Rational use of medicines to improve quality of therapy

Rational use of medicines to improve quality of therapy

 

Lack of access to medicines is a major problem in any health system, but access is of little advantage if the medicines are not used correctly. The availability of essential medicines, equipment and supplies, together with rational use by prescribers, dispensers and patients are two important indicators for the quality of health care services. Irrational use of medicines is a serious global problem that is wasteful and harmful.

To improve the use of medicines, we need a two-pronged approach: on the community end, we address perceptions and behaviours; on the health provider’s side, we address the professional knowledge, skills and practices needed for effective use of medicines through rational prescribing and dispensing.

  • Rationale use of medicines
A baseline study on medicine use - also called rational use of medicines study (RUM), based on WHO/INRUD standard methodology – was conducted in 2012 serving to explore the current situation and to identify potential areas for planning interventions.

Of the 270 public facilities in the six districts of Dodoma, a random sample of 120 facilities was included. Pharmacy graduates from St John’s University in Dodoma were trained and questionnaires were pilot tested. A total of 3510 encounters were collected and recorded retrospectively and 1397 encounters were collected and recorded prospectively.

Among many findings requiring attention, the most critical is the high use of antibiotics (66%). A similarly serious finding is the low availability of key medicines in the visited health facilities that prevents appropriate prescribing and use of medicines.

This comprehensive study allowed an insight in the use of medicines in Dodoma region. It can be used to understand gaps and define priority activities for further investigation and action. It can also be used baseline for measuring the impact of interventions.

 

A concurrent study explored adherence to national Standard Treatment Guidelines (STG). We focused on the quality of pharmacotherapy exploring the medicines prescribed for a given diagnosis. In total diagnoses of 2’886 patient cases were recorded and analysed. The results are worrisome as complete adherence to STG was found in only 31% cases and wrong treatment was found in 30% of diagnoses. About one third of cases received at least the correct medicine but additional unnecessary or wrong medicines. We are planning interventions focusing on the main diseases to improve pharmacotherapy as this affects availability of medicines and ultimately health outcomes.