Medicine Information to promote RUM

Nani Sukasediati

EDM- WCO Indonesia

Outline

1. Rational use of medicine (RUM)

2. Factors and strategies related to RUM

3. Information and education in RUM

4. 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

Patient careManaging Medicine

supply

Rational use of medicines

RATIONAL USE/QUALITY USE/PRUDENT USE OF MEDICINES IN GPP

Identify drug problem

Dev. of care plan

Implement of c p

Review of c p

selection

procurement

distribution

Use of med

Medical care

Nursing care

Pharmaceutical care

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

workloadworkload

InformationInformation

SupervisionSupervision

TrainingTraining

trainingtrainingROLEROLEMODELMODEL

InformationInformation

FinanceFinance

InformationInformation

EXPIREDEXPIREDDATEDATE

availabilityavailability

Culture Culture

reliabilityreliability

ConsultationConsultationtimetime

behaviorbehavior

INFOINFO

MedicineMedicineuseuse

PrescribersPrescribersSupplySupply

PatientPatient dispenser

STRATEGY TO PROMOTE RUM

EDUCATIONEDUCATION

MANAGERIAL/FINANCINGMANAGERIAL/FINANCING

REGULATION/ POLICIESREGULATION/ POLICIES

3.

Information and education

to promote RUM

WHO 12 key interventions ↑ RUM1. Est. multidisciplinary national body to coordinate policy

on medicines use (Dir. of Promoting RUM, MoH) 2. Use of STG3. National EDL4. Est. D/PTC in hospital and district5. Incl. problem based pharmacotherapy training in

undergraduate curricula6. CPD as licensure requirement CPD PUKA.ppt7. Supervision, audit, feedback8. Independent information on medicines9. Public education on medicines10.Avoidance of conflicting financial incentives11.Use appropriate and enforced regulation12.Sufficient gov’t expenditure : availability med and staff

Training for Health provider

Advocacy LG U

HCshospital

Approach

Community empowerment CBIA

MODULESMODULES

Promoting RUM Promoting RUM

Monitoring, supervisionMonitoring, supervision

Education Education

~ 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)Health professionals : MTP (QIMC)

Adult learning processAdult learning processSelf initiative learning processSelf initiative learning process Monitoring:

problem identification & measurement

Description of the recent situation

Training:problem solving

Reflection of Reflection of previous experienceprevious experience

Problem solving & scientific/reality

testing

Planning:setting target of improvement

80%80%

20%20%Agreement on target

of improvement

Follow quality improvement management cycleFollow 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

Pills, Politics and Practice 25 YEARS OF PROMOTING PEOPLE-CENTRED MEDICINES POLICY

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

• 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

n=102 internal medicine residents Am J Med 2001; 110:551

A little38%

A lot 1%

None61%

How much influence do sales representatives have on your prescribing?

n=102 internal medicine residents Am J Med 2001; 110:551

A little33%

A lot 51%

None16%

How much influence do sales representatives have on other physicians' prescribing?

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