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Year : 2018  |  Volume : 8  |  Issue : 1  |  Page : 1-2

Optimisation of rational prescribing to maximise the health benefit in scarce resourced countries

Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional (National Defence University of ), Kem Sungai Besi, Kuala Lumpur 57000, Malaysia

Date of Web Publication5-Jan-2018

Correspondence Address:
Mainul Haque
Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Sungai Besi, Kuala Lumpur 57000
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/AIHB.AIHB_65_17

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How to cite this article:
Haque M. Optimisation of rational prescribing to maximise the health benefit in scarce resourced countries. Adv Hum Biol 2018;8:1-2

How to cite this URL:
Haque M. Optimisation of rational prescribing to maximise the health benefit in scarce resourced countries. Adv Hum Biol [serial online] 2018 [cited 2018 Mar 17];8:1-2. Available from: http://www.aihbonline.com/text.asp?2018/8/1/1/222250

Prescribing is an intricate work that necessitates an understanding of evidence from clinical trials bearing in mind distinct patient aspects. Thereafter, rational prescribing portrays a sensible and reasonable approach that comprises ‘making a diagnosis, estimating prognosis, establishing the goals of therapy, selecting the most appropriate treatment and monitoring the effects of the treatment.’[1] A rational prescribing also described as ‘a model takes efficacy, toxicity, cost and convenience into account when selecting the appropriate medication.’[2] The WHO defines rational use of medicines (RUM) requires that ‘patients receive medications appropriate to their clinical needs, in doses that meet their requirements, for an adequate period, and at the lowest cost to them and their community.’[3] The notion of the RUM is an ancient one, dating as far back as 300 BC when the Grecian physician Herophilus (325 BCE-255 BCE) said that ‘medicines are nothing in themselves, but are the very hands of god if employed with reason and prudence.’[4] Irrational prescribing speaks about prescribing that found lacking to comply ideal treatment standards.[5] This may evident in five distinct manners as follows: ‘underprescribing, overprescribing, incorrect prescribing, extravagant prescribing and multiple prescribing.’[6] It has been also reported that irrational prescribing is unethical and as it did not follow the standard treatment protocol, thereafter, often leads to extensive health hazards by increasing incidence of the adverse effects, drug interactions and the emergence of drug resistance, especially in antimicrobial therapy.[7] Irrational prescribing has become a global threat as it is ubiquitous from corner to corner countries, hospitals and in health-care systems.[3],[8] According to the WHO estimation, more than 50% of all pharmaceutical products are inappropriately prescribed, distributed and sold[9] and more than half of all patients use the medicines prescribed for them incorrectly.[10],[11] As more than 40% of therapeutic costs are pharmaceutical costs,[10] and non-adherence also represents a waste of substantial economic resources due to unnecessary drug sales and implies a significant waste of health resources in the world.[12] Multiple research from low-resource countries reported that unnecessary and overuse of injections increases the possibility of adverse effects due to unsafe syringes to transmit HIV, hepatitis B and C.[13],[14],[15] In China, due to low prescribing from Essential Medicine List (EDL) significantly increased the costs of treating hypertension, gout and bacterial infections when equated with the RUM. Other types of irrational medicine use were initiated more frequently for bacterial infections (7.4%) than for hypertension (1.6%), diabetes (1.3%) and gout (1.7%).[16] The WHO reported utilisation medicine from EDL promotes RUM.[17] A number of studies from India reported that cost of treatment, especially regarding medicine was found high due to polypharmacy, the absence of generic medicine and irrational fixed-dose combinations.[18],[19],[20] Therefore, potentially increases the possibility of adverse drug reactions and unnecessary financial burden on patients.[21] The WHO educated guess that the RUM can improve in about 50%–70% cost-efficiency in medicines overheads.[22] One systematic review concluded that physicians' lack of knowledge regarding costs, their high propensity towards proprietary expensive branded medicine to prescribe and underrate the price, and again, overrate the price of inexpensive generic medicines, validate doctors' perception and acceptance of the large difference in cost between inexpensive and expensive medicines. This disagreement successively promotes overall medicine expenditures without ensuring any substantial benefit.[23] New generation medicine of any intraclass medications does not essentially epitomise better than their older cousins. However, new generation medicine, without a doubt, will be more expensive, at least for the period of their patent protection phase.[2] ‘Statins, proton pump inhibitors, angiotensin-converting enzyme inhibitors and selective serotonin reuptake inhibitors were determined to have class equivalence for efficacy, toxicity and convenience.’[2] It has been estimated that mentioned four categories of medicine can save $222 million for public drug programmes, and $521 million nationally through rational prescribing.[2] Irrational prescribing is a disease which is demanding global health change to cure, but immunisation on the road to this disease is possible.[6],[24] The prescription pattern monitoring studies (PPMS) offer a bond between areas such as RUM, pharmacovigilance, evidence-based medicine, pharmacoeconomics, pharmacovigilance and pharmacogenovigilance.[25] Several studies reported that regular educational interventions during undergraduate studies and continued medical education programme improve prescribing behaviour.[26],[27] Subsequently, regular educational interventions and PPMS can optimise rational prescribing and promote healthcare even with minimum resources.

