Rational Drug Use

The Philippines, compared to it's neighbor countries has the highest drug prices in Asia next to Japan. Medicines are priced way too high beyond the reach of ordinary Filipinos so much so that many patients die, not because medicines are unavailable but primarily patients cannot afford to buy them.  This high cost is due to an unregulated free-market forces that wreak havoc on the country’s healthcare system.  Indeed, compared to the demand side, the supply side — the pharmaceutical industry — is so dominant that it can dictate whatever price it wants. Corollary to this, patients are often prescribed medically inappropriate, ineffective and economically inefficient drugs. One major challenge of the country's health system is to ensure that all citizens of the country have access to essential, life-saving medicine and rational drug use.

What is Rational Drug Use?

Rational drug use is defined as that of prescribing the appropriate drug that is available at the right time and at a price people can afford; it should be dispensed correctly, taken by the patient in the right dose at the right intervals and for the right length of time. The appropriate drug must be effective, and of acceptable quality and safety.  The World Health Organization (WHO) states that rational use of drug requires that patients receive medicines appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community. 

The Problems

The type of irrational drug use varies from country to country.  In the Philippines for example, studies show that the following problems are common:

• Prescribing multiple drugs when single or no drug therapy is indicated  (example: antidiarrhoeals for simple diarrhoea, multivitamins for malnutrition)

• Prescribing antibiotics and injectables when they are not recommended,(example: antibiotics for viral infections, injections for malaria fever)

• Using the brand name of drugs instead of their generic names (example: prescribing “Biogesic” instead of the generic name "paracetamol" first together with the brand name )

• Prescribing expensive broad spectrum medicines when cheap narrow spectrum medicines are equally effective and available (example: cephalexin instead of cotrimoxazole for pneumonia)

• Country’s inability to maintain availability of safe and effective drugs in need (example: unavailability of Oral Replacement Solutions for diarrhoea)

The Causes
 

The causes of irrational drug use is not only due to a single factor but due to several interconnected factors like:

• The Patients (consumers)
• The Prescribers - this mainly refers to the doctors but it cannot be denied that some health professionals like nurses, midwives, and most specially pharmacists and their assistants often "prescribe" to consumers.
• The family and workplace 
• The supply system including industry influences (pharmaceutical industry, distributors and suppliers)
• Regulation, drug information and misinformation (government, media)
• And combinations of these factors.

Studies

• UP-PGH – retrospective analysis of 1,578 prescriptions  (ER) done in 1989 showed prescribed antibiotics were inappropriate in 65.2% of cases and 61% were given prophylactically

• UST Clinical Division – 1990-1991 – 58% of patients were given antibiotics either singly or in combination.  4% showed no clear indication; 42% received antibiotics for therapy; 54% for surgical prophylaxis.  Based on standards, inappropriate use of antibiotics was at least 35% of cases

• St. Luke’s Medical Center – 45.7% of therapeutic regimens and 89.4% of prophylactic regimens were inappropriate

(Source: Inappropriate Use of Antibiotics by: Emmanuel Edwin R. Dy, MD)

The Role of the Physician in the Promotion of Rational Drug Use

• Proper Diagnosis
• Specify the Therapeutic Objective
• Appropriate Drug Therapy with consideration to cost
• Adequate Drug Information, Instructions and Warnings

In 1994 the WHO published a book "Guide to Good Prescribing - A Practice Manual" which was written to help medical students develop good prescribing skills.  It has been observed that medical students believe that with experience their prescribing skills will improve but more often than not, while pharmacologic knowledge was acquired, practical prescribing skills after training remained weak.  Although intended for medical students who are about to go into the clinical phase of their training, postgraduates residents and practicing physicians would do well to read this book and perhaps find it as an incentive for change. Good prescribing habits lead to safe and effective treatment, less adverse reactions, lower costs and ultimately, rational drug use.