Saturday, 3 June 2017

Rational use of medicines: What does the word ‘rational’ mean?

Rational use of medicines: What does the word ‘rational’ mean? As doctors taking care of patients, our guiding principles remain ‘beneficence (act in the best interest of the patient)’ and ‘non maleficence (do no harm)’. Medicines cure, control and prevent disease. Hence, rational use of medicines is a very important aspect of patient care as it impacts patient outcomes. What does the word ‘rational’ mean? The dictionary meaning of the word ‘rational’ as defined in the Oxford English Dictionary is that which is “based on reasoning or reason” or that which is “sensible, sane and moderate”. In 1985, the World Health Organization (WHO) convened a Conference of Experts on the Rational Use of Drugs in Nairobi in 1985, which defined the rational use of medicines as “The rational use of drugs 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 the community”. The ‘Five Rights’ of safe medication administration by the Institute of Healthcare Improvement also advocate the same: Right patient, Right drug, Right time, Right dose and Right route. Four more ‘Rights’ have been added to this: Right documentation, Right action (reason for prescribing the medication), Right form and the Right response. So, why is rational use of drug important? Globally, medicines are being overused, underused or misused. Common types of irrational medicine use include: • Polypharmacy i.e. use of too many medicines in a patient • Use of antimicrobials, often in inadequate dosage, for non-bacterial infections • Over-use of injections when oral formulations would be more appropriate • Not prescribing drugs as per clinical guidelines • Inappropriate self-medication, often of prescription-only medicines Irrational use of drugs may cause adverse drug reactions, wastes precious resources and results in health hazards, most notable being antimicrobial resistance, which has now become a major public health problem, one which will leave us practically with no options to treat infections, if not checked in time. Lack of knowledge or being unaware about drugs and their adverse effects has often been cited as a prime reason for irrational use of medicines, which also has legal implications. Ignorance therefore is not a defense. Doctors should be aware of the drugs used in the National List of Essential Medicines (NLEM). They should appreciate that drugs included in the NLEM are comparable to non-NLEM drugs; they are also significantly cheaper. Doctors should also know about the concept of ‘Price to Retailer’ i.e. the price of a drug at which it is sold to a retailer which includes duties and does not include local taxes. This ‘Price to Retailer’ is fixed by the government. My definition of rational use of medicine is “Optimal drug, optimal duration, minimum time, earliest IV to oral switch and affordable”. Indian Medical Association (IMA) has launched a series of initiatives in this regard. “Jaroorat Bhi Hai Kya” is one such campaign to promote rational use of drugs and/or rational ordering of investigations and hospitalizations. Off-label use of drugs and/or procedures should be used very carefully and not without the approval of the Ethics Committee. We have planned similar campaigns “Use Wisely not Wildly”, “Will it benefit” and “Think Before you Ink”. Dr KK Aggarwal National President IMA & HCFI

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