of eradicating Helicobacter pylori;

• using an expensive drug when a cheaper one is equally effective;

• using a drug which is more potent than necessary;

• using drugs for longer than needed or at higher doses than necessary, e.g. non-steroidal anti-inflammatory drugs;

• not using drugs for long enough, e.g. chemotherapy of tuberculosis;

• using too low or too high a dose;

• patients misunderstanding the best way to use their medicines.

Figure 4.1. Change in use of typical and atypical antipsychotic drugs (expressed as Defined Daily Dose DDD/1000 inhabitants/day) in Italy

Source: Dialogo sui Farmaci, Italy.


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