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Book Review: The Role of Education in the Rational use of Medicines

Post Publication Peer Review

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Medicines are a major component of healthcare budgets in most countries. In developing nations people often have to pay out of pocket for healthcare and medicine expenses. Irrational use of medicines wastes scarce resources and has a number of other deleterious consequences including the development of antimicrobial resistance. Education in rational use of medicines (RUM) has an important role both among healthcare professionals and the general public.
The South East Asian Regional Office (SEARO) of the World Health Organization (WHO) had brought out a booklet titled ‘The role of education in the rational use of medicines’. The booklet was published in 2006 but was not widely publicized. I first became aware of the booklet during the First Global Forum on Bacterial Infections at New Delhi, India when Dr. Kathleen Holloway one of the persons involved with the book mentioned about the book and copies still being available.
The book addresses activities conducted to promote RUM in the SEARO region and starts with an executive summary which summarizes the contents of the book. WHO has developed twelve core interventions to promote the rational use of medicines ranging from a multidisciplinary body overseeing policy, drug and therapeutics committees and adequate government expenditure to ensure availability of medicines. Educational strategies include training of providers including healthcare students, printed materials and media-based approaches. I have been involved in educating medical students about rational use of medicines in my institution and often write articles about RUM in magazines and newspapers. Interventions to improve the use of medicines can be divided into educational, managerial, economic and regulatory. Clinical practice guidelines and drug (medicine) and therapeutics committees in hospitals are important to promote RUM. The third chapter deals with perspectives from the SEARO region. Among organizations which have been active here are the Delhi Society for Promotion of Rational Use of Drugs (DSPRUD) in India, Gadjah Mada University in Indonesia, International Network for Rational Use of Drugs, Nepal (INRUD Nepal), and Thai Network for Rational Use of Drugs (ThaiNRUD) in Thailand.
A major challenge in promoting RUM is the lack of a single body which oversees the subject. Also concepts like RUM and essential medicines have been considered as mainly relevant to developing nations and were not felt to be important to rich, developed nations. Shortage of medicines in public health facilities continues to be a problem in many developing nations. Medicines are available only for some months of the year in public health facilities and in Nepal the Community Drug Program was developed to ensure availability of medicines all through the year. Strong relationships between healthcare providers and the pharmaceutical industry and aggressive promotion can contribute to irrational use. I especially liked the subsection on training health professionals as this is an area of my particular interest. Recently we have conducted a module on pharmaceutical promotion for second year medical students and the emphasis of our small group learning sessions is on using essential medicines rationally.
Public education plays a very important role in RUM and I feel it has not received the attention it deserves. Two of my colleagues had conducted educational sessions for school teachers in Lalitpur district, Nepal and the school teachers were supposed to convey the knowledge to their students and the community. The Indian Institute of Health Management Research (IIHMR) organizes regular programs on promoting rational use of medicines in the community. Street theater and mass media are two approaches which can be especially effective in the SEARO region. The table summarizing impact of interventions undertaken in this region is useful but most interventions are old and information may be out of date. A number of programmes for healthcare professionals have been conducted but their long term impact is not clear. Also the industry aggressively promotes newer medicines and more expensive treatments and has greater resources and influence compared to organizations promoting RUM.
Education programs on RUM in schools are important and the book briefly mentions programs for school children and also for postgraduate students and technical schools. I agree that healthcare students should have well prepared and conducted modules on this subject in their curricula and professional bodies should conduct these sessions for their members. Unfortunately I feel the emphasis on this area and resources available are not adequate. In medicals schools programs on RUM exist in some schools but not in others.  WHO had published two excellent books titled ‘Guide to good prescribing’ and ‘Teacher’s guide to good prescribing’ but continued emphasis on and development of this area is lacking. Even in the recently concluded First Global forum teaching healthcare students about rational use of antibiotics was not a priority area. I hope the situation will change soon.
The book is well produced and will be of interest to a number of individuals and stakeholders involved in RUM. However, steps to ensure the book is more widely disseminated and available will be helpful and a new edition of the book should be published.           
About the book:
World Health Organization Regional Office for South-East Asia. The role of education in the rational use of medicines. New Delhi, India: 2006. SEARO Technical Publication series No. 45.  
ACKNOWLEDGEMENTS
The author would like to thank Dr. Kathleen Holloway for gifting a copy of the book.

Source(s) of Funding

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None.

Competing Interests

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None.

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