KaneeshaRoarkeHSC560ExcelsiorCollege The World Health Organization (WHO) describes medication treatmentas responsible (relevant, precise and accurate) during a patients’ duration onit and that the patient receives the appropriate treatment where applicationssatisfy their specific conditions, for a sufficient period and at aninexpensive cost (World Health Organization, 2002). Inappropriate use ofantibiotics is when one or numerous provisions listed above are not met. Thisinterpretation includes use by prescribers, distributors, and patients. Thepurpose of this paper is to analyze data on how to contend the fraudulent andimproper use of antibiotics and other prescription therapies and to recommendpolicies to help us move forward.
While the definition from the WHO does alsoinclude matters of safety and expense, this is not the key issues for thispaper and will not be heavily discussed in detail, but rather focus on theinappropriate use and the effects it has.Battlingimproper use of antibiotic therapies entails the following:· Timing specific medication use in order to understand the amountand standard of improper use;· Examining the latent causes of unsuitable use of antibiotics inorder to recognize the barriers to practice innovation and arbitrations thatmay overwhelm these barriers;· Drafting, executing and appraising the above interventions thatfocus on prescribing habits that need to be reform.Strivingtowards a policy climate that will promote antibiotics to be handled competentlyand aid in the effectiveness of any interventions achieved.Worldwideit is noted that more than half of all drug therapies, antibiotics included,may be ordered, distributed or marketed inappropriately (Holloway & Henry,2014, p. 85). However, even with the inappropriate ordering, distribution andmarketing half of those patients neglect to take their medication as prescribedor directed (World Health Organization, 2003).
Inappropriate use of medicationcome in various models from polypharmacy, excessive use of antibiotics,negligence on prescribing per clinical regulations, improper self-medicationrather than following the directed dosing orders by providers. All thesefactors have consequences due to their inappropriate use.Inapplicable administration of antibiotics dissipates capital andcan be dangerous to both the patient and society. Unfavorable effects,including prescription mistakes and adverse reactions, produce substantialmorbidity and mortality issues and data such as higher incidences of medicationreactions and hospitalization, although patient dissent with therapy maydecrease the probability of before-mentioned events in unusual events (Remesh,Balan, & Gnanadurai, 2014). A methodical examination found that the averageportion of preventable drug-related admittances to the hospital is 3.7%, withnearly a third of those showing improper ordering by the provider, anotherthird because of patient noncompliance and approximately a quarter because dueto failure to follow up on medication therapy (Howard, et al., 2007). The sadfact is the inappropriate use of many drugs from opioids, antibiotics andsteroids have been shown by some studies to rank amidst the top ten reasons ofmortality in the United States and cost us up to $.
6 million per hospital peryear (White, Arakelian, & Rho, 1999, p. 446). When it comes to antibioticuse, much of it improper use adds to antimicrobial endurance, which is on therise not just in the United States but worldwide and producing notable health issueand death (Livermore, 2003).
There is a definite association between outpatientantibiotic treatment and penicillin-resistant pneumococci that has been notedthrough a study in Europe (Albrich, Monnet, & Harbarth, 2004). Calculationsof the yearly expenses due to antimicrobial resistance have been stated to be $4000–5000 million in the USA and not only that but the use of hypodermicneedles is aided in cost, the only way to lower these costs and increasingrates of morbidity and mortality rates is to determine the size and kinds ofinept drug and antibiotic use (Smolinski, Hamburg, & Lederberg, 2003).Theinitial action in fighting improper administration of drugs is to compute themedication use in order to assess the system-wide range of the issues, identifythe varieties of difficulties and have a baseline amount to use for assessingthe influence of interventions implemented. If there are no metrics whenattempting to measure the use of drug therapies, the system cannot obtain thelegislative backing required to advance in future interventions to promotebetter use antibiotic therapies and other drugs. Inappropriate drug andantibiotic use in the advanced countries is a commonly documented issue instudies such as a current study that determined that in the United States andEurope alone that 12% of adults 65 years and older living at home and 40% ofadults 65 years and older residing in nursing homes are appointed inappropriatemedication therapies (Karandikar, Chaudhari, Dalal, Sharma, & Pandit, 2013).Inthe UK, it was determined that when every error in a primary care practice,including the ordering and internal pharmacy distribution processes, werelooked, 4 to 21% of the patients obtained the optimal results from theirmedications (Garfield, Barber, Walley, Willson, & Eliasson, 2009).
Figuresshow that antibiotic misuse isn’t just a United States issue but surveillanceof antibiotic use in Europe showed considerable deviations in antibiotic useover many countries in outpatient antibiotic utilization in 2003 (Adriaenssens,et al., 2011). The amount of prescribed daily doses per 1000 citizens wasnearly 30, but only around ten in some smaller countries and the classes ofantibiotic administered also varied (Adriaenssens, et al., 2011).
However, itis essential to show that regardless of if the country was big or small therewere, overprescribing of antibiotics by practitioners we confirmed (Roosmalen,Braspenning, P A G M De Smet, & Grol, 2007). The extensive difference inantibiotic ordering has been seen in hospitals all the way down to pediatricpractices, where prolonged antibiotic use for surgical prophylaxis was observedin 40% of patients (Clavenna & Bonati, 2012). Outpatient antibioticadministration in the southern European regions is comparable to that in theUnited States, where the ubiquity of self-medication with antimicrobialtherapies can differ extensively across Europe. The ubiