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Rational prescribing in the Caribbean
Fraser, Henry S.
Afiliação
  • Fraser, Henry S; University of the West Indies, Cave Hill. School of Clinical Medicine and Research
West Indian med. j ; 47(Suppl. 3): 28, July 1998.
Artigo em Inglês | MedCarib | ID: med-1720
Biblioteca responsável: JM3.1
Localização: JM3.1; R18.W4
ABSTRACT
Inappropriate, wasteful and, often, irrational drug use has long been recognised worldwide. Overuse of antibiotics, especially for influenza, overuse of injections in primary care, use of unproven remedies, use of multiple drugs for self-limiting illness and inappropriate dosing are but a few of the recognised problems. Wastefulness on the one hand and patient dissatisfaction with service and outcome on the other are some of the recognised consequences. In the Caribbean the relative availability of a fairly wide range of drugs has created a laissez faire approach to drug use in many countries. The private sector is dominated by influential drugs companies, whose representatives provide the majority of drug education updating for many primary care physicians. As a result newly marketed drugs feature strongly in the prescribing patterns of the private sector. In the public sector drugs supply systems vary considerably across the Caribbean, from highly sophisticated annual international tendering in some countries (e.g. Barbados) and common tendering by the Eastern Caribbean Drug Service for the eight countries of the Organisation of Eastern Caribbean States (OECS) to be more ad hoc, traditional patterns of purchasing of other countries. Only Barbados publishes an annually updated National Formulary; OECS does so every two or three years, and other countries at intervals of 5 to 10 years. Thus prescribers often lack up to date, locally relevant guidelines, and there is no mandatory, even minimum continuing education in therapeutics for doctors. Government expenditures on drugs vary from US$2.00 in Guyana to US$40.00 in Barbados (1996/97 figures). In spite of the emphasis of the World Health Organisation Drug Action Programme on essential drug list, rational prescribing and the formulary process, it can not be said that satisfactory progress has been made in the Caribbean. Cultural factors ("champagne tastes and mauby pockets"), politics, commercial interests and marketing pressures, and the lack of appropriately trained personnel to promote better therapeutic practices, may all play a part. An effective, participatory formulary process with an up-to-date, user-friendly formulary, treatment guidelines, interactive education and prescription audit are techniques shown to improve prescribing practices. Both medical education and medical services should be paying more attention to "better value for money".(AU)
Assuntos
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Coleções: Bases de dados internacionais Contexto em Saúde: ODS3 - Meta 3.8 Atingir a cobertura universal de saúde / ODS3 - Saúde e Bem-Estar Problema de saúde: Arranjos Financeiros / Coordenação Multissetorial / Meta 3.8 Atingir a cobertura universal de saúde Base de dados: MedCarib Assunto principal: Prescrições de Medicamentos / Farmacopeia / Medicamentos sem Prescrição Tipo de estudo: Guia de prática clínica Limite: Humanos Idioma: Inglês Revista: West Indian med. j Ano de publicação: 1998 Tipo de documento: Artigo
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Coleções: Bases de dados internacionais Contexto em Saúde: ODS3 - Meta 3.8 Atingir a cobertura universal de saúde / ODS3 - Saúde e Bem-Estar Problema de saúde: Arranjos Financeiros / Coordenação Multissetorial / Meta 3.8 Atingir a cobertura universal de saúde Base de dados: MedCarib Assunto principal: Prescrições de Medicamentos / Farmacopeia / Medicamentos sem Prescrição Tipo de estudo: Guia de prática clínica Limite: Humanos Idioma: Inglês Revista: West Indian med. j Ano de publicação: 1998 Tipo de documento: Artigo
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