Trainer's Guide
Problems of Irrational Use of Drugs

OBJECTIVES

Participants will be able to:

1. Identify the magnitude and nature of inappropriate drug utilization in several settings.
2. Understand the adverse impacts of inappropriate use of drugs.
3. Describe the factors that influence the decision-making process in drug use.
4. Identify factors that influence the behavior of prescribers and patients in choosing specific medication therapies.
5. Relate these issues to specific medication use problems in their own settings.

Read the Session Notes.

Prepare a list of medication use problems to be referred to in the Activities section that follows.

 

VISUAL AIDS-LISTING

1. Title Slide
2. Objectives
3. What is Rational Use of Drugs?
4. Rational Use of Drugs = Pathology of Prescribing
5. Examples of commonly Encountered Inappropriate Prescribing Practices
6. Components of the Drug Use System
7. Factors Underlying Irrational Use of Drugs
8. Impact of Inappropriate Use of Drugs
9. Activity 1-Meaning of Appropriate Use
10. Drugs per Case by Age Group
11. Drugs per Case by Diagnosis
12. % of Patients Receiving Antibiotics
13. % of Patients Receiving Injections
14. Injection Use by Diagnosis
15. URI Treatment Pattern
16. Other Drug Use Problems
17. Average Number of Drugs per Patient
18. % Prescribed as Generics
19. % Receiving Antibiotics
20. % Receiving Injections
21. Average Consultation Time
22. Average Dispensing Time
23. % Patients Knowing Drug Dosing
24. % of Key Drugs in Stock
25. Activity 2-Identifying a Priority Problem
26. Conclusion

First Component

· (30 minutes) 2 VA 's 1-8

Defining Rational Use of Drugs

Note that the definition presented is based on a medical model. Other people have different perceptions of what is irrational. For a storekeeper, selling a profitable but unnecessary drug may be rational. For a poor patient, buying one antibiotic tablet may be rational.

Note for trainer: Do not spend undue time discussing the examples given.

Second component

· (30 minutes) 2 VA 9

Activity 1-Meaning of Appropriate Use

This is a short activity, which has the aim of showing that different people have different perspectives about what is "rational" or "appropriate". Explain clearly that we are interested in the real world situation not the "ideal" situation. Emphasize that we are looking for the perspectives of the person identified.

Third Component

· (30 minutes) 2 VA's 10-15

Examples of Irrational Use

This component covers various examples of how drug use can be characterized. Point out that drug use can be characterized for all diagnoses combined, or for specific diseases. Do not try to compare practices for under 5 and over 5 subgroups. Focus on how few patients received no drugs, no antibiotics, or no injections.

Fourth Component

· (30 minutes) 2 VA's 16 -24

Drug Use Patterns in Developing Countries

In this component of the session highlight the variation between countries. Point out that variations may be due to differences in morbidity patterns, but are often due to differing practices which do not have a clinical basis. Try not to elicit suggestions for the reasons for the extreme outliers. Point out that very low levels may also reflect inappropriate use, for example, if antibiotics are unavailable and not always used when they are needed.

Fifth Component

· (45 minutes) 2 VA 25

Activity 1: Identifying a Priority Problem.

The point of this activity is to show that while there are many different problems in drug use, it is possible to develop priorities for addressing them.

Conclusion

· (15 minutes) 2 VA 26

At the end of the session summarize the key point that drug use can be characterized and measured in a systematic way.

 

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