Medicine Information to promote RUM

1. Medicine Information to promote RUM Nani Sukasediati EDM- WCO Indonesia

2. Outline • Rational use of medicine (RUM) • Factors and strategies related to RUM • Information and education in RUM • WHO Ethical Criteria

3. 1. Rational Use of Medicine

4. 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

5. RATIONAL USE/QUALITY USE/PRUDENT USE OF MEDICINES IN GPP Review of c p distribution Nursing care Use of med Patient care Pharmaceutical care Managing Medicine supply Implement of c p procurement Identify drug problem Medical care selection Dev. of care plan Rational use of medicines

6. Medicines should not be seen as a chemical But a chemical plus information for its correct use (RD WHO Searo, 2nd ICIUM 2004)

7. 2. Factors and strategies related to RUM

8. Factors influencing medicines use Information training EXPIRED DATE ROLE MODEL Information availability Supply Prescribers reliability Finance Medicine use Training Culture Patient dispenser Consultation time Supervision behavior Information INFO workload

9. STRATEGY TO PROMOTE RUM EDUCATION MANAGERIAL/FINANCING REGULATION/ POLICIES

10. 3. Information and education to promote RUM

11. WHO 12 key interventions ↑ RUM • Est. multidisciplinary national body to coordinate policy on medicines use (Dir. of Promoting RUM, MoH) • Use of STG • National EDL • Est. D/PTC in hospital and district • Incl. problem based pharmacotherapy training in undergraduate curricula • CPD as licensure requirement CPD PUKA.ppt • Supervision, audit, feedback • Independent information on medicines • Public education on medicines • Avoidance of conflicting financial incentives • Use appropriate and enforced regulation • Sufficient gov’t expenditure : availability med and staff

12. Education Community empowerment CBIA Approach Training for Health provider hospital HCs Advocacy LG U MODULES Promoting RUM Monitoring, supervision Technical assistant ~

13. 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

14. Consumers/Layman education of RUM • Knowledgeable ? • Awareness, alert ? • Skilled in selection and decision? • Changing habit and behavior ?  better use of medicine

15. 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)

16. CBIA – CaraBelajarIbuAktif • 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.

17. Monitoring: problem identification & measurement Training: problem solving Description of the recent situation Reflection of previous experience 80% 20% Problem solving & scientific/reality testing Planning: setting target of improvement Agreement on target of improvement Health professionals : MTP (QIMC) Adult learning process Self initiative learning process • Follow quality improvement management cycle

18. 4. WHO Ethical Criteria for Medicine Promotion 1988

19. 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.

20. 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)

21. 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

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

23. 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.

24. 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

25. 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

26. 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

27. Medical representative • Free samples of prescription medicine • Symposia and other scientific meeting • PMS and Dissemination information • Promotion of exported medicines

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

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

30. 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

31. Thank You Please ?? and comments