RATIONAL DRUG USE ACTIVITIES Burçak DenizDEDEOĞLU MD PhD Burçak Deniz DEDEOĞLU, MD. PhD. Head of Rational Drug Use Department Ministry of Health of Turkey General Directorate of Pharmaceuticals and Pharmacy
RATIONAL DRUG USE The rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of timeand at the lowest cost to them and their community. Conference of Experts on the Rational Use of Drugs, World Health Organization, Nairobi, Kenya, WHO/CONRAD/WP/RI, (25-29.12.1985). 2
PRINCIPLES of RATIONAL DRUG USE Rely on accurate diagnosis in treatment planning, Determine the right drug, right dose, right time, and the correct way of the application, Assess the success of treatment, side effects and compliance, Predict the interactions in use of multiple drug, Assess the practicability and the cost of treatment. 3
World Health Organization, conf.of experts, Kenya Nairobi, 1985. Efficacy Safety Appropriateness Cost 4
INAPPROPRIATE USAGES Polypharmacy Unnecessary and excessive use of drugs Incompatible prescribing with clinical guidelines Inappropriate personal treatments Inappropriate choice of new drugs 5
WORLD HEALTH ORGANIZATION RECOMMENDATIONS The institution that provides the coordination Evidence based dclinical i l guidelines The essential drugs list Drug and treatment committees Pharmacotherapy and prescribing trainings Continuous medical education Health staff feedback Public awareness and education 6
STAKEHOLDERS Decision maker of which drug will use (doctor) Supplier of the drug (pharmacist) Applier of the drug (nurse, patient/relatives) Producer 7
INSTITUTIONALISATION Rational drug use department was established within the General Directorate of Pharmaceuticals and Pharmacy 12 October 2010. 8
Advertisement Training Guidelines Hospitals Legislations Drug boxes Pharmaceutical waste management Meetings Time temperature indicator Monitoring and evaluation 9
ADVERTISEMENT 10
MY DRUG; NEITHER LESS, NOR MORE! Slogan, logo, mascot Short films Newspaper advertisements Leaflet Bill poster 11
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MEDIA Health programs in national TV and radio channels. Web site; www.akilciilac.gov.tr 13
INFORMATIVE VIDEOS Informative videos related, routes of administration of all drugs forms and issues must be considered. Rational Drug Use website Hospitalandfamilyhealthcenters and waitingrooms rooms, TV. 14
TRAINING 15
TRAINING PROGRAMS Primary school curriculum Medical school curriculum Faculty of pharmacy curriculum Medical Specialty Exam 16
DISTANCE TRAINING VLE RADUS project about RDU was prepared by Refik Saydam National Public Health Agency. Pilot practice for the family physicians i in Ankara. Distance training modules of Turkish Pharmacist Association. 17
TRAINING IN STATE HOSPITAL Sincan State Hospital, 27.01.2011 Çubuk State Hospital, 06.04.2011 Gölbaşı State Hospital. 18
FACE TO FACE TRAINING ACTIVITIES Turkish Pharmacological Society Turkish Pharmacists Association Training activities for the physicians, pharmacists and auxiliary health care personnel. 19
TEBRP (Assistance for pharmaceutical care) The installation of the CD which was prepared by Turkish Pharmacist Association, was completed for pharmacies. It was sent to all family and community health centers for free. 20
GUIDELINES 21
DIAGNOSIS AND TREATMENT GUIDELINES FOR THE PRIMARY CARE The guideline, prepared by Refik Saydam National Public Health Agency, is in the update period. Interviews to provide access to the web database of the guideline. Interviews to provide access to the web dtb database of the formulary. 22
DIAGNOSIS AND TREATMENT GUIDELINES FOR THE SECONDARY CARE Guidelines for the secondary care. Meetings with the societies. 23
HOSPITALS 24
SERVICE QUALITYSTANDARDS Addition of new topics about rational drug use to Service Quality Standards in Hospitals. Health lthperformance and Quality Regulations entered into force on 1 July 2011 25
Standards Arrangements to ensure rational drug use Set up a team, responsible for rational drug use A representative from management, physicians and pharmacistsshould should be inteam; İn relation to rational drug use; Hospital policy should ldbe dt determined d Activities should be planned and implemented 26
Standards The arrangements for the awareness in patients. Patients should be informed about the use of drugs. Arrangements such as brochures, posters, videos ın areas frequently used by patients. Inpatient trainings. 27
PHARMACOVIGILANCE General Directorate of Pharmaceuticals and Pharmacy, Drug Safety Monitoring, Evaluation Department An integral part of Rational Rti ldrug Use 405 pharmacovigilance contact persons in hospitals 28
PHARMACEUTICALS TRACK & TRACE SYSTEM Follow up of drugs throughout h t the country First in the world Data matrix 29
LEGISLATIONS 30
TANITIM YÖNETMELİĞİ Recommendation letter to the related societies to include a session about the rational drug use at congresses. The Regulation on Promotional Activities of Medicinal Products for Human Use. 31
THE REGULATION onpromotional ACTIVITIES The Regulation on Promotional Activities of Medicinal Products for Human Use, Second part, Scientific and Educational Activities, Article 7 (6); In meetings supported by license/permit holders, a session will placedonrationaldrug use. The content of this session will be under the presentations, training materials and diagnostic treatment guidelines approved by theministry. 32
DRUG BOXES 33
Safe drug box cap design for drugs with narrow therapeutic index, Slogans about rational drug use on drug boxes, Big font size on the direction for use 34
PHARMACEUTICAL WASTE MANAGEMENT 35
PHARMACEUTICAL WASTES Ministry of Environment and Urbanism Legislation for Management of Hazardous Waste Legislation for Management of Pharmaceutical Waste Drug collection campaigns??? Ekolojik Enerji Ltd. Şti. (İstanbul) İZAYDAŞ (Kocaeli) 36
MEETINGS 37
Related Societies, Rational Drug Use Representatives meeting; 20.01.2011 81 Provincial i lhealth lthdirectorates, t Rational Drug Use Representatives meeting; 24 27.05.2011 38
ICIUM (International Conference for Improving Use of Medicines) November 14 18, 2011 Antalya Turkey 39
TIME TEMPERATURE INDICATOR 40
WORLD HEALTH ORGANİZATİON RECOMMENDATİONS Cold chain drugs The color of the indicator will change if any problem occurs Preventing the destruction of drugs that are not yet robust, although the nonsuitable conditions Increasing the reliability in the use of drugs 41
MONITORING AND EVALUATION 42
In order to determine the effectiveness of the program; monitoring and evaluation was planned before and during the programme periodically. 43
Surveys for physicians, pharmacists, nurses and public. Questionnaire applications, Simulated patient visits, Focus group surveys, Evaluation studies for drugs in houses. 44
THANKS FOR YOUR ATTENTION 45
0 312 218 31 21 0 312 218 31 22 0 312 218 31 33 akilci.ilac@iegm.gov.tr www.akilciilac.gov.tr