Promoting Drug and Therapeutics Committees in the Developing

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Promoting Drug and Therapeutics Committees in the Developing World

Promoting Drug and Therapeutics Committees in the Developing World

Promoting Drug and Therapeutics Committees in the Developing World Terry Green John Chalker Kathleen

Promoting Drug and Therapeutics Committees in the Developing World Terry Green John Chalker Kathleen Holloway Rational Pharmaceutical Management Plus World Health Organization March 2004 RPM + is supported by the U. S. Agency for International Development

What is a DTC? Drug & Therapeutics Committees § The committee designated to ensure

What is a DTC? Drug & Therapeutics Committees § The committee designated to ensure the safe & effective use of medicines in health facilities § develops policies for managing drug use § administers and manages the formulary system § evaluates the clinical use of drugs § DTCs are important because there is widespread inappropriate use of medicines § Polypharmacy, antibiotic overuse, injection overuse and non-sterile injections, non-compliance with guidelines… § leading to increased antimicrobial resistance, spread of hepatitis B/C & HIV, waste of resources, increased adverse drug reactions and poor patient outcome

Responsibilities of a DTC Establishing Standards (1) EML & STG development (2) Evaluating drugs

Responsibilities of a DTC Establishing Standards (1) EML & STG development (2) Evaluating drugs (3) Drug Use Evaluation criteria Correcting problems to achieve standards (1) Interventions to promote rational drug use (2) Interventions to prevent medication errors, quality problems, stock-outs & ADRs Regular Assessment DTC’s role to ensure quality of therapeutic care (1) ABC/VEN (2) Indicator Studies (3) Drug use evaluation (4) Regular review of reports of medication errors and ADRs Investigating reported problems (1) Investigation of medication errors, drug quality problems, stock-outs and ADRs (2) Qualitative investigation why a drug use problem exists

Objectives of the MSH/WHO DTC Project § To promote DTCs in the developing world

Objectives of the MSH/WHO DTC Project § To promote DTCs in the developing world § DTCs have been shown to be effective in promoting rational drug use in developed countries, but there has been minimal use of these committees in developing countries

Interventions during 2000 -3 § DTC training materials were developed by MSH and WHO

Interventions during 2000 -3 § DTC training materials were developed by MSH and WHO § “Drug and Therapeutics Committees: a practical guide” developed by WHO and MSH and published in 2004 § 4 international and 8 national courses conducted in Asia, Africa, Latin America, E. Europe & aimed at doctors, pharmacists, hospital administrators & MOH officials § Follow-up workshop for participants

Structure & content of training course § 16 half -day modules and a field

Structure & content of training course § 16 half -day modules and a field trip to hospitals § Formulary management § Drug Selection § Determining efficacy, safety, cost, quality § Adding and deleting drugs § Identifying drug use problems § Qualitative and quantitative methods § Strategies to improve drug use § Educational, managerial, and regulatory strategies

Training follow-up activities § E-mail correspondence with participants § DTC Web site § Workplans

Training follow-up activities § E-mail correspondence with participants § DTC Web site § Workplans displayed and progress reported § Discussion boards § Announcements § Links to resources § Follow-up workshop in Africa

Training results § 361 people trained from 56 countries § 87 (24%) responded to

Training results § 361 people trained from 56 countries § 87 (24%) responded to follow-up e-mail request § 57 (16%) participants had undertaken 152 DTC related activities

Post-course country DTC activities § § § § 29 training courses organized by DTC

Post-course country DTC activities § § § § 29 training courses organized by DTC participants 72 DTCs in 14 countries created/restructured 9 new drug selection processes in 6 countries STGs developed in 12 institutions in 6 countries 7 DUEs undertaken in 4 countries 8 ABC/VEN analyses undertaken in 5 countries 7 ADR reporting systems developed in 5 countries 8 training programmes on rational use of drugs in 6 countries

Major problems identified by participants to implement DTCs § Lack resources and institutional support

Major problems identified by participants to implement DTCs § Lack resources and institutional support § Non-compliance with essential drug list (formularies) § Non-compliance with STGs § Pharmaceutical company influences § Decreasing revenues with improved drug use

Solutions proposed by participants § Use locally collected evidence on irrational drug use to

Solutions proposed by participants § Use locally collected evidence on irrational drug use to convince officials § Provide incentives to DTC members e. g. training, recognition by administration for DTC work § Develop specific Terms of Reference approved by healthcare administrators § Link procurement to STGs and formularies § Provide training to DTC members & administrators § Build a critical mass of activity to show administration the value of the committee and demonstrate that DTC activities can save money § Link procurement to DTC’s formulary/EDL

Conclusions Key Lessons § DTCs can be promoted and implemented in developing countries through

Conclusions Key Lessons § DTCs can be promoted and implemented in developing countries through a combination of training and active follow-up support § Increased follow-up support increased the productivity of many DTC course participants Policy Implications § Promotion of DTCs is possible in resource poor settings and can result in improved use of medicines but requires institutional support and investment from government and donors Future Research § Rigorous evaluation of the impact of DTCs on drug use and costs saved from improved use