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Medicines Selection

The document outlines the process of medicine selection in healthcare, emphasizing the importance of creating a limited list of essential medicines that are effective, safe, and affordable for the population. It details the criteria for selection, prioritization methods like ABC and VEN analysis, and the roles of multidisciplinary teams in both national and hospital settings. The aim is to ensure that essential medicines are consistently available and that healthcare providers are familiar with a manageable number of medicines for effective treatment.

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71 views22 pages

Medicines Selection

The document outlines the process of medicine selection in healthcare, emphasizing the importance of creating a limited list of essential medicines that are effective, safe, and affordable for the population. It details the criteria for selection, prioritization methods like ABC and VEN analysis, and the roles of multidisciplinary teams in both national and hospital settings. The aim is to ensure that essential medicines are consistently available and that healthcare providers are familiar with a manageable number of medicines for effective treatment.

Uploaded by

katendeibrahim81
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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MEDICINES SELECTION

ngandajay@gmail.com
SELECTION
Involves reviewing prevalent health
problems, identifying treatments of choice,
choosing medicines and dosage forms and
deciding which medicines to be available at
which level of care.
Public Sector
Selection is done nationally to determine which
items should be available at each level of care.
Private Sector
Sometimes are left out of national process and
selection is left to each facility or organization.
SELECTION
Selection aims at providing a limited list
of medicines and dosage forms that are
appropriate to the health problems of a
country or community.
These medicines should always be
available to the public at any one time.
Medicines are selected according to the
level of care.
Essential medicines
concept
Essential medicines are those that satisfy
the health care needs of the majority of the
population at a price patients and the
community can afford. The essential
medicines should be available at all times,
in adequate amounts, and in appropriate
dosage forms, in the context of a
functioning health system.
EM concept
• Majority of health problems are treated
with a small number of medicines
• Health professionals use few medicines
in practice (and use more rationally)
• Procurement and distribution are more
efficient with fewer medicines
• Patients can be better informed when
fewer medicines are used
Everything is easier with
a few well-selected medicines
Criteria for selection
The choice of medicines should be based on the following factors:
Proven efficacy, safety and pharmacological profile
Ability to treat a good proportion of the population
Availability; possibility of local manufacture
Adequate quality (bioavailability & stability)
Cost effectiveness
Relevance to the Pattern of prevalent diseases
Level of Treatment facilities
Training and experience of the available personnel
Financial resources
Genetic, demographic and environmental factors
Adequate scientific data and performance in a variety of
settings.
Prioritization of
selection
The following methods can be utilized to
ensure that prioritization is carried out in a
rational manner:
ABC analysis.
VEN (Vital, Essential and Non Essential)
analysis.
Therapeutic category analysis.
ABC analysis
Method for determining and comparing
pharmaceutical costs for a health system,
facility or pharmacy.

Itis the analysis of medicine


consumption and cost in order to
determine which items account for the
greatest proportion of the budget.
Which medicines?
ABC system (Analysis); classifies
expenditures according to value or cost of
item.
Class A: includes 10-20% of items that
have higher unit costs and account for 75-
80% of expenditures.
Class B: includes 10-20% of items and
accounts for 15-20% of drug expenditures.
Class C: represents 60-80% of drug items
with low unit costs that account for only 5-
10% of expenditures.
VEN classification
This is a method that can be used to
prioritize selection, purchase or use of
medicines according to their potential
health impact.
It utilizes the essential medicines list and
classifies medicines on the basis of public
health importance.
It is the most commonly used technique
VEN classification system
Vital items have first priority, because they
are lifesaving or critical for achieving
targeted health outcomes. If these items are
not available, it could mean the death of a
patient or irreparable injury.
Essential items have second priority; if these
items are not available, the patient could
suffer pain or great discomfort.
Necessary items are needed and therefore on
the order form; however, they have third
priority. (Drugs for minor self limited illness)
Example (from EMHSLU 2012) for HC4
Class Examples

Vital Oxygen, Inj. Diazepam, Inj.


Diclofenac, pethidine, Inj. Ceftriaxone
1g, caps chloramphenicol, Vit A,
Coartem, Artesunate, Amoxycillin,
Oxytocin, etc
Essential Tabs diclofenac, tabs prednisolone,
tabs promethazine, praziquantel, inj.
Cloxacillin, ketoconazole, Griseofulvin
etc
Necessary Inj. Lignocaine, tabs erythromycin,
miconazole pessaries,
dihydroartemisinin+piperaquine,
proguanil, etc
Selection Tools

1. EMHSLU 2016
2. National Drug Register
3. National drug formulary
4. National Treatment guidelines
• Formulary list- list of drugs approved for use in
a specific health care setting.

• A formulary manual- summary of information


on a selected number of drugs, usually based on
essential drug list (provides information and
indications, dosage, length of treatment,
interactions, contraindications, etc.). E.g. BNF

• Standard treatment guidelines (STGs) –


recommends treatment of choice for specific
diseases (disease centered)
Levels of selection
National level-essential medicines
list or National formulary.
Health facility level-hospital/health
unit medicines list or formulary.
Prescribing level-selection basing on
a specific diagnosis for a particular
individual patient.
Who selects medicines
Selection ideally involves a multidisciplinary team. At
the national level, it includes:
Representatives from the Ministry of Health.
Representatives from purchasing department.
Representatives from regional and local health
facilities.
Medical and paramedical prescribers.
Disease control programs.
Technical experts
◦ Experts in clinical medicine.
◦ Pharmacology & clinical pharmacology.
◦ Pharmacy.
◦ Clinical microbiology.
Selection at hospital
settings
Medicine selection by a committee is also
the best approach at hospital level – often
done by the medicines and therapeutics
committee (MTC).
Judicious selection of committee members
with relevant backgrounds and previous
experience can facilitate the rational
selection of medicines.
 Selection should be based on the national
essential list.
The Need to Be Selective
• It controls prescribing habits
• Facilitates better purchase prices
• Simplifies mgt of supplies and stock
• Prescribers become familiar to fewer
medicines.
• Drug availability is promoted.
• Focused education of the patients.
• Easier dispensing.
• Reduced confusion and increased
adherence to treatment.
Hospital essential medicines
list
The medicines on the list should be
available at all times.
Prescribers should constantly be updated on
the available medicines.
Prescribers should only prescribe from the
essential medicines list.
◦ This ensures that patients are able to access
medicines at the hospital instead of having to
purchase them in another facility or a pharmacy.
How to select
Use a consultative process.
Selection criteria should be clear and evidence
based.
The different levels for use should be identified.
List common diseases and complaints in an
area e.g. country, district, county etc.
Identify the treatment choices that can be used
to manage the diseases.
The treatment choices are based on evidence
from research done on humans who have the
same diseases.
How to select
The medicines selected as treatment choices
are listed on the essential medicines list and
the formulary.
The specific management of the diseases is
documented in the treatment guidelines.
 The STGs are printed out and distributed to
the health workers.
 Training and supervision done to ensure
proper use and compliance with the STGs.
END

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