Health is considered a basic human right and is a matter of prime concern for all human beings. There is growing concern about the health care delivery systems in our society. In today's health care delivery, which is principally based on the physicians, there is a pressure for quick relief due to lack of time and other factors of the health care delivery network, which additionally puts to the cost of the total treatment of the clinical ailments in search of the better clinical outcome.

This particular aspect of the health care economics affects all particular segments of the society and in fact affects mostly the poor. Factors like level of education, provision of basic curative/preventive health care, compliance, physical and social environments and the socio-economic status indirectly influence the clinical decision making process. In a country like India, a limited budget is allocated for health care especially for drug procurement and it is vital to optimize this expenditure as an individual or as a national policy. Unsuitable, irrational, non-productive use of pharmaceuticals is commonly practiced in such situations especially in the developing countries like us. There is a growing concern about rational use of drugs and its prescription patterns.

Today, rational use of drug/pharmaceuticals is an issue of the utmost importance. This growing concern is not only important for promotion of appropriate use of pharmaceuticals in the health care delivery and its economic considerations but also to provide health related quality of life (HRQOL) for a community.

The rapidly increasing cost of drugs prescribed across the country is a major concern at the community level. The harmful impact of poor quality prescriptions, under- and over-dosing of the drugs, copying and assortment of drugs, adversely affects the community as a whole in terms of the health expenditures.

Common types of irrational use of drugs include non-compliance with health provider prescription, self-medication with prescription drugs, overuse and misuse of antibiotics, overuse of relatively safe drugs, use of needless luxurious drugs such as life style drugs etc. This particular activity is influenced by promotions from pharmaceutical companies, lack of government regulations, easy but unreliable, unauthenticated availability of drug information.

WHO defines the rational use of drugs as "Rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, at the lowest cost to them and their community". The National Health Policy 2002 of India also gives thrust on rational use of drugs so as to optimize the various aspects of the health care.

Rational use of drugs is mainly concerned with three important aspect of health care such as;

1. Appropriate medications for the respective clinical ailment,
2. Proper dose regimens so as to meet requirements of patient for an appropriate duration of time,
3. Pharmacoeconomics or cost aspects of the treatment.

It involves the amalgamation of the appropriateness of the indication, drug, cost and the patient.

Several guidelines are available for treatment of various diseases along with medications and their regimen from various international and national associations and bodies, but in the real life situations, prescription patterns do not always obey the rules to these guidelines or the criteria, which in turn is termed as 'irrational prescribing'. One of the major debates in this regard is experienced based practice versus evidence based practice of the clinicians. The other aspects like availability of drugs, health budget, and pinpoint intentional promotional activities of the pharmaceutical industry to the decision makers.

Promotion of rational use of drugs

It is important to understand a drug use problem by evaluating existing drug use practices. Many strategies could be used to improve or promote the rational use of drugs.

Educational approaches attempt to update physicians, dispensers - pharmacists, or patients to use drugs in the proper, rational and efficient way. The steps like continuous medical education (CME), training, group discussions, seminars, workshops and printed education materials can help to a greater extent.

Other approach like offering specific documentary services such as drug formularies with cost information, standard treatment guidelines, formation of Pharmacy and Therapeutics Committees, setting up structured drug prescription form can help clinical decision makers with a list of the drugs which are most effective and economic in treating important health problems of the patients.

Taking into consideration the economic aspect of the health care treatment, WHO has taken an initiative by making 'Essential drugs list'. Essential drugs are selected to accomplish the needs of the majority of the community in terms of diagnostic, prophylactic, therapeutic categories of drugs based on the criteria of risk-benefit ratio, cost-effectiveness, demographic or environmental factors and quality aspects of the drugs. This has provided a rational basis not only for drug procurement at national level but also for establishing drug requirements at various levels within the health care system.

Standardizing diagnostic and treatment protocols, which can help health workers to take most appropriate actions based on patient symptoms and clinical signs, can also certainly help the physicians to reduce the number of drugs prescribed and offer optimized treatment plan. This particular aspect will definitely useful for rational use of important therapeutic categories of the drugs such as antibiotics.

Self-monitored prescription practice is an initiative to be adopted by physicians. This will be helpful in avoiding duplicity and polypharmacy or multiplicity of the drugs. This also will help physicians to make a self-monitored plans for specific disease ailments for which structured therapy can be offered.

An intervention by the regulatory bodies such as Food and Drug Administration can also help to improve the rational use of drugs. This can be achieved by restricting decision makers by placing absolute limits on availability of drugs. Strict rules for misuse of drugs by steps like limiting or banning registration of a drug, changing product registration status, which can also put a break on the irrational use of drugs. The intervention can also be done for use of specific drug for an approved indication and avoid using it in other non approved clinical indications without sufficient clinical evidence and certification by inventor company and the regulatory bodies.

Conclusion

Polypharmacy, overuse of prescription drugs and OTC products, misuse of drugs, are the major problems that we look in present clinical scenario. Immediate reduction in these problems is not easy since there are lots of constraints, such as lack of resources, lack of knowledge of paramedics, low levels of patient's knowledge and habits including demographic constraints. Advent of the 'generics' in the pharmaceutical markets, has helped to reduce the overall cost of the treatment but also has increased risk of their over use by the physicians or self medication.

The effective interventions for improving rational use of drugs can be expected from all the members of the health care delivery team. There also needs a political will from decision makers so that these interventions are likely to be implemented on a countrywide basis so as to uplift the medical and all the allied paramedical professions. The steps taken in this direction will be helpful to reduce morbidity and mortality rate associated with the drug use. It also will improve the allocation of the resources leading for better availability of necessary drugs with proper costs.

At the receiving end, patients will be benefited with decreased risk of unwanted affects such as adverse drug reactions and the emergence of drug resistance. Promoting the rational use of drugs will finally results in improved quality, increased accessibility and better quality of life for the community.

The author is with Pharmacy Group, Birla Institute of Technology and Science, Pilani, Rajasthan 333031. Email:plkole@bits-pilani.ac.in