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Rational use of medicines.

Holloway, K., Dijk, L. van. Rational use of medicines. In: World Health Organization. The World Medicines Situation Report 2011. Geneve: World Health Organization, 2011.
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1. Irrational use of medicines is an extremely serious global problem that is wasteful and harmful. In developing and transitional countries, in primary care less than 40% of patients in the public sector and 30% of patients in the private sector are treated in accordance with standard treatment guidelines; 2. Antibiotics are misused and over-used in all regions. In Europe, some countries are using three times the amount of antibiotics per head of population compared to other countries with similar disease profiles. In developing and transitional countries, while only 70% of pneumonia cases receive an appropriate antibiotic, about half of all acute viral upper respiratory tract infection and viral diarrhoea cases receive antibiotics inappropriately; 3. Patient adherence to treatment regimes is about 50% worldwide and lower in developing and transitional countries, where up to 50% of all dispensing events are inadequate (in terms of instructing patients and/or labelling dispensed medicines); 4. Harmful consequences of irrational use of medicines include unnecessary adverse medicines events, rapidly increasing antimicrobial resistance (due to over-use of antibiotics) and the spread of blood-borne infections such as HIV and hepatitis B/C (due to unsterile injections) all of which cause serious morbidity and mortality and cost billions of dollars per year; 5. Effective interventions to improve use of medicines are generally multi-faceted. They include provider and consumer education with supervision, group process strategies (such as peer review and self-monitoring), community case management (where community members are trained to treat childhood illness in their communities and provided with medicines and supervision to do it) and essential medicines programmes with an essential medicine supply element. Printed materials alone have little effect and for guidelines to be effective they need to be accompanied by reminders, educational outreach and feedback; 6. Less than half of all countries are implementing many of the basic policies needed to ensure appropriate use of medicines, such as regular monitoring of use, regular updating of clinical guidelines and having a medicine information centre for prescribers or drug (medicine) and therapeutics committees in most of their hospitals or regions; 7. The second International Conference on Improving Use of Medicines in 2004 and World Health Assembly Resolution WHA60.16 in 2007 recognized the difficulty of promoting rational use of medicines in fragmented health systems. They recommend a cross-cutting health system approach and the establishment of national programmes to promote rational use of medicines, which would require much more investment than governments and donors have so far been willing to give. (aut.ref.)