The ultimate goals of studying and intervening in medicine use practices include -
- Improving quality of health care through effective and safe use of pharmaceuticals
- Improving cost-effectiveness of health care through economic and efficient use of pharmaceuticals
Before attempting an intervention to change medicine use practices, underlying reasons for problem behaviors must be understood. Interdisciplinary collaboration involving health and social science experts is of utmost importance in this task.
Strategies to improve rational prescribing can be characterized as targeted or system-oriented approaches.
Targeted approaches include educational and managerial interventions, while system approaches include economic and regulatory interventions.
Educational strategies seek to inform or persuade and include -
- Training of prescribers (formal and continuing education, supervisory visits, group lectures, seminars, workshops)
- Printed materials (clinical literature and newsletters, treatment guidelines, medicine formularies, flyers, leaflets)
- Approaches based on face-to-face contact (educational outreach, patient education, influencing opinion leaders)
Managerial strategies seek to guide practice and include -
- Supervision, monitoring, and feedback
- Approaches to selection, procurement, and distribution (limited procurement lists, drug use review and feedback, hospital and regional drug and therapeutics committees, cost information)
- Prescribing and dispensing approaches (structured medication order forms, standard diagnostic and treatment guidelines, course-of-therapy packaging)
Economic strategies seek to promote positive financial incentives while removing perverse incentives for prescribers. These economic strategies include changes in how health care providers are reimbursed; disallowing medicine sales by prescribers removes the financial incentive for overprescribing.
Regulatory strategies seek to use laws and regulations to influence prescribing through restrictions and requirements.
They include -
- Pharmaceutical registration
- Limited medicine lists
- Prescribing restrictions
- Dispensing restrictions
An intervention should be focused on a specific problem behavior and targeted at the facilities or people that have the greatest need for improvement. Interventions should be carefully selected with regard to efficacy, feasibility for implementation in the existing system, and cost. Before wide-scale implementation of an intervention, evaluating its effectiveness and cost in the existing health setting is imperative.
Programs to ensure rational use of medicines should be an integral part of health and medical care services. The responsibility for promoting rational use of medicines belongs to decision makers, administrators, and clinicians as well as health care professionals, consumers, educators, and pharmaceutical companies.