Role use by establishment of PTC, Pharmacy and Therapeutic

Role
of WHO , Government and  Pharmacist in
promotion of Rational use of drugs

According
to WHO :

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                     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 lowest
cost to them and their community “1

Contributing
factors

                    Irrational  drug use is the major  heading problem in our society almost all the
medicines prescribed to the patients are taken by them incorrectly this will
lead ultimately towards patient incompliance.1 This mainly happens due to misuse
,overdose and underdose . The other related factors include

To overwhelmed all such problems WHO , Government
and pharmacists have significant rules that can promote rational drug use.

Role
of  WHO

1.    
Establishment of a
multidisciplinary national body to coordinate policies on medicine use

2.    
Use of clinical
guidelines

3.    
Development and use of
national essential medicines list

4.    
Establishment of drug
and therapeutics committees in districts and hospitals

5.    
Inclusion of
problem-based pharmacotherapy training in undergraduate curricula

6.    
Continuing in-service
medical education as a licensure requirement

7.    
Supervision, audit and
feedback

8.    
Use of independent
information on medicines

9.    
Public education about
medicines

10.                       
Avoidance of perverse
financial incentives

11.                       
Use of appropriate and
enforced regulation

12.                       
Sufficient government
expenditure to ensure availability of medicines and staff. WHO has a role
in encouraging rational drug use by establishment of PTC, Pharmacy and  Therapeutic
committee. 1

The foremost
objective of  PTC is to provide optimal
care and patient safety through rational drug therapy in an institution

Accomplishment

   Through
advisory and educational role in an institution .

Advisory
role

Under advisory role , the committee indorses
adaptation of or to contribute in formulation of policies concerning evaluation
,selection and therapeutic use of drugs.2

Educational
role

                   
The committee indorses adaptation of or to contribute in formulation of
programs planned to meet the necessities 
of professional staff ( physicians , pharmacists and other health care
professionals) on the  information
regarding drugs and their appropriate use .2

RESPONSIBILTIES
:

ü Establish
standards

ü Solve
problem to attain standards

ü To
inquire about related problems

ü Founding
standards

ü To
have view of valuations ,consignments and assignments 3

Role
of Government :

Rational Drug
Use Indicators: Comparison of Pakistan and LMICs

Title

Pakistan

LMICs

Drugs per prescription

3 or >†

2.39†

Drugs per prescription public sector

2.77?

Nil

Drugs per prescription private sector

4.51*

Nil

Antibiotics per patient encounter

70%†/ 52%?

45%†

Injections per patient encounter

60%†/14.7%?

23%†

Medicines prescribed from formulary

50%?

71.7 %

Facilities having national formulary

20%?

78%†

Prescribed by brand names

88%*

78†40†

Mean dispensing time

38 sec#

105 sec†

Mean consultation time

2-9 min#

4 min †

Self-medication of antibiotics

6-11%‡

Nil

Source:
† WHO: The World Medicines Situation; 2004

*Das N, Prescribing
practices of consultants at Karachi, Pakistan.2001

†WHO: The World Medicines
Situation; 2004. / ?Networks: EDSP Baseline Survey Report; 2002

?
Das N, Prescribing practices of consultants at Karachi, Pakistan. 2001, Najmi:
Prescribing practices: an overview of three teaching hospitals in Pakistan.
1998,

Bano
N, Najam R, Qazi F. Irrational
drug use based on self medication for some common clinical conditions in an
educated population of Karachi. Pka J Med Sci. 2012;28(3):359-62. 4

 

·       
The above table shows the negligence
towards rational drug use in PAKISTAN as compared to LMICs so there is a need
to empower such procedures that would make the current situation better in such
case

·       
The role of government towards promotion
of rational drug use is mainly IMPLEMENTATION
. Implementation of

 

1.Laws and regulations5

2.Policies venture about excessive propagation  and prescribing, and establishment quality
parameters at provider and community pharmacy.5

3.Provision of facilities 5

4. Essential drugs list should be available all the
times in pharmacies , hospitals and retailers 5

5.Public should be made mindful  merits of Essential drug list via media and
other sources 5

6 .Keeping in view the above point Government should
only registered cost effective and quality drugs this criteria should be
mentioned in all healthcare and educational programs.

STUDY
1

Clopidogeral is sold for RS 1 and other sells the
same drug of 100Rs

STUDY
2

Flouroquinolones are registered which has is least
therapeutic and more toxic such malpractices should be discouraged . 5

8.Government should update the criteria regarding
drug registeration for this only data approved by regulatory authorities  e.g 
FDA USA, British Medicines Commission  and European Medicine Commission should be
acknowledged 5

9.Entitlements grounded on unprincipled and irrational
practices implemented by organizations and health care professionals should not
be recognized .5

10. MOH should promote such drugs that has approved
clinical indications and banned to promotion of such drugs that are unchecked.5

11.Developing countries like PAKISTAN has financial
barrires in order to facilitate the health care system so in our country
Government should implement such policies that must generate a revenue in which
drug therapy should have best standards and minimum costs .6

12. Government should establish COMMUNITY PHARMACY so that community pharmacist may have access to
dispensing and this can control also medication errors  7

13. Establishment of Research and development
institution so that health care can be improved 7

 ROLE
OF PHARMACIST IN PROMOTION OF RATIONAL USE OF DRUGS

As the pharmacist has
emerging role in our society the reason is that they have vast knowledge about drugs
; from discovery until they are administered in the patients .So the major
issues encountered regarding irrational uses are :

Lack of knowledge of
patients regarding :

·       
diseases
and their treatment ultimately their benefit to them

·       
Purpose
of treatment the related drug its beneficial outcomes ,sideffects and serious
adverse effects.

·       
Serious
outcomes of medication adherence .

·       
 Significance of dosage regimen .

·       
Harmful
effects of drug resistance

·       
Multiple
therapy

·       
Serious
consequences of  self medication.

Ultimately all these problems effects the
society and this proves that there is need of motivation to discouarge all such
above malpractices.

Ø Pharmacist should work as community pharmacist
to monitor the flow of medications and their effects in community 6

Ø Pharmacist should work as a  QA and QC analyst to take control over safety
,efficacy and quality of medications 6

Ø Pharmacist should play role regarding unwanted
effects of medicines , their scheduling , consequences of  multiple therapy , polypharmacy  , self medication and medication adherence.

Ø 
Pharmacist
should play an important role as a hospital pharmacist to have a control on procurement
, inventory , sale,  distribution and drugs
quality.8

Ø Pharmacist should monitor the  prescriptions to in patients ,OP .8

Ø 
They
should participate in organization and execution of clinical trials 8

Ø They should
take part actively and with other health care professionals in meetings
,committees and councils to spread education about rational drug use 8

x

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