1. Burçak Deniz DEDEOĞLU, MD. PhD. Head of Rational Drug Use Department Ministry of Health of Turkey General Directorate of Pharmaceuticals and Pharmacy RATIONAL DRUG USE ACTIVITIES

2. RATIONAL DRUG USE The 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 and at the lowest cost to them and their community. 2 Conference of Experts on the Rational Use of Drugs, World Health Organization, Nairobi, Kenya, WHO/CONRAD/WP/RI, (25-29.12.1985).

3. Rely on accurate diagnosis in treatment planning, Determine the right drug, right dose, right time, and the correct way of the application, Assess the success of treatment, side effects and compliance, Predict the interactions in use of multiple drug, Assess the practicability and the cost of treatment. 3 PRINCIPLES of RATIONAL DRUG USE

4. World Health Organization, conf. of experts, Kenya-Nairobi, 1985. Efficacy Safety Appropriateness Cost 4

5. INAPPROPRIATE USAGES Polypharmacy Unnecessary and excessive use of drugs Incompatible prescribing with clinical guidelines Inappropriate personal treatments Inappropriate choice of new drugs 5

6. The institution that provides the coordination Evidence-based clinical guidelines The essential drugs list Drug and treatment committees Pharmacotherapy and prescribing trainings Continuous medical education Health staff feedback Public awareness and education 6 WORLD HEALTH ORGANIZATION RECOMMENDATIONS

7. STAKEHOLDERS Decision maker of which drug will use (doctor) Supplier of the drug (pharmacist) Applier of the drug (nurse, patient/relatives) Producer 7

8. INSTITUTIONALISATION Rational drug use department was established within the General Directorate of Pharmaceuticals and Pharmacy - 12 October 2010. 8

9. Advertisement Training Guidelines Hospitals Legislations Drug boxes Pharmaceutical waste management Meetings Time temperature indicator Monitoring and evaluation 9

10. ADVERTISEMENT 10

11. 11 “MY DRUG; NEITHER LESS, NOR MORE! ” Slogan, logo, mascot Short films Newspaper advertisements Leaflet Bill poster

12. 12

13. MEDIA Health programs in national TV and radio channels. Web site; www.akilciilac.gov.trwww.akilciilac.gov.tr 13

14. INFORMATIVE VIDEOS Informative videos related, routes of administration of all drugs forms and issues must be considered. Rational Drug Use website Hospital and family health centers waiting rooms, TV. 14

15. TRAINING 15

16. TRAINING PROGRAMS Primary school curriculum Medical school curriculum Faculty of pharmacy curriculum Medical Specialty Exam 16

17. DISTANCE TRAINING VLE-RADUS project about RDU was prepared by Refik Saydam National Public Health Agency. Pilot practice for the family physicians in Ankara. Distance training modules of Turkish Pharmacist Association. 17

18. TRAINING IN STATE HOSPITAL Sincan State Hospital, 27.01.2011 Çubuk State Hospital, 06.04.2011 Gölbaşı State Hospital. 18

19. FACE TO FACE TRAINING ACTIVITIES Turkish Pharmacological Society Turkish Pharmacists Association Training activities for the physicians, pharmacists and auxiliary health care personnel. 19

20. TEBRP (Assistance for pharmaceutical care) The installation of the CD which was prepared by Turkish Pharmacist Association, was completed for pharmacies. It was sent to all family and community health centers for free. 20

21. GUIDELINES 21

22. DIAGNOSIS AND TREATMENT GUIDELINES FOR THE PRIMARY CARE The guideline, prepared by Refik Saydam National Public Health Agency, is in the update period. Interviews to provide access to the web database of the guideline. Interviews to provide access to the web database of the formulary. 22

23. DIAGNOSIS AND TREATMENT GUIDELINES FOR THE SECONDARY CARE Guidelines for the secondary care. Meetings with the societies. 23

24. HOSPITALS 24

25. SERVICE QUALITY STANDARDS Addition of new topics about rational drug use to Service Quality Standards in Hospitals. “Health Performance and Quality Regulations” entered into force on 1 July 2011 25

26. Standards Arrangements to ensure rational drug use Set up a team, responsible for rational drug use A representative from management, physicians and pharmacists should be in team; İn relation to rational drug use; Hospital policy should be determined Activities should be planned and implemented 26

27. Standards The arrangements for the awareness in patients. Patients should be informed about the use of drugs. Arrangements such as brochures, posters, videos ın areas frequently used by patients. Inpatient trainings. 27

28. PHARMACOVIGILANCE General Directorate of Pharmaceuticals and Pharmacy, Drug Safety Monitoring, Evaluation Department An integral part of Rational Drug Use 405 “pharmacovigilance contact persons” in hospitals 28

29. PHARMACEUTICALS TRACK & TRACE SYSTEM Follow-up of drugs throughout the country First in the world Data matrix 29

30. LEGISLATIONS 30

31. TANITIM YÖNETMELİĞİ Recommendation letter to the related societies to include a session about the rational drug use at congresses. The Regulation on Promotional Activities of Medicinal Products for Human Use. 31

32. THE REGULATION on PROMOTIONAL ACTIVITIES The Regulation on Promotional Activities of Medicinal Products for Human Use, Second part, Scientific and Educational Activities, Article 7 (6); “In meetings supported by license/permit holders, a session will placed on rational drug use. The content of this session will be under the presentations, training materials and diagnostic treatment guidelines approved by the Ministry.” 32

33. DRUG BOXES 33

34. Safe drug box cap design for drugs with narrow therapeutic index, Slogans about rational drug use on drug boxes, Big font size on the direction for use… 34

35. PHARMACEUTICAL WASTE MANAGEMENT 35

36. PHARMACEUTICAL WASTES Ministry of Environment and Urbanism Legislation for Management of Hazardous Waste Legislation for Management of Pharmaceutical Waste Drug collection campaigns ??? Ekolojik Enerji Ltd. Şti. (İstanbul) İZAYDAŞ (Kocaeli) 36

37. MEETINGS 37

38. Related Societies, Rational Drug Use Representatives meeting; 20.01.2011 81 Provincial Health Directorates, Rational Drug Use Representatives meeting; 24-27.05.2011 38

39. ICIUM (International Conference for Improving Use of Medicines) November 14-18, 2011 Antalya-Turkey 39

40. TIME TEMPERATURE INDICATOR 40

41. WORLD HEALTH ORGANİZATİON RECOMMENDATİONS Cold chain drugs The color of the indicator will change if any problem occurs Preventing the destruction of drugs that are not yet robust, although the nonsuitable conditions Increasing the reliability in the use of drugs 41

42. MONITORING AND EVALUATION 42

43. In order to determine the effectiveness of the program; monitoring and evaluation was planned before and during the programme periodically. 43

44. Surveys for physicians, pharmacists, nurses and public. Questionnaire applications, Simulated patient visits, Focus group surveys, Evaluation studies for drugs in houses. 44

45. THANKS FOR YOUR ATTENTION… 45

46. 0 312 218 31 21 0 312 218 31 22 0 312 218 31 33 akilci.ilac@iegm.gov.tr www.akilciilac.gov.tr