Promoting rational drug use in the community
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Promoting Rational Drug Use in the Community. What influences drug use by consumers. Objectives. To be able to: Identify various factors which influence drug use by consumers Recognise relative importance of the factors with respect to efforts to promote rational drug use by consumers.

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Promoting Rational Drug Use in the Community

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Promoting rational drug use in the community

Promoting Rational Drug Use in the Community

What influences drug use

by consumers


Objectives

Objectives

To be able to:

  • Identify various factors which influence drug use by consumers

  • Recognise relative importance of the factors with respect to efforts to promote rational drug use by consumers

What influences drug use by consumers

Promoting Rational Drug Use in the Community


The session

The session

  • Various factors which influence drug use by consumers

  • by level of influence

  • related both to environment and behaviour

  • provides a basis to analyse problems

  • to be used in the development of interventions

What influences drug use by consumers

Promoting Rational Drug Use in the Community


Layers of influence

Layers of influence

  • the family level

  • the community

  • the health service institution

  • the national level

  • the international level

What influences drug use by consumers

Promoting Rational Drug Use in the Community


The family level

The family level

  • perceived need for drugs

  • ideas about efficacy and safety

  • uncertainty - poly-pharmacy

  • division of drug consumption roles

  • cost of medicines

  • literacy level

  • the power of medicines

What influences drug use by consumers

Promoting Rational Drug Use in the Community


Perceived safety and efficacy

Perceived safety and efficacy

  • related to colour, taste and shape of medicines

  • related to dosage form

  • depends on compatibility between medicine and the person

  • depends on cause of illness

  • related to past experiences

  • new medicines perceived to be better

What influences drug use by consumers

Promoting Rational Drug Use in the Community


Gender roles and medicines

Gender roles and medicines

Philippines

  • mothers buy

  • mothers give to children

  • neighbours or relatives give advice

  • husband not consulted generally

Pakistan

  • fathers buy

  • mothers give to

    children

  • men have

    information about

    medicines and

    tell wives how to

    use them

What influences drug use by consumers

Promoting Rational Drug Use in the Community


The community level

The community level

  • local drug-use culture

  • drug supply system

  • community information channels

What influences drug use by consumers

Promoting Rational Drug Use in the Community


Community drug distribution

Community drug distribution

Town

Drugstores (35%)

Neighbourhood

Clinics (2%)

stores (40%)

MEDICINES (n=1324)

Hospital (1%)

Neighbours and

Doctors (7%)

relatives (5%)

Household stocks and

free-clinics (8%)

Neighbourhood

Source: Hardon A (1991). Confronting ill health: medicines, self-care and the poor in Manila

What influences drug use by consumers

Promoting Rational Drug Use in the Community


The health institution level

The health institution level

  • utilisation of health service

  • quality of health worker prescribing

  • quality of communication during consultation

  • quality of medicine dispensing

  • regular supply of medicines

  • cost of medicines

What influences drug use by consumers

Promoting Rational Drug Use in the Community


Extent to which health worker advice is sought

Extent to which health worker advice is sought

  • Thailand: 7% of 1755 episodes (rural)

  • Philippines: 8% of 1411 episodes (urban) 20% of 422 episodes (rural infants)

  • Pakistan: 56% in NGO-PHC area, 48% in controls (rural)

  • Ghana: 42% in urban, 43% in rural

What influences drug use by consumers

Promoting Rational Drug Use in the Community


The national level

The national level

  • Implementation of essential drugs policy

  • Drug promotion

  • Drug costs, financing and reimbursement policies

  • Advocacy by consumer and patient organizations

  • Health communication on medicines in school curricula, and in TV and radio programmes

What influences drug use by consumers

Promoting Rational Drug Use in the Community


Drug promotion

Drug promotion

  • Industry expenditure on marketing: research = 2 : 1

  • In fact 35% of sales revenues for drug marketing

  • Commercial drug info : public funded drug info = 50 : 1 (UK)

  • Drug promotion emphasises benefit, often lacking information on risks

What influences drug use by consumers

Promoting Rational Drug Use in the Community


Who ethical criteria on drug promotion adopted in 1988

WHO ethical criteria on drug promotion (adopted in 1988)

  • consistent with national health policy

  • contains reliable claims

  • contains no omission which can lead to health risks

  • should not be designed to disguise its real nature

What influences drug use by consumers

Promoting Rational Drug Use in the Community


Ethical criteria adoption

Ethical criteria adoption:

  • WHO (1988): ethical criteria only adopted in 17 out of 42 national drug policies

  • Australia (1995): only 29% of 140 advertisements to the public contain warnings or cautions about health risks

What influences drug use by consumers

Promoting Rational Drug Use in the Community


Otc advertising iocu study

OTC advertising: IOCU study

  • 238 OTC ads in 11 countries reviewed (1994)

  • most ads do not comply with WHO ethical criteria

  • 75% do not mention side-effects nor contraindications

What influences drug use by consumers

Promoting Rational Drug Use in the Community


Increase in promotion towards consumers

Increase in promotion towards consumers

  • prescription drugs are increasingly registered as OTC drugs

  • before patient was ignorant and prescriber the target, now consumer is target as “expert” in need of info.

  • direct to consumer advertising of prescription drugs increases

  • increase in promotion of life style drugs

What influences drug use by consumers

Promoting Rational Drug Use in the Community


Top dtca expenditures

Top DTCA expenditures

  • 137 million US$ on Claritin

  • 93 million US$ Viagra*: to treat impotence/improve sexual performance

  • 75 million US$ on Xenical*: to reduce weight

  • 57 million US$ on Zyrtec

  • 45 million US$ on Zyban*: to quit smoking

    *life-style drugs

What influences drug use by consumers

Promoting Rational Drug Use in the Community


The international level

The international level

  • Implementation of multilateral agreements affecting drugs

  • Health consequences of global trade agreements

  • Donor support for essential drugs programmes

  • Global consumer advocacy

  • The Internet

What influences drug use by consumers

Promoting Rational Drug Use in the Community


Zyban information from the internet

Zyban: Information from the Internet

  • Nicotine-free ZYBAN is a prescription-strength medicine

  • ZYBAN is the first nicotine-free pill approved to help you quit smoking

  • You start taking ZYBAN and continue to smoke

  • ZYBAN is priced lower than other smoking cessation therapy

What influences drug use by consumers

Promoting Rational Drug Use in the Community


Activity tasks

Activity tasks

  • Participants should have read the case studies prior to session

  • Appoint a rapporteur and facilitator

  • Facilitator should check if case study has been read. If not, allow for time

  • The facilitator guides the discussion

  • Answer discussion questions

  • Rapporteur reports in plenary

What influences drug use by consumers

Promoting Rational Drug Use in the Community


Dtca discussion questions

DTCA discussion questions

  • Make an inventory of the ways in which prescription drugs are promoted to consumers in the Philippines

  • Discuss use of Viagra by young men as aphrodisiac. What factors influence it?

  • Define possible solutions to this misuse

  • Discuss pros and cons of DTCA in the Philippines

What influences drug use by consumers

Promoting Rational Drug Use in the Community


Discussion questions drugs used as abortifacients

Discussion questions: drugs used as abortifacients

  • What medicines are used as abortifacients in the Philippines

  • What are health risks?

  • What factors determine this misuse?

  • What can be done to discourage this misuse?

What influences drug use by consumers

Promoting Rational Drug Use in the Community


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