Rational use of medicines – an important issue in pharmaceutical policy

Abstract

In this article the authors deal with issues of drug utilisation from a clinical and policy perspective. They address the difficulties of managing drug therapy on a population level, which is known among professionals, as the problem of rational use of medicines. Various definitions and interpretations are presented and compared. This is followed by a presentation of the concerns associated with pharmaceutical marketing from a policy perspective, including the fear that the dominance of information produced by industry may lead to irrational drug use. Next, the authors review the tools for policy making including educational, managerial, and regulatory interventions. The (often overlapping) concepts of medicines management, clinical pharmacy and pharmaceutical care are then discussed to show how professionals, sometimes in collaboration with policymakers, have tackled the problem of nonrational use of medicines. The authors address the question as to whether the rational use of medicines a universal concept, whether it can be and whether it should be? They argue that, as with most concepts, the rational use of medicines must always be viewed in context. They conclude that pharmacy needs to adapt its way of thinking to include the issue of context. They point out that clinical pharmacists today already adapt their decisons to each patient and patient group. Policy-makers are encouraged to adopt a similar approach because populations as well as particular market situations vary and therefore policy solutions cannot be considered universal.

Irrational Use of Medicines—A Summary of Key Concepts

“…The World Bank has also defined rational medicine use as comprising two key principles: (1) the use of drugs according to scientific data on efficacy, safety, and compliance; and (2) the cost-effective use of drugs within the constraints of a given health system [4,11]. …”

“…The WHO and the World Bank definitions differ in two main areas: (1) the use of scientific data in prescribing, which appears to be more enforced in the Word bank definition; and (2) while the World Bank definition incorporates countries’ financial capacity as a consideration in medicine use, the WHO advocates for the use of medicine with the lowest cost wherever possible, irrespective of the particular health system [4]. …”

“…There is an on-going debate as to whether the rational use of medicines should be defined as a universal concept or customized to suit individual context [4]. These discussions are borne out of the observation that countries face different challenges, and have varied health system capacities [4].…”

“…Promoting the rational use of medicines requires effective policies as well as efficient collaboration between health professionals, patients, and entire communities. Adequate understanding regarding the relevant aspects of medicine use on the part of all stakeholders is essential to drive collaborative efforts towards addressing the problem of irrational medicine use [4,5]. Tackling the issue of irrational medicine use is considered to be essential not only to improve healthcare delivery towards ensuring patient safety, but also to allow for optimal utilization of resources.…”

Quantifying the Impact of Drug Exposure Misclassification due to Restrictive Drug Coverage in Administrative Databases: A Simulation Cohort Study

“…Although some administrative databases capture all drugs irrespective of drug coverage, this is the exception rather than the norm. Drug policies that limit coverage through nonformulary status or "special authorization" criteria for coverage are common cost-containment mechanisms employed by single party payers to guide prescribing [10,11]. However, to the extent that drugs with restrictive coverage policies are still used in the population, but not captured in administrative databases, these policies have the potential to result in drug exposure misclassification in pharmacoepidemiologic studies [8].…”