P-drugs & Rational Prescribing

P-drugs & Rational Prescribing

1. Definition & framing of rational drug use

• Rational use of medicines (WHO definition, quoted verbatim in KDT): "rational use of medicines requires that the patients receive medication 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 to their community" (KDT 8e Ch.5, p.81).
  • Four embedded requirements: right clinical indication, right (individualised) dose, adequate duration, lowest cost to patient and community (KDT 8e Ch.5, p.81).
• It is widely assumed that drug use by qualified doctors of modern medicine is rational; in reality irrationality abounds in almost every aspect of drug use — medically inappropriate, ineffective and economically inefficient use occurs worldwide, more so in developing countries (KDT 8e Ch.5, p.81).
• Rational use of medicines addresses every step in the supply–use chain — selection, procurement, storage, prescribing, dispensing, monitoring and feedback — but the chapter scope is restricted to rational prescribing and related aspects (KDT 8e Ch.5, p.81).
• Drug therapy is the most frequently chosen therapeutic option once a diagnosis is reached; the available options also include surgery, psychiatric treatment, radiation, physical therapy, health education, counseling, further consultation (second opinions), and no therapy (Katzung Ch.66, p.1220).
  • At a US office visit the physician/authorised professional prescribes medication 67% of the time, averaging one prescription per visit, and patients receive on average 12.3 prescriptions per year — quantifying how central prescribing is to practice (Katzung Ch.66, p.1220).
• A written prescription is defined as the prescriber's order to prepare or dispense a specific treatment — usually medication — for a specific patient (Katzung Ch.66, p.1220).