National

1

• National prescribing rule
• Newly prescribed drugs is provided for not more
  than 2 weeks
• Long term medications is provided for not more
  than 3 months
• Other medications is provided for not more than
  1 month
• OCPs is provided for not more than 6 months.

2

• Lazaros et. al. JAMA 279 1200, 1998
• Meta analysis (39 prospective studies in Toronto)
• Serious ADRS requiring hospitalization or causing
  permanent disability or death 6.7
• Fatal ADRS 0.32
•  ? ADR ? 4 - 6th leading cause of death.

3

• HUSM experience
• Errors in prescribing process
• Wrong dose
• Wrong frequency
• Wrong duration
• Wrong administration technique

4

• Patient factors
• Failure to take drug or partial compliance
• Taking more drugs than instructed
• Self-treatment
• Wrong technique of administration
• Taking expired drugs

5

• Explanations
• Lack of knowledge
• Influenced by others
• Negative attitudes
• Own experience
• Own perceptions
• Difficult/complicated regimen
• Extremes of age and need for assistance

6
2nd P-Drug workshop 1999
7
WHO Organisational Structure
Yasuhiro Suzuki
Jonathan Quick
8
WHO's mission in medicines for 20002003 includes
four main objectives

• Policy
• Access
• Quality and Safety
• Rational Use of Drugs

9
WHOs Mission in Essential Drugs and Medicines
Policy

• To help save lives and improve health by
• closing the huge gap between the potential that
• essential drugs have to offer and the reality
  that for
• millions of people particularly the poor and
• disadvantaged -- medicines are unavailable,
• unaffordable, unsafe or improperly used.

10
WHOs Mission in Essential Drugs and Medicines
Policy(cont.)

• The Organization works to fulfill its mission in
• essential drugs and medicines policy by
• providing global guidance on essential drugs and
• medicines, and working with countries at their
• request to implement national drug policies to
• ensure equity of access to essential drugs, drug
• quality and safety, and rational use of drugs.

11
Rational Use of Drugs

• Ensure therapeutically sound and
• cost-effective use of drugs by health
• professionals and consumers

12
Rational Use of Drugs

• Improving the use of drugs by health
• workers and the general public is crucial
• to
• reduce morbidity and mortality
• from communicable and non-
• communicable diseases, and
• contain drug expenditure.

13
Rational Use of Drugs

• A sound rational drug use programme in any
• country has three elements
• Rational drug use strategy and monitoring -
  advocating rational drug use, identifying and
  promoting successful strategies, and securing
  responsible drug promotion.
• Rational drug use by health professionals
• Rational drug use by consumers

14
Rational drug use strategy and monitoring

• Support countries in implementing and
• monitoring a national strategy to promote
• rational use of drugs by health
• professionals and consumers.

15
Rational drug use by health professionals

• Develop national standard treatment
• guidelines, essential drugs lists,
• educational programmes and other
• effective mechanisms to promote rational
• drug use by health professionals.

16
Priorities for global guidance for 20002001

• Review of the development, dissemination and use
  of the WHO Model List of Essential Drugs
• Review and dissemination of WHO Standard
  Treatment Guidelines
• Training materials and curriculum review for
  undergraduate training
• Guidelines for Drugs and Therapeutics Committees
• International training materials and training in
  public education
• International training materials and training in
  pharmaco-economics
• Regional rational drug use training courses in
  French and Spanish (?for African countries)
• Standard indicators and protocols to monitor drug
  promotion practices

17
What are essential drugs?

• "Essential drugs are those drugs that satisfy
  the health care needs of the majority of the
  population
• they should therefore be available at all
  times in adequate amounts and in the appropriate
  dosage forms, and at a price that individuals and
  the community can afford."

18
History of Essential Drug List

• 1897 Aspirin was introduced as the first
  synthetic
• pharmaceutical
• 1941 Introduction of first modern antibiotics
  i.e
• Penicillin
• 1943 First commercial antimalarial
• 1944 First antituberculous drug
• 1950s Introduction of oral contraceptives,
• antidiabetics and
  antipsychotics
• 1977 WHO published first model list of
  Essential
• drugs (208)
• 1997 WHOs 10th model list of essential drugs
  (306)
• The 11th Model List -- describing just over 300
  drugs -- was revised in November 1999 and
  published in December 1999.
• N.B Malaysias EDL contains 419 items and a
  supplemental list

19
Progress on PRUD activities

• Extensive research has shown that standard
  treatment guidelines,
• essential drugs lists and formularies do promote
  rational prescribing of
• drugs by prescribers.
• By the end of 1999, 157 countries had an
  essential drugs list.
• 135 countries have developed national treatment
  guidelines, of which 112 have been updated in the
  last five years.
• There are now more than 100 national formularies,
  
• By the end of 1999, 88 countries in all six WHO
  regions had introduced the essential drugs
  concept into curricula for medicine and pharmacy
  students.

20
Progress on PRUD activities (cont.)

• The WHO Guide to Good Prescribing  has proved
  to be another invaluable tool. Translated into 18
  languages and now available on at least six
  different web-sites, it continues to be one of
  the Organizations most successful publications.
  Primarily intended for undergraduate medical
  students who are about to enter the clinical
  phase of their studies, it provides step-by-step
  guidance on the process of rational prescribing.

21
Progress on PRUD activities (cont.)

• The WHO Model List of Essential Drugs, and
  regional and international rational drug use
  courses, form a large part of ongoing WHO efforts
  to improve drug use by health professionals.
• International training courses for university
  teachers in problem-based pharmacotherapy
  teaching are held every year in Europe, Africa
  and Latin America.
• Two randomized controlled trials with over ten
  centres in developed and developing countries
  have shown that the teaching methods transfer
  lasting skills in rational prescribing.

22
Progress on PRUD activities (cont.)

• WHO Monographs on Selected Medicinal Plants
• are also doing much to promote rational drug
  use, but in the area of traditional medicine. The
  Monographs were recently recommended by the
  European Commission to Member States as an
  authoritative reference.

23
Other Activities

• International Conference of Drug Regulatory
  Authorities (ICDRA)
• International Conference on Harmonisation (ICH)
• WHO Programme for International Drug Monitoring
• UMC (Uppsala monitoring centre) the Global
  Intelligence Network for Benefits and Risks in
  Medicinal Products
• The WHO Collaborating Centre for Drug Statistics
  Methodology