Promoting rational use of medicines

Rational use of medicines requires that "patients receive medications 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.

A major global problem

Irrational use of medicines is a major problem worldwide. WHO estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take them correctly. The overuse, underuse or misuse of medicines results in wastage of scarce resources and widespread health hazards. Examples of irrational use of medicines include: use of too many medicines per patient ("poly-pharmacy"); inappropriate use of antimicrobials, often in inadequate dosage, for non-bacterial infections; over-use of injections when oral formulations would be more appropriate; failure to prescribe in accordance with clinical guidelines; inappropriate self-medication, often of prescription-only medicines; non-adherence to dosing regimes.

WHO advocates 12 key interventions to promote more rational use:

• Establishment of a multidisciplinary national body to coordinate policies on medicine use
• Use of clinical guidelines
• Development and use of national essential medicines list
• Establishment of drug and therapeutics committees in districts and hospitals
• Inclusion of problem-based pharmacotherapy training in undergraduate curricula
• Continuing in-service medical education as a licensure requirement
• Supervision, audit and feedback
• Use of independent information on medicines
• Public education about medicines
• Avoidance of perverse financial incentives
• Use of appropriate and enforced regulation
• Sufficient government expenditure to ensure availability of medicines and staff.