For student of PHARM.D , M.B.B.S , B.D.S , D.P.T, NUTRITIONIST.

1. RationalUseofMedicine
Presented by
Dr.Muhammad Umair
Pharm.D
MPhil. (Clinical)
Lecturer
Lahore Pharmacy College of
Lahore Medical & Dental College

2. Definition
“The rational use of drugs requires that patients receive medications
appropriate to their clinical needs, in doses that meet their own
individual requirements for an adequate period of time, and at the
lowest cost to them and their community”
(WHO, 1985)

3. Rational Use of Medicine (RUM)
The aim of any pharma-management system is to deliver the correct
medicine to the patient
Appropriate selection, procurement, and distribution are precursors to
RUM.
RUM fulfils following criteria;
Appropriate indication
Appropriate medicine
Appropriate dosage
Correctly dispensed
Appropriately informed patients
Patient adherence

5. Examples of Irrational Use of Medicine (IUM)
Poly Pharmacy
Average no. of medicines per prescription
Unnecessary medication/ no medicine needed
Antibiotics misuse (RTIs)
Wrong Medicine
Less than 40% patients are treated according to STGs
Ineffective Medicine/ Medicine with doubtful efficacy
Multivitamins, Tonics
Unsafe Medicines
Anabolic steroids for athletes and as appetizers for children

6. Underuse of available effective medicine
No therapy for mental disorders
ORT for diarrhoea
Incorrect use of medication
Incomplete antibiotic therapy

7. Factors Causing IUM
1) INTERNATIONAL LEVEL
Drug promotion and marketing
Misleading, biased, scientifically inaccurate
Encourage over use
High cost
Market dynamics
Invest more in developed countries
2) NATIONAL LEVEL
Weak Laws and Regulations
Poor quality medicines
Poor HRM
Economic status

8. Factors Causing IUM
3) HEALTH SYSTEMS LEVEL
Unreliable suppliers
Poor planning of the drug needs
Poor infrastructure for storage
Poor information management systems
Lack of monitoring and supervision
4) PRESCRIBERS LEVEL
Lack of information and training
Outdated prescribing practices
Heavy patient load
Pressure from pharma-industries (Conflict of interest)

9. Factors Causing IUM
5) DISPENSING LEVEL
Lack of qualification and training
Heavy patient load
6) PATIENTS & COMMUNITY LEVEL
Non adherence
Cultural beliefs
Accessibility
Affordability
Education
Availability

10. Adverse Impact of IUM
Impact of Quality of Medicine Therapy and Medical Care
Impact on Antimicrobial Resistance
Impact on Cost
Psychosocial Impact

11. Vicious CircleLeadingto IUM

12. Intervention Strategies to Improve
Medicine Use
EDUCATIONAL STRATEGIES
Training of prescribers
Formal education
In-service education (CME)
Supervisory visits
Printed materials
Clinical literature
Treatment guidelines & formularies
Others
Patient education
Influence opinion leader

13. MANAGERIAL STRATEGIES
Monitoring supervising & feedback
D & TC
Health survey teams
Government inspectors
Self assessment
Selection procurement & distribution
Limited procurement list
Drug use review
Regional drug committees
Prescribing and dispensing approaches
Structured medicine order forms
Diagnostic and treatment guidelines
Course of therapy packaging

14. ECONOMIC STRATEGIES
Price setting
Capitation based budgeting
Reimbursement and user fees
Insurance
REGULATORY STRATEGIES
Medicine registration
Limited medicine lists
Prescribing restrictions
Dispensing restrictions

15. Developing a Strategy
There are six steps to develop a strategy to promote RUM given as;
Identify the problem and recognize the need for action
Identify underlying causes and motivating factors
List possible interventions
Assess recourses available for action
Choose intervention(s) to test
Monitor the impact and restructure the intervention

16. Core Policies to Promote RUM
1) A mandated multi-disciplinary national body to coordinate
medicine use policies
2) Clinical guidelines
3) Essential medicines list based on treatments of choice
4) Drugs and therapeutics committees in districts and hospitals
5) Problem-based pharmacotherapy training in undergraduate
curricula
6) Continuing in-service medical education as a licensure requirement

17. 7) Supervision, audit and feedback
8) Independent information on medicines
9) Public education about medicines
10) Avoidance of perverse financial incentives
11) Appropriate and enforced regulation
12) Sufficient government expenditure to ensure availability of medicines
and staff

18. Ready to Jump ???