Roleof WHO , Government and Pharmacist inpromotion of Rational use of drugsAccordingto WHO : Rationaluse of drugs requires that ” patients receive medications appropriate to theirclinical needs , in doses that meet their own individual requirements for an adequate period of time and at lowestcost to them and their community “1Contributingfactors Irrational drug use is the major heading problem in our society almost all themedicines prescribed to the patients are taken by them incorrectly this willlead 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 , Governmentand pharmacists have significant rules that can promote rational drug use.Roleof WHO 1. Establishment of amultidisciplinary national body to coordinate policies on medicine use2. Use of clinicalguidelines3. Development and use ofnational essential medicines list4. Establishment of drugand therapeutics committees in districts and hospitals5. Inclusion ofproblem-based pharmacotherapy training in undergraduate curricula6.
Continuing in-servicemedical education as a licensure requirement7. Supervision, audit andfeedback8. Use of independentinformation on medicines9. Public education aboutmedicines10. Avoidance of perversefinancial incentives11. Use of appropriate andenforced regulation12. Sufficient governmentexpenditure to ensure availability of medicines and staff. WHO has a rolein encouraging rational drug use by establishment of PTC, Pharmacy and Therapeuticcommittee.
1The foremostobjective of PTC is to provide optimalcare and patient safety through rational drug therapy in an institutionAccomplishment Throughadvisory and educational role in an institution .AdvisoryroleUnder advisory role , the committee indorsesadaptation of or to contribute in formulation of policies concerning evaluation,selection and therapeutic use of drugs.2Educationalrole The committee indorses adaptation of or to contribute in formulation ofprograms planned to meet the necessities of professional staff ( physicians , pharmacists and other health careprofessionals) on the informationregarding drugs and their appropriate use .2RESPONSIBILTIES: ü Establishstandards ü Solveproblem to attain standards ü Toinquire about related problemsü Foundingstandards ü Tohave view of valuations ,consignments and assignments 3Roleof 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, Prescribingpractices of consultants at Karachi, Pakistan.2001 †WHO: The World MedicinesSituation; 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,BanoN, Najam R, Qazi F.
Irrationaldrug use based on self medication for some common clinical conditions in aneducated population of Karachi. Pka J Med Sci. 2012;28(3):359-62. 4 · The above table shows the negligencetowards rational drug use in PAKISTAN as compared to LMICs so there is a needto empower such procedures that would make the current situation better in suchcase · The role of government towards promotionof rational drug use is mainly IMPLEMENTATION. Implementation of 1.
Laws and regulations52.Policies venture about excessive propagation and prescribing, and establishment qualityparameters at provider and community pharmacy.53.Provision of facilities 54. Essential drugs list should be available all thetimes in pharmacies , hospitals and retailers 55.Public should be made mindful merits of Essential drug list via media andother sources 56 .
Keeping in view the above point Government shouldonly registered cost effective and quality drugs this criteria should bementioned in all healthcare and educational programs.STUDY1Clopidogeral is sold for RS 1 and other sells thesame drug of 100Rs STUDY2 Flouroquinolones are registered which has is leasttherapeutic and more toxic such malpractices should be discouraged . 58.
Government should update the criteria regardingdrug registeration for this only data approved by regulatory authorities e.g FDA USA, British Medicines Commission and European Medicine Commission should beacknowledged 59.Entitlements grounded on unprincipled and irrationalpractices implemented by organizations and health care professionals should notbe recognized .
510. MOH should promote such drugs that has approvedclinical indications and banned to promotion of such drugs that are unchecked.511.Developing countries like PAKISTAN has financialbarrires in order to facilitate the health care system so in our countryGovernment should implement such policies that must generate a revenue in whichdrug therapy should have best standards and minimum costs .
612. Government should establish COMMUNITY PHARMACY so that community pharmacist may have access todispensing and this can control also medication errors 713. Establishment of Research and developmentinstitution so that health care can be improved 7 ROLEOF PHARMACIST IN PROMOTION OF RATIONAL USE OF DRUGS As the pharmacist hasemerging 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 majorissues encountered regarding irrational uses are :Lack of knowledge ofpatients regarding :· diseasesand their treatment ultimately their benefit to them· Purposeof treatment the related drug its beneficial outcomes ,sideffects and seriousadverse effects.· Seriousoutcomes of medication adherence .
· Significance of dosage regimen .· Harmfuleffects of drug resistance · Multipletherapy· Seriousconsequences of self medication.Ultimately all these problems effects thesociety and this proves that there is need of motivation to discouarge all suchabove malpractices. Ø Pharmacist should work as community pharmacistto monitor the flow of medications and their effects in community 6Ø 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 unwantedeffects of medicines , their scheduling , consequences of multiple therapy , polypharmacy , self medication and medication adherence.Ø Pharmacistshould play an important role as a hospital pharmacist to have a control on procurement, inventory , sale, distribution and drugsquality.8Ø Pharmacist should monitor the prescriptions to in patients ,OP .8Ø Theyshould participate in organization and execution of clinical trials 8Ø They shouldtake part actively and with other health care professionals in meetings,committees and councils to spread education about rational drug use 8