Strategies to Improve Drug Use Educational to inform

Strategies to Improve Drug Use Educational: to inform or persuade Managerial: to structure or guide decisions Regulatory: to restrict or limit decisions Framework for Changing Drug Use Practices 1

Managerial Strategies 1 GOAL: to structure or guide decisions • Changes in Selection, Procurement, Distribution – – – essential drugs lists morbidity-based quantification kit system distribution • Changes Aimed at Prescribers – – utilization review (audit) and feedback diagnostic and treatment guidelines structured drug order forms peer group monitoring Framework for Changing Drug Use Practices 2

Managerial Strategies 2: GOAL: to structure or guide decisions • Changes Aimed at Dispensers – allowing generic substitution – improved labeling – course of therapy packaging • Changes in Economic Incentives – patient cost-sharing – revolving drug funds – cost controls Framework for Changing Drug Use Practices 3

Standard Treatment Guidelines • STG’s lead prescribers to most cost-effective treatments • Particularly useful for low level workers • Can be used for training, examinations and audit • Used for procurement Framework for Changing Drug Use Practices 4

Prescribing Audits plus "Feedback" to Prescriber Establish Criteria & Guidelines for Review AUDIT (COLLECT DATA ON) PRESCRIBING NOTIFY PRESCRIBERS OF RESULTS · Individuals or Groups · Letters or Patient Notes or in Person AUDIT (COLLECT DATA ON) PRESCRIBING · Comparison with Guidelines · Comparison with Peers Framework for Changing Drug Use Practices 5

Regulatory Options GOAL: To Restrict Decisions • • • Market Controls Limiting Drug Registration Banning Previously Registered Drugs Rx - only to OTC Controlling Content in Drug Advertising Prescribing and Dispensing Controls – Limiting Drugs Supplied in Public Sector – Restricting Specific Drugs to Higher Levels of Care – Required Generic Prescribing – Allowing Generic Substitution – Limits on Number or Quantity of Drugs per Patient Framework for Changing Drug Use Practices 6