1. 1 Role of Dispensers in Promoting Rational Drug Use

2. The Role of Dispensers in Promoting Rational Drug Use 2 The Role of Dispensers in Promoting Rational Drug Use: Objectives Identify who can be a dispenserIdentify who can be a dispenser Identify factors that influence dispensingIdentify factors that influence dispensing Describe methods to enhance dispenser-patient communicationsDescribe methods to enhance dispenser-patient communications Identify ways to influence a dispenser's behaviorIdentify ways to influence a dispenser's behavior

3. The Role of Dispensers in Promoting Rational Drug Use 3 Case Report A female student, age 20, suffering from tonsilitis, was seen by a doctor in a 600-bed hospital OPD. She obtained a drug from the hospital pharmacy and took it as instructed. She felt very weak after taking the drug. Three days later she became severely comatose and was admitted to the same hospital. She took chlorpropamide 250 mg four times a day. The OPD doctor claimed that he prescribed chloromycetine 4x250 mg daily for her tonsilitis. The patient eventually died two weeks after hospital admission.

4. The Role of Dispensers in Promoting Rational Drug Use 4 Who Are Dispensers? Pharmacists, pharmacy techniciansPharmacists, pharmacy technicians Pharmacy assistantsPharmacy assistants Nurses, nurse aidsNurses, nurse aids DoctorsDoctors Drug sellersDrug sellers ShopkeepersShopkeepers Taxi driversTaxi drivers Family membersFamily members

5. The Role of Dispensers in Promoting Rational Drug Use 5 Prescriber and Dispenser In the real world of drug use (rational and irrational)— A PRESCRIBER IS— Anyone with a recommendation for treatment A DISPENSER IS— Anyone who gives out a treatment

6. The Role of Dispensers in Promoting Rational Drug Use 6 What Does a Dispenser Need? Knowledge/source of information:Knowledge/source of information: Skills:Skills: Others:Others: drug informationdrug information product informationproduct information consultationconsultation communication skillcommunication skill promotional/marketing techniquespromotional/marketing techniques supplysupply dispensing equipmentdispensing equipment dispenser-prescriber relationshipdispenser-prescriber relationship status/role in the health care systemstatus/role in the health care system

7. The Role of Dispensers in Promoting Rational Drug Use 7 Dispensing Process Receive prescriptionReceive prescription Interpret prescriptionInterpret prescription Retrieve medication/ingredientsRetrieve medication/ingredients Prepare and processPrepare and process Communicate with patientCommunicate with patient Ensure patient's understandingEnsure patient's understanding Monitor compliance by patientMonitor compliance by patient Keep recordsKeep records

8. The Role of Dispensers in Promoting Rational Drug Use 8 Potential Errors and Problems Wrong interpretation of prescription (or diagnosis)Wrong interpretation of prescription (or diagnosis) Retrieval of the wrong drug from stockRetrieval of the wrong drug from stock Wrong dosagesWrong dosages Inadequate packaging/labelingInadequate packaging/labeling Inaccurate counting, compoundingInaccurate counting, compounding Inadequate or nonexistent labelingInadequate or nonexistent labeling No knowledge of proper drug complianceNo knowledge of proper drug compliance Insufficient knowledge of the disease processInsufficient knowledge of the disease process Insufficient time to talk with patients about their drugsInsufficient time to talk with patients about their drugs Inability to communicate to patients about therapyInability to communicate to patients about therapy

9. The Role of Dispensers in Promoting Rational Drug Use 9 Assessing Dispensing Conditions Dispensing point conditionsDispensing point conditions Dispensing time? Communication time?Dispensing time? Communication time? How often do errors occur?How often do errors occur? Who is responsible for dispensing?Who is responsible for dispensing? Dispensing training in country?Dispensing training in country? Salaries and wages for dispensers?Salaries and wages for dispensers? Dispensing packaging?Dispensing packaging?

10. The Role of Dispensers in Promoting Rational Drug Use 10 Roles of Prescriber/Physician in Promoting Rational Drug Use DiagnosisDiagnosis PrescribingPrescribing Drug InformationDrug Information

11. The Role of Dispensers in Promoting Rational Drug Use 11 Roles of Pharmacist/Dispenser in Ensuring Rational Drug Use ProcurementProcurement DistributionDistribution PrescribingPrescribing InformationInformation Additional roles:Additional roles: –Communication with physician –Treatment guidelines –Research on prescribing and utilization –Consumer education

12. The Role of Dispensers in Promoting Rational Drug Use 12 Improving Patient Compliance with Therapy Dispenser-patient communicationDispenser-patient communication Packaging for patient usePackaging for patient use LabelingLabeling Written informationWritten information

13. The Role of Dispensers in Promoting Rational Drug Use 13 Dispenser-Patient Communication Dispensers communicate with patients how to take drugsDispensers communicate with patients how to take drugs Ensuring their understanding is very importantEnsuring their understanding is very important

14. The Role of Dispensers in Promoting Rational Drug Use 14 Packaging for Patient Use

15. The Role of Dispensers in Promoting Rational Drug Use 15 Labeling

16. The Role of Dispensers in Promoting Rational Drug Use 16 Dispensing in the Public or Private Sector Public SectorPublic Sector –Cheap but long delays and frequent stock- outs –Generic drugs Private SectorPrivate Sector –Expensive but convenient –Brand name drugs

17. The Role of Dispensers in Promoting Rational Drug Use 17 Interventions GhanaGhana –Poster intervention UgandaUganda –Field training Kenya and IndonesiaKenya and Indonesia –Private drug sellers PhilippinesPhilippines –Discussions with drug-selling storekeepers

18. The Role of Dispensers in Promoting Rational Drug Use 18 Sample Package Insert

19. The Role of Dispensers in Promoting Rational Drug Use 19 Conclusion Dispensing is a critical part of drug useDispensing is a critical part of drug use Dispensing is often neglected in training and EDP programsDispensing is often neglected in training and EDP programs Interventions exist to improve dispensingInterventions exist to improve dispensing Patients benefit from better dispensingPatients benefit from better dispensing