This chapter defines rational medicine use and gives examples of irrational medicine use and the adverse effects that can result. It considers some of the factors underlying irrational medicine use and possible strategies to address the problem.
Rational use of medicines requires that "patients receive medications appropriate to their clinical needs, in doses that meet their individual requirements, for an adequate period of time, and at the lowest cost to them and their community" (WHO 1985).
Irrational medicine use occurs with polypharmacy (when more than one medicine is used unnecessarily), with the use of wrong or ineffective medicines, or with underuse or incorrect use of effective medicines. These actions negatively affect the quality of medicine therapy, raise health care costs, and may cause adverse reactions or negative psychosocial effects.
Prescriber lack of knowledge and experience is only one factor in irrational medicine use. Other underlying factors can affect the dispensing process, patient or community decisions and use, and the health system itself.
Strategies to address irrational medicine use can be characterized as educational, managerial, economic, or regulatory. Whichever method is selected, a successful intervention is likely to focus on key factors, target facilities with the poorest practices, and use credible sources and communication channels. Personal contact (faceto- face meetings, for example) can sometimes be used to convey a limited number of key messages; these can be repeated and clarified using a variety of media.
When implementing an intervention strategy, the logical steps are to -
- Identify the problem
- Understand the underlying causes
- List possible interventions
- Assess available resources
- Choose an intervention
- Monitor and restructure the activity as necessary
Interventions should be based on an understanding of the cause of the problem and focus on active strategies to change behavior. Experience indicates that the most effective interventions are those that -
- Identify key influence factors
- Target individuals or groups with the worst practices
- Use credible information sources
- Use credible communication channels
- Use personal contact whenever possible
- Limit the number of messages
- Repeat key messages using a variety of methods
- Provide better medicine use alternatives to existing practices