"Establishment of a Directorate of Rational Drug Use in"
Establishment of a Directorate of Rational Drug Use in Oman by Dr Brian C Gunn Senior Clinical Pharmacist Advisor Background • Lack of locally trained health personnel – Recruitment mainly from Middle East and Asian sub-continent – Variety of backgrounds and experiences • Dramatically rising expenditure on medicines – Almost doubled in one year alone • Free services leading to high public demand and expectations • Rapidly expanding and developing health services • Lack of control over prescribing and dispensing in the private sector • General lack of human resources 2 Recruitment of Key Personnel • Director – Pharmacist – Clinical pharmacology background • Primary Care Physician – Research experience in RDU - had conducted patient KAP study in Muscat governorate • Senior Clinical Pharmacist – RDU experience in different countries, clinical and academic experience, high computer literacy • Senior Clinical Pharmacologist – Academic and industrial experience • Auditor All have teaching experience 3 H.E. THE UNDERSECRETARY FOR HEALTH AFFAIRS Director Office of H.E. the Undersecretary for Health Affairs Directorate General Directorate General of Directorate General of Pharmaceutical Affairs of Health Services and Drug Control Health Affairs Governorate of Muscat Dhofar Region South Batinah Region North Batinah Region South Batinah Region Al Dhahira Region Director of Director of Directorate of Private Health Director of South Sharquiya Health Services Health Services Institutions Treatment Al Wusta Mussandam Rational Drug Use Affairs Abroad North Sharquiya Department 4 Main Functions • Research & assessment – Qualitative and quantitative • Training • Monitoring and supervision • Recommendation of policy and encouragement of good practice in all sectors 5 Plan of Operations • Terms of reference – Standard operating procedures • Baseline studies • Induction workshops and training seminars for all cadres • Research and audit • Interventions – Where appropriate 6 7 Prescribers • Many are expatriates • Variety of backgrounds and training • Bring own country experiences to Oman • Often face problems with local patients • Sometimes lack of support from administration 8 Pharmacists & Assistant Pharmacists • Many are expatriates • No clear job descriptions • Tend to be mainly involved with administration and supply • Under-utilised resource • Training strong on science but relatively weak on management skills • Clinical skills just being developed 9 Logos “Together we realise “Together we realise rational drug use” rational antibiotic use” Oman Health Situation • Rapidly evolving health system (started 1970) • Political will to achieve excellent health care system • Many positive changes in short period • Excellent infrastructure • Strong commitment to use of IT – Most PHC units are now computerised 11 Public • Free medication often leads to high demand and abuse • Locals have much leverage over expatriate health workers • Wide variety of education and literacy • Strong traditional beliefs and expectations about health and medication in general • Lack of health-system controls • Large and under-regulated private sector 12 Major Successes • Training Programmes in RDU for all cadres • National Reduction in Antibiotic Consumption • Publication of ONF and Pharmacotherapy Charts 2003 & 2004 • New guidelines issued for NSAIDs and Atypical Antipsychotics • Dedicated workshops on rational antibiotic use • Networking with university, private sector, other institutions 13 Major Successes [Cont.] • Establishment of induction examinations for all new MOGPs • Financial analysis of PHC facilities • Training of key pharmacists in field research and drug management • Gradually increasing awareness and acceptance of DRDU role People are now “talking the talk” and “walking the walk “ of rational drug use 14 Spin Offs • Some health regions now conducting own PRDU workshops • Almost all regions doing RDU research • Many interventions ongoing or have already been carried out 15 Constraints • Lack of human resources and difficulty in recruitment [big job – small team] • Tendency to spread ourselves too thin • Rapidly changing priorities • Getting the information we need at the time we need it and in a convenient form • Dependency on a number of different directorates, departments and levels of administration 16 Constraints (cont’d) • Lack of robust measures to prove successful outcomes • Public education has been slow to get started • At start up only one member of the team had been on an international RDU training course 17 Summary, Conclusions & Recommendations • Not burdened with many duties outside of rational drug use • Freedom to plan operations • Report directly to policy making level • Need to be persuasive & non-confrontational • DRDU acts as a “Rapid Response Unit” • Avoid an “FBI” or “drug policeman” approach • Avoid being “fire-fighters” 18 “A program of rational use requires a permanent multidisciplinary approach and a network of functional epidemiologic monitoring” Dr Luis Bavestrello F. 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