Akademik Veri Yönetim Sistemi
LEUKEMIA RESEARCH, cilt.39, sa.2, ss.16-17, 2015 (SCI-Expanded)
Irrational drug use is not only our country’s
problem, but also a global public health problem.
As a result of irrational use of drugs all around the
world, the concept of rational use of medicine for
the first time has been introduced by World Health
Organization (WHO) conference of experts in
Nairobi 1985 (1). The rational use of drugs has been
described as patients should receive medications
in compliance with 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.
When rational use of medicine cannot be achieved, increased mortality
and morbidity, increased adverse drug reactions and hospitalization,
drug wastage, drug resistance, environmental pollution and wasted
economical resources will occur.
According to WHO, physicians should follow the 6 steps to improve
rational drug prescribing. (I) Identify the patient’s real problem. This may
be a specific problem as in infectious diseases or non specific or a drug’s
adverse effect, (II) determine the target of treatment such as to relieve
pain, to eradicate bacteria or to improve quality of life (III) list possible
intervention or treatment. This may be a non drug treatment or drug
treatment. Drug must be chosen taking into account the parameters of
efficacy, safety, suitability (high risk group of patients, contraindications,
the diversity of the formulation etc.) and costs. Current diagnostic and
treatment guidelines should be based. Special groups (children, elderly,
pregnancy, breastfeeding women, patients with kidney and liver failure,
history of drug/OTC/herbal or food allergies) should be interpreted with
caution, (IV) (if necessary) start the treatment by writing an accurate
and complete prescription e.g. name of drugs with dosage forms, dosage
schedule. It is thought that common prescription errors are missing
information, inappropriate choice of drug, incompatibility among drugs
in prescription (drug –drug interactions), unreadable handwriting (if
it is not e-prescription), (V) Given suitable information instruction and
warning regarding the treatment such as total duration of the treatment,
adverse effects of drug, dosage schedule, risk of stopping the therapy
suddenly, drug storage conditions, contraception when using drug and
cost of treatment, (VI) monitor the treatment, if necessary stop or change
the treatment.
Although all these steps are the responsibility of the physician, physicians
are only one of the responsible parties for rational use of drugs.
Responsible parties are physicians, pharmacists, nurses, other medical
staff, patients and patients’ relatives, pharmaceutical industry, regulatory
authorities and others (media, academia, the educational system etc.) for
rational use of drugs.
Because so many parties responsible for the rational drug use, WHO
suggests 12 national strategies to promote rational use of medicines (2).
1. A mandated multi-disciplinary national body to coordinate medicine
use policies
2. Clinical guidelines
3. Essential medicines list based on treatments of choice
4. Drugs and therapeutics committees in districts and hospitals
5. Problem-based pharmacotherapy training in undergraduate curricula6. Continuing in-service medical education as a licensure requirement
7. Supervision, audit and feedback
8. Independent information on medicines
9. Public education about medicines
10. Avoidance of perverse financial incentives
11. Appropriate and enforced regulation
12. Sufficient government expenditure to ensure availability of medicines
and staff
On the other hand, things that need to be done to improve the rational
use of medicines in 27 EU member states are summarized in six key title
according to the “Rational Use of Medicine in Europe Executive Summary
Report” published in February 2010 (3).
1. INN prescribing (International Nonproprietary Name NN)
2. Prescription guidelines
3. Pharmaceutical budgets for doctors
4. Promoting the use of generic drugs
5. Prescription monitoring
6. Information activities targeted at the general public.
In Turkey, people can buy drugs without prescription (except for
controlled drugs), and so self-medication rates have been reported
to be high, and can be the cause of wasted resources, the emergence
of resistant strains of microorganisms, and serious adverse reactions.
World Health Organization refers that at least half of the antibiotics
consumed by humans is unnecessary (2). Overuse and misuse of
antimicrobials contributes to antimicrobial resistance. A major issue of
concern to hematologists is the intensive use of antibiotic in patients
with immune suppressed, receiving chemotherapy, or undergoing bone
marrow transplantation. For the first time, in a study including Turkey,
validated data on antibiotic use in seven newly independent states
(Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Moldova, Tajikistan),
five southern and eastern European countries (Bosnia and Herzegovina,
Croatia, Montenegro, Serbia, Turkey), and Kosovo, have been collected
and analysed. This study provided publicly available total antibiotic-use
data for 13 non-EU countries and areas of the WHO European region. (4).
In this study, Turkey had the highest antibiotic use in Europe, and on the
basis of this finding, the Turkish government already published a Rational
Drug Use National Action plan 2013–2017, with quantitative targets to
reduce antibiotic use. In fact, although positive developments accelerated
in recent years, applications within the context rational drug use started
at after 1990 in Turkey (5). Prescription monitoring and evaluation
process is one of the interesting title among these activities. Physicians’
prescriptions can be analyzed and evaluated and the feedback related
them can be given by way of “Prescription Information System” which was
developed to promote rational use of medicine in our country (6).
The pharmaceutical industry can contribute to rational drug use before
prescribing process. It is important to creation and the implementation
of marketing strategies and, appropriately storing and distributing of
the drug. The responsibilities of pharmaceutical companies concerning
rational use of drugs are also to provide clear and understandable drug
leaflet, drug formulations in accordance with treatment guidelines and
rational drug use, appropriate drug containers. On the other hand, some
factors related to pharmaceutical companies can influence compliance
of patients. Advertisements for OTC drugs can result in the patient
stopping taking the “real” medication, or promotional activities of the
pharmaceutical manufacturers may affect rational prescribing.
On the other hand, non-rational usage of drugs enhance the percent of
medical cost in the health funds. Different methods are recommended to
control the drug expenditure
all around the world:
• Implementation the principles of rational drug use
• Regulations relating to prescription writing
• Awareness for preventive and protective treatment
• Promoting the use of generic drugs (While original drugs offer a new,
effective, and safe treatment to humanity, generic drugs constitute an
economical alternative) In conclusion, irrational use of medicines is a serious global public health
problem. But, as stated by the World Health Organization “Irrational
prescribing is a difficult disease to cure, but prevention is possible”.