Why Rational Use of Medicines?

Medicines are nothing in themselves, but are the very hands of God if employed with reason & prudence.
– Herophilus, a Greek physician, 300 B.C

The concept that Herophilus stated in 300 B.C is evident today when World Health Organisation (WHO) defines rational medicine use as “…patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, and the lowest cost to them and their community.”1World Health Organisation – Rational use of Medicines.

In simple words, what WHO is advocating today is: “Ordering the right medicine for the right patient at the right time and in the right amount with due consideration of costs“.

The Cambridge/Oxford English Dictionary defines “Rational” as that which is based on reason, which is sensible, sane or moderate.

However, today medicines are being used irrationally and this is not a local or country specific problem, but has emerged as a global problem. WHO observes that, “… more than half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take them correctly. The overuse, underuse or misuse of medicines results in wastage of scarce resources and widespread health hazards.2World Health Organisation – Rational use of Medicines.

So what constitutes irrational use of medicine and why it occurs?

Constituents of Irrational Medicine Use 3Piggy bank icon adapted from DryIcons 4Thumbs Down icon adapted from FlatIcon

  • Use of Wrong Medicine – WHO estimates that less than 40% of patients in developing countries, are treated according to standard treatment guidelines 5Managing for rational medicine use – WHO document. For eg. Many children with acute diarrhea are indiscriminately prescribed and dispensed unnecessary and ineffective antibiotics/antidiarrheals instead of the recommended Oral Re-hydration Therapy (ORT).
  • Use of Ineffective Medicine – Excessive and unnecessary use of multivitamin tonic is an example. A review of prescription quality at a Pharmacy in Goa, India showed than in one week, 40% of prescriptions included multivitamin preparations.6Irrational drug use in India: a prescription survey from Goa. It occurs primarily because of common practice or because of common beliefs held by patients, that more the medicines are prescribed, the better.
  • Use of Unsafe Medicines – For eg use of anabolic steroids for growth or appetite stimulation in children/adults 7Managing for rational medicine use – WHO document. The likelihood of adverse reactions or side-effects outweigh the perceived therapeutic benefits.
  • Use of More Medicines than required (Polypharmacy): For eg. a patient with upper respirator infection receiving prescriptions for antibiotics, cough remedies, analgesics and multivitamins 8Irrational drug use in India: a prescription survey from Goa. .
  • Underuse/incorrect use of effective medicines: Several studies show that ORT was prescribed to only a small proportion of children with acute diarrhea in children. Antibiotics are one of the most frequently used incorrectly. Many studies indicate the frequent use of antibiotics for viral infections where they are ineffective. Patients often self medicate using antibiotics or other prescription only medicines, they take only as much medicines as needed to feel better and then save the remainder for a future illness.
  • Use of Medicines when none is needed: In many countries, both developed and developing, the majority of children suffering from minor upper respirator tract infections are treated with antibiotics, which are not needed.

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What is the result of this irrationality?

  • Quality of patient care: The irrational use of medicines can jeopardize patient care and can negatively influence the outcomes of treatment. It can result in increased mortality rates as well as result in increased risk of unwanted side effects. For eg. Diarrhea still remains as the second leading cause of death amongst children. Appropriate use of ORT has made an impact on reducing the deaths but still improvements have to be made to further promote its use rather than unwanted medicines for its treatment.
  • Unwanted side effects can result and effect the outcome of treatment For eg. An over-dosage of gentamicin can lead to permanent hearing problems.
  • Antimicrobial resistance: Antimicrobials have been our saviors for a lot of infections. However, the rampant and irrational use of them has lead to the emergence and spread of microbes that are resistant to the first line of antimicrobials. This results in the use of second or third line antimicrobials, which are more expensive and sometimes even toxic.
  • Rise in therapeutic Cost: irrational medicine use causes patients to spend excessively on medicines and waste financial resources. In addition, there is a large inflow of money that goes into treatment of ailments arising as side effects of inappropriate medicine use. It leads to a vicious cycle of un-ending treatment and spending and has a huge impact financially on the patient and the economy.

What are the factors behind this irrationality?

Factors Influencing Prescribing

Factors Influencing Prescribing & Medicine Use9Center doctor character “designed by Freepik.com”

There are many interrelated factors that influence medicine use. The health system, prescriber, dispenser and patient are all involved in the therapeutic process, and all can contribute to irrational use in a variety of ways (see the diagram).10Adapted from – Managing for rational medicine use – WHO document

We believe a medicine would be used rationally, when:

  • There is an appropriate indication for a condition that requires medication, i.e. prescribing is based on sound medical considerations
  • A patient is given an appropriate medicine, considering efficacy, safety, suitability, and cost
  • There is an Appropriate dosage, administration and duration of treatment
  • The patient is appropriate for the chosen medicine i.e. the likelihood of adverse reactions is minimal
  • The medicine is correctly dispensed, providing appropriate information about the prescribed medicines to the patient, and
  • The patient adheres to the treatment.

Thus, to be able to solve the problem of irrational medicine use effectively and completely, a major challenge is to address all the different stakeholders.

And this would require consorted efforts from many organizations, including Govt, to work in a collaborative way.

We at Aashritha, have decided to focus on Patient and Community stakeholders, by promoting judicious use of medicines amongst the consumers, by following an integrated approach to well being.

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