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World Health Organization. The Pursuits of Responsible Use of Medicines Sharing and Learning from Country Experience. Technical Report prepared for the Ministers Summit on The Benefits of Responsible Use of Medicines: Setting Policies for Better and Cost-effective Health Care; WHO/EMP/MAR/2012.32.WHO Fact sheet N'338. Geneva, Switzerland: World Health Organization; 2010. Available from: http://www.apps.who.int/iris/bitstream/10665/75828/1/WHO_EMP_MAR_2012.3_eng.pdf. [Last accessed on 2017 Oct 09].  Back to cited text no. 3
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World Health Organization. The Role of Education in the Rational Use of Medicines. SEARO Technical Publication Series No 45 Distribution: General. World Health Organization, Regional Office for South-East Asia; 2006. Available from: http://www.apps.who.int/medicinedocs/documents/s16792e/s16792e.pdf. [Last accessed on 2017 Oct 09].  Back to cited text no. 9
Holloway K, Green T. The World Medicines Situation 2011. Rational Use of Medicines 3rd ed. Geneva, Switzerland: World Health Organization Press; 2011. Available from: http://www.who.int/medicines/areas/policy/world_medicines_situation/WMS_ch14_wRational.pdf. [Last accessed on 2017 Oct 09].  Back to cited text no. 10
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Massele AY, Mashalla YJ, Kayombo EJ, Mwaiselage JD, Mwamba NE, Kaniki I, et al. Reducing therapeutic injection overuse through patients-prescribers Interaction Group Discussions in Kinondoni District, Dar es Salaam, Tanzania. Tanzan J Health Res 2011;13:69-73.  Back to cited text no. 13
Potharaju HR, Kabra SG. Prescription audit of outpatient attendees of secondary level government hospitals in Maharashtra. Indian J Pharmacol 2011;43:150-6.  Back to cited text no. 14
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Chowdhury AK, Roy T, Faroque AB, Bachar SC, Asaduzzaman M, Nasrin N, et al. A comprehensive situation assessment of injection practices in primary health care hospitals in Bangladesh. BMC Public Health 2011;11:779.  Back to cited text no. 15
Zhang WY, Li YR, Li YJ, Li XQ, Zhao WG, Lu RZ, et al. A cross-sectional analysis of prescription and stakeholder surveys following essential medicine reform in Guangdong Province, China. BMC Health Serv Res 2015;15:98.  Back to cited text no. 16
World Health Organization. Promoting Rational Use of Medicines: Core Components. Geneva, Switzerland: World Health Organization; 2002. Available from: http://www.archives.who.int/tbs/rational/h3011e.pdf. [Last accessed on 2017 Oct 09].  Back to cited text no. 17
Pathak AK, Kumar S, Kumar M, Mohan L, Dikshit H. Study of drug utilization pattern for skin diseases in dermatology OPD of an Indian tertiary care hospital - A prescription survey. J Clin Diagn Res 2016;10:FC01-5.  Back to cited text no. 18
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Pradhan S, Panda A, Sahu S, Behera JP. An evaluation of prevalence and prescribing patterns of rational and irrational fixed dose combinations (FDCs): A hospital based study. Int J Med Sci Public Health 2017;6:58-62.  Back to cited text no. 20
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