Drug formularies Tiriyagosi MoH (1).pptx

National Essential drug formularies and treatment guidelines

1. National Essential Drug List, Formularies & Treatment guidelines Dr. C. Molake-Tiroyakgosi; PharmD Ministry of Health

2. OBJECTIVES Concept of Essential Drugs Overview of the National Drug Policy Rational Drug use National Guidelines and functions Advantages of adherence to Guidelines

3. DEFINITIONS National Standing Committee On Drugs ( NASCOD ): Central Committee formed to ensure Rational Drug Selection and Use in all the facilities Botswana Essential Drugs Action Program ( BEDAP ) : A coordinating centre for all matters pertaining to drug treatment policies Functions as the secretariat for NASCOD, collating information on drug use from facilities for deliberation by NASCOD

4. The Botswana National Drug (Medicines) Policy General Aim: To make drugs of acceptable safety, efficacy and quality available and affordable to all those who need them and to promote their rational use by prescribers, dispensers and consumers.

5. The Botswana National Drug (Medicines) Policy (BNDP) Specific Objectives of the BNDP To ensure the availability and accessibility of essential drugs to all citizens To ensure the use of safe, effective and good quality drugs To ensure good dispensing and prescribing practices To promote rational use of drugs by prescribers, dispensers and patients

6. Rational Medicine Use The Rational Use Of Medicines (RUD) : The practice of ensuring that patients receive medicines appropriate for their indications, in the right doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them, provider and the community. (WHO Conference of experts-Nairobi 1985)

7. The Essential Drugs (ED) Concept A concept started by WHO in the 1970s which aims to ensure a reliable supply of safe and effective drugs to the majority of the population Set against background that: Essential Drugs (ED) are cost-effective and are vital elements of health care. Majority of the population can be treated with fewer drugs that are carefully selected to address common health problems.

8. The Essential Drugs (ED) Concept cont’d From the ED concept WHO developed a Model drug list in 1977 which had 208 individual medicines- EDL Essential Drugs: Satisfy or address the health needs of the majority of the population Should always be available in adequate amounts and appropriate dosage forms MOH has long adopted the ED Concept within Health Care system → BEDL

9. The Botswana Essential Drugs List The BEDL was formulated to address the challenges of increasing drug budget and to manage expiries A tool that can be used to promote cost effective procurement and rational use of drugs. Aims to present a consensus on drug treatment options.

10. Advantages of a limited list of essential drugs Consistency/Standardization of care Fewer irrational treatment options available Gain more experience with fewer drugs Procurement and Logistics efforts concentrated on limited products resulting in more manageable: -procurement - storage -distribution Lower prices due to increased purchase power

11. The BEDL Layout and Classification of Drugs Drugs arranged according to pharmacological class e.g. anti-hypertensives, gastro-intestinal drugs, etc Indicate level of facility where drug is kept and category of prescriber who can initiate prescription. Clinic and Health Post list Specialist nurses list Medical officer’s list Specialist list Special Orders

12. The BEDL Layout and Classification of Drugs Drugs arranged according to pharmacological class e.g. anti-hypertensives, gastro-intestinal drugs Indicate level of facility where drug is kept and category of prescriber who can initiate prescription. Clinic and Health Post list Specialist nurses list Medical officer’s list Specialist list Special Orders

13. The BEDL Layout and Classification of Drugs Decision on how to classify drugs : Training Complexity of disease Tests required to diagnose Drug (safety, monitoring required, availability of similar/ alternative drugs over-use potential and consequences) cost

14. Drug Selection Drug selection shall be guided by good pharmaceutical and economic principles and WHO Essential Drugs Concept Criteria for inclusion Pattern/prevalence of disease in Botswana Registration status according to DRSA Documented efficacy and safety of the drug Quality and stability of drug Cost

15. Who influences addition/deletion of a product Facilities through DTCs BEDAP NASCOD Drug Regulatory Unit Private Sector Recommendations for additions and deletions to be submitted to BEDAP/NASCOD through DTCs

16. Why Rational Use? About 80% of the time disease conditions are managed by use of drugs! [WHO-May 2010] More than 50% of all medicines are prescribed, dispensed, and sold inappropriately Half of all patients fail to take them correctly [WHO] More than 50% of countries fail to implement basic policies to promote rational use of drugs Less than 40% of patients in public sector and 30% in private are treated according to standard treatment guidelines

17. Why RUD? Cont… The consequences of inappropriate use are huge: Antimicrobial Resistance [AMR] Poor response to antibiotics, prolonged illness, hospital stay, necessitate surgery, may need removal of infected organ, drainage, higher mortality, spread of resistant microbes, need for better molecules, higher cost of care. AMR not only affects the individual but also the community!! It also increases the burden on the health system !

18. Why RUD? Cont… Adverse Drug Effects & Medication Errors Costs the individual and the system, increased risks and liability Wastage of public funds – inappropriate medicine use is wasteful Distorts quantification figures - which forecasts procurement demand.

19. How then do we promote rational use of drugs ?

20. Is an Essential Drug List or a Formulary adequate?? NO

21. Best approach! Standardizing Treatments STG- A systematically developed statement designed to assist practitioners and patients in making decisions about appropriate healthcare for specific clinical circumstances.

22. Why Standardize Treatment? Treatment of diseases may have different approaches Many practitioners will not remember the best method or approach; promotes diversity in treatment offered for the same condition. Applying the most effective treatment benefits both the patient and healthcare system The best example: Our HIV/AIDS treatment model! Our outcomes are better!

23. STGs offer Therapeutically Effective and Economically Efficient use of Drugs! I. Advantages for healthcare providers: Provides standardized guidance to practitioners Indicates the most appropriate drugs for use Produces better outcome Enables the procurement system to ensure the listed drugs are made available Helps those new in the system to follow and provide standardized care Enables practitioners to concentrate on making the correct diagnosis

24. STGs offer Therapeutically Effective and Economically Efficient use of Drugs! II. For Health Policy Makers: Ensures funds are used more more efficiently Provides the most effective therapy Provides a basis for evaluating the quality of care offered. Provides information on the standards of care to educate clients A good vehicle for integrating programs at primary-care facilities.

25. STGs offer Therapeutically Effective and Economically Efficient use of Drugs! III. For Supply Chain Management Provides quantitative data to forecast procurement demand Determines course pack size or monthly refill pack size for procuring suitably packed products.

26. STGs offer Therapeutically Effective and Economically Efficient use of Drugs! IV. For Patients: Patient receive optimal standardized drug therapy and good outcomes. Enables consistent and predictable treatment from all providers at all levels of the health system Improves availability due to the selective medication use and more guided procurement. To paying clients cost of care is affordable.

27. CONCLUSION If guidelines are inaccurate and incomplete they can do more harm than good. [Evidence based reliable information must be used] Health science is dynamic; new evidences must be considered and updates must be periodically provided . [Updates are done after a decade or more] Guidelines are meant to treat the population, not necessarily each patient. There is need for individualization in care Practitioners may limit their evaluation to fit into a standard treatment and fail to make an accurate diagnosis Peer pressure, Patient pressure, Company pressure.

28. Thank you