consumer perspectives on rational use of medicine (rum) · why rational •more than 50% of all...
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Consumer Perspectives onRational use of Medicine (RUM)Purnawan Junadi
FKMUI, 2018
Rational Use of Drugs or Medical Resources?
• RUD/RUM: "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)
• RUMR: Patients/ Communities receive any medical intervention for diagnosis and treatment appropriate to their clinical needs, for an adequate period of time, and at the lowest cost to them and their community
Why Rational• More than 50% of all medicines worldwide are prescribed,
dispensed, or sold inappropriately and
• 50% of patients fail to take them correctly
• Conversely, about one-third of the world’s population lacks access to essential medicines.
• the proportion of national health budgets spent on medicines ranges between 10% and 20% in developed countries and between 20% and 40% in developing countries.
Rational reasons for irrational uses
1. Lack of knowledge,
2. Skills or independent information,
3. Unrestricted availability of medicines,
4. Overwork of health personnel,
5. Inappropriate promotion of medicines and
6. Profit motives from selling medicines.
Reasons for Self Medication• Poor access to desirable health care
• Poor regulation prescription drugs and pharmacy practices
• Overzealous advertisements of medications,
• Poorly informed public on matters of health and self-care;
• High burden of diseases, with overlapping symptoms,
• Poverty which puts consultations out of reach for people
Strategi1. the types of irrational use of medicines, so that strategies
can be targeted to wards changing specific problems;
2. the amount of irrational use, so that the size of the problem is known and the impact of the strategies can be moni-tored;
3. the reasons why medicines are used irrationally, so that appropriate, effective and feasible strategies can be chosen
Proporsi RT yang Menyimpan Obat dan Jenis Obat yang Disimpan, Riskesdas 2013
35.264.8
Menyimpan Obat
Tidak Menyimpan Obat
*)Termasuk obat keras dari puskesmas & RS tertentu yg diberikan langsung tanpa menggunakan resep
Proporsi RT yang Menyimpan ObatKeras Tanpa Resep*), Riskesdas 2013
Proporsi RT berdasarkan Jenis Obat yg Disimpanmenurut Tempat Tinggal, Riskesdas 2013
35,5 35,9 35,7
83,679,2 82,0
26,430,1 27,8
17,213,2 15,7
6,8 6,8 6,4
0.0
20.0
40.0
60.0
80.0
100.0
Perkotaan Perdesaan Indonesia
Obat Keras Obat Bebas Antibiotika Obat Tradisional Obat Tidak Teridentifikasi
Proporsi RT yang Menyimpan Antibiotika TanpaResep*), Riskesdas 2013
74,7
86,193,4
0.0
20.0
40.0
60.0
80.0
100.0
Goro…
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*)Termasuk antibiotika dari puskesmas & RS tertentu yg diberikan langsung tanpa menggunakan resep
Proporsi RT berdasarkan Sumber Obat menurutTempat Tinggal, Riskesdas 2013
50,2
25,5
41,135,3
40,537,2
16,9 16,6 16,818,7
31,5
23,4
4,2 4,9 4,3
0.0
20.0
40.0
60.0
80.0
100.0
Perkotaan Perdesaan Indonesia
Apotek Toko obat/ warung Yankes formal Nakes Lainnya
Proporsi RT berdasarkan Sumber Obat menurutKuintil Indeks Kepemilikan, Riskesdas 2013
15,4
25,0
35,7
45,5
55,5
43,1 41,3 39,137,0
32,3
19,7 17,3 18,3 16,8 14,7
30,5 28,724,4 22,3 19,2
5,8 4,5 4,8 3,8 4,3
0.0
20.0
40.0
60.0
80.0
100.0
Terbawah Menengahbawah
Menengah Menengah atas Teratas
Apotek Toko obat/ warung Yankes formal Nakes Lainnya
Proporsi RT berdasarkan Status Obat menurut TempatTinggal, Riskesdas 2013
31,1 33,8 32,1
46,7
34,4
42,246,3 48,1 47,0
0.0
20.0
40.0
60.0
80.0
100.0
Perkotaan Perdesaan Indonesia
Sedang digunakan Untuk persediaan Obat sisa
Pengetahuan masyarakat ttg Obat
Parameter
• Pengetahuan: Ciri ciri obatbermutu, aturan minum obatantibiotik, dan logo obat.
• Sikap responden: pertimbanganresponden dalam memilih obat, dan pemberian obat anak
• Perilaku; sumber informasitentang obat, dan membaca label obat sebelum membeli obatserta informasi yang dibaca.
Hasil
• PSP masyarakat dalam memilihobat yang aman dan bermutuberkisar mendekati 50% .
• indeks nilai 4,65 (skala 1- 10)
• Saran: KIE dari pemerintah, /BPOM /Kemenkes kepadamasyarakat masih perlu banyakditingkatkan
Selma Siahaan et. all: Know ledge, Attitude , and Practice of Communities on Selecting Safe Medicines in Three Provincies in Indonesia, JurnalKefarmasian Indonesia Vol.7 No.2 - Agustus 2017: 136 -145
Affirmative actions
BPJS era: game change
BPJS
Cons
ProvGov
Ina CBG
Referral system
Roles change
Reduce reasons for irrational uses1. Lack of knowledge, 2. Skills or independent
information, 3. Unrestricted availability
of medicines, 4. Overwork of health
personnel, 5. Inappropriate promotion
of medicines and 6. Profit motives from
selling medicines.
KIE
REGULATION
REGULATION
REGULATION
Psl 16/18UU 23/2014
Reduce Reasons for Self Medication• Poor access • Poor regulation
prescription drugs• Overzealous
advertisements of medications,
• Poorly public information
• High burden of diseases, • Poverty
UHC
Gov Payment
Regulation
Regulation
KIE
KIE stake holders• Universities/ heath institute
• Consumer organizations
• Mass Media