Medicine Information
to promote RUM
Nani Sukasediati
EDM- WCO Indonesia
Outline
1.
2.
3.
4.
Rational use of medicine (RUM)
Factors and strategies related to RUM
Information and education in RUM
WHO Ethical Criteria
1.
Rational Use of Medicine
Rational/Quality/Prudent Use
 Patients receive medications appropriate to their
clinical needs, in doses that meet their own
individual requirements, for an adequate period of
time, at the lowest cost to them and their community
 Therapeutically sound medicines used by the health
professionals and cost effective
 Principles :
-
correct
Cost-effective
Evidence based : quality, safety, efficacy
Comply to the guideline
RATIONAL USE/QUALITY USE/PRUDENT USE
OF MEDICINES IN GPP
Review of c p
distribution
Nursing care
Use of med
Managing Medicine
supply
Patient care
Pharmaceutical care
Implement of c p
Identify drug problem
procurement
Medical care
selection
Dev. of care plan
Rational use of medicines
Medicines should not be seen as a chemical
But a chemical plus information for its
correct use
(RD WHO Searo, 2nd ICIUM 2004)
2.
Factors and strategies
related to RUM
Factors influencing medicines use
Information
training
EXPIRED
DATE
ROLE
MODEL
Information
availability
Supply
Prescribers
reliability
Finance
Medicine
use
Culture
Consultation Patient
time
behavior
INFO
Training
dispenser
Supervision
Information
workload
STRATEGY TO PROMOTE RUM
EDUCATION
MANAGERIAL/FINANCING
REGULATION/ POLICIES
3.
Information and education
to promote RUM
WHO 12 key interventions ↑ RUM
1. Est. multidisciplinary national body to coordinate policy
on medicines use (Dir. of Promoting RUM, MoH)
2. Use of STG
3. National EDL
4. Est. D/PTC in hospital and district
5. Incl. problem based pharmacotherapy training in
undergraduate curricula
6. CPD as licensure requirement CPD PUKA.ppt
7. Supervision, audit, feedback
8. Independent information on medicines
9. Public education on medicines
10. Avoidance of conflicting financial incentives
11. Use appropriate and enforced regulation
12. Sufficient gov’t expenditure : availability med and staff
Education
Community empowerment
CBIA
Training for Health
provider
Approach
hospital
HCs
Advocacy LG U
MODULES
Promoting RUM
Monitoring, supervision
~
Technical assistant
Education on medicines
Main targets :
• Community / consumers, lay person.
Significant portion and leverage
• Health professionals : CPD, basic curricula
• Decision maker : advocacy on financing,
LGU health expenditure
Consumers/Layman education of RUM
•
•
•
•
Knowledgeable ?
Awareness, alert ?
Skilled in selection and decision?
Changing habit and behavior ?
 better use of medicine
Education methods for layman
• Written passive:
– Posters, banners, leaflets
– Booklet
– Articles (magazine, newspapers)
• Oral :
– Lectures (passive)
– Discussion groups, interactive discussion
(active)
• Media passive and active
– TV, films
– Radio : spot, jingle,
– Video
– Traditional media (puppet show, street plays)
CBIA – Cara Belajar Ibu Aktif
• Format : small discussion group
• Method : interactive discussion, presided by
tutor
• Participants : mothers/woman belongs to civil
society, religious group
• Discussion objects : medicines stored in their
household, medicines at their surrounding
• Purpose : enhance their skill in selection
medicine through understanding the API and its
benefit.
Health professionals : MTP (QIMC)
Adult learning process
Self initiative learning process
Monitoring:
problem identification
& measurement
Training:
problem solving
Description of the
recent situation
Reflection of
Problem solving &
previous experience scientific/reality
testing
Planning:
setting target of improvement
Agreement on target
of improvement
Follow quality improvement management cycle
4.
WHO Ethical Criteria
for Medicine Promotion 1988
WHO report 2005
• Irrational use of AM : greatest contribution to AM
resistant
Pneumonia, disentry, gonorrhoe, hopsitals
infection : 70-90% to first line AM
The more we use them, the more we lose them
(Strama).
• 2,3-7m hepatitis B & C cases and 160 ths new
cases HIV using 15b injection/year. 50% are not
in steril condition
• ADR : 4-10% in patients in developing countries.
• 2/3 world pop have access to medicines,
half of them are prescribed incorrect
• 50% medicines in the world, are being
prescribed, dispensed, and sold incorrect.
and 50% of patients use it inappropriate
• WHO Promotion budget on RUM 0,2%
$2,3b (’02-’03) vs global sales promotion of
precription drugs $282,5b (’00)
Summary of studies in Indonesia
•
•
•
-
Suryawati, 1997
Permenkes 386/1994 ttg periklanan
Spot survey
69% tdk menyebut bhn aktif
29-36% indikasi tdk benar
20% menulis informasi produsen
31% memberi informasi menyesatkan
Regulation of medicine promotion
• In 2004, 89 countries (46%, WHO survey)
reported that they regulated drug promotion
•
•
Often delegated to industry self-regulation
Few resources: for example, in Canada less
than 1 full-time dedicated staff person, no
fines or sanctions since 1978
Pills, Politics and Practice
25 YEARS OF PROMOTING PEOPLE-CENTRED MEDICINES POLICY
• WHO Ethical Criteria for Medicinal Drug
Promotion, 1988
•
First international ethical standard
•
Aim is to support rational drug use, public
health
– Specific types of information must be provided in
advertising
– Promotion should not take advantage of concern for
health
– Should not be disguised as education or science
– Generally, direct-to-consumer advertising of
prescription
–
drugs should not be allowed.
Objective
“The main objective … is to support and
encourage the improvement of health care
through the rational use of drugs.”
- WHO Ethical Criteria for Medicinal Drug
Promotion
Criteria
• Ethical criteria : varies among society,
should lay the foundation for proper
behavior concerning promotion of
medicines, consistent with truthfulness
and righteousness, should assist in
judging if promotional practice are in within
the acceptable ethical standards
Criteria
• Applicability and implementation Promotion : general
principles for ethical standard, do not constitues legal
obligation
• Promotion :all informations, persuasive activities by
manufactures, and distributors, the effect of which to induce
prescription, supply, purchase and/or use of medicine
available in the country, scientific/evidence based
comparison should be factual
• Advertising : appropriate language, should help people
make rational decision
• Free samples on OTC to public promotional : difficult to
justify
• Information for patients : leaflets, package inserts, booklets
•
•
•
•
•
Medical representative
Free samples of prescription medicine
Symposia and other scientific meeting
PMS and Dissemination information
Promotion of exported medicines
How much influence do sales representatives
have on your prescribing?
A lot
1%
A little
38%
None
61%
n=102 internal medicine residents
Am J Med 2001; 110:551
How much influence do sales representatives have on
other physicians' prescribing?
None
16%
A lot
51%
A little
33%
n=102 internal medicine residents
Am J Med 2001; 110:551
Summary
• Empowerment in medicine use is the key
issues to promote RUM : through cross cut
community
• 3 target groups of information and
education : consumers/lay person, health
providers/professionals, decision makers.
• Particular methods of empowerment has
been developed
• How to disseminate the method of CIE