Combating inappropriate use of medicines.
Combating inappropriate use of medicines.
复制标题
DOI：
10.1586/ecp.11.14
复制
发表时间：
2011-05-01
影响因子：
4.4
通讯作者：
Holloway, Kathleen Anne
中科院分区：
文献类型：
--
作者：
Holloway, Kathleen Anne
在全球范围内，可能只有不到一半的患者按照指导方针接受治疗，一半以上的患者没有按照处方或分发的药物服用。这种不适当的使用浪费资源，并在缺乏令人满意的结果、严重不良事件和增加的抗菌素耐药性方面造成患者伤害。打击不适当使用药物的工作涉及四个主要步骤：衡量药物使用情况;确定不适当使用的决定因素;制定、实施和评价干预措施的影响，以改善药物使用情况，同时考虑到导致不适当使用的因素;努力建立一个鼓励适当使用的有利政策框架。本文讨论了关于如何有效打击药物不当使用的全球证据，并参考了上述四个步骤。为打击不当使用药物而采取的大多数干预措施都是教育性质的，影响相对较小，而且没有考虑到行为的决定因素。综合干预，包括管理和教育部分，似乎比单一干预更有效。不到一半的国家拥有积极鼓励适当使用药物的政策框架。由于卫生系统各不相同，十分复杂，因此需要根据每个国家的具体情况，制定一套全国协调的干预措施和政策，才能对药物使用产生实质性影响。现在，全球日益认识到，必须加强卫生系统，在国家一级进行协调，打击不当使用药物的现象，并协调对发展中国家的国际援助，以确保这种援助有助于打击不当使用药物的现象。本文讨论了这为打击不适当使用药物提供的机会。
Globally, it is possible that less than half of all patients are treated in compliance with guidelines and more than half of all patients fail to take their medicines as prescribed or dispensed. Such inappropriate use is wasteful of resources and causes patient harm in terms of lack of satisfactory outcome, serious adverse events and increased antimicrobial resistance. Combating inappropriate use of medicines involves four major steps: measuring the use of medicines; identifying the determinants of inappropriate use; developing, implementing and evaluating the impact of interventions to improve the use of medicines while taking into account the factors underlying inappropriate use; and working towards an enabling policy framework that encourages appropriate use. Global evidence on how to effectively combat inappropriate use of medicines is discussed herein, with reference to the aforementioned four steps. Most interventions undertaken to combat inappropriate use of medicines have been educational in nature, have had a relatively small impact and have not taken into account the determinants of behavior. A combination of interventions, involving managerial as well as educational components, appears to be more effective than a single intervention. Less than half of countries have a policy framework that actively encourages appropriate use of medicines. Since health systems are varied and complex, a nationally coordinated package of interventions and policies, contextualized to each country, will be needed to have any substantial impact on medicine use. There is now increasing global awareness of the need to strengthen health systems, to have national coordination to combat inappropriate use of medicines and to have coordination of international aid to developing countries in order to ensure it contributes to combating inappropriate use of medicines. The opportunities this presents for combating inappropriate use of medicines are discussed in this article.