APPROPRIATE MEDICINE
USE
2
Inappropriate
medicine
use
q Inadequate
diagnosis
q Inadequate
prescribing
⇒ Non adherence to standard guidelines
⇒ Poly-pharmacy, wrong doses/route/duration
⇒ Expensive/un-necessary medications
q Inadequate
dispensing/administra#on
⇒ Wrong incomplete labelling, instructions, etc
q Inadequate
adherence/incorrect
use
in
the
community
⇒ Wrong dose/duration
⇒ Incomplete doses
⇒ Self medication
⇒ Questionable quality medicines 3
Factors
affec/ng
medicine
use
category
Factors
Health
workers’
Training,
CMEs,
experience,
peer
factors
pressure,
authority
and
supervision
System
factors
Workload,
infrastructure,
laboratory,
organiza#on
of
work
Supply
chain
Availability
of
medicines,
quality
of
medicines,
Pa#ents’
factor
Pa#ents’
demands,
socio
cultural
factors
Other
eternal
Industry
pressure,
drug
factors
informa#on,
financial
incen#ves,
regulatory
framework
4
Consequences
of
inappropriate
use
Reduced
MORTALITY
quality
of
therapy
MORBIDITY
6
The
problem
in
summary
q Inappropriate
medicine
management
and
use
causes:
⇒ Adverse clinical outcomes
⇒ Waste of resources
LOW QUALITY,
LOW COST EFFECTIVENESS,
LOW EFFICIENCY
7
Uganda’s
situa/on
WORLD
BANK
REPORT
2013
Inappropriate
treatment
64%
42%
Inappropriate
diagnosis
WHO
INTERVENTIONS
9
UCG
and
EMHSLU
10
PROCESS
LIST
OF
COMMON
DISEASES
AND
COMPLAINTS
TREATMENT CHOICE
• SELECTION
OF
PRIORITY
CONDITIONS
• SCIENTIFIC
EVIDENCE,
• COST
EFFECTIVENESS,
• IMPLEMENTABILITY
12
LIMITATIONS
q NOT
A
COOK
BOOK
⇒ Does not have all the answers
⇒ Clinical judgement still applies!
q NOT
A
TEXTBOOK
⇒ It has mainly common conditions
⇒ For primary care (not specialist)
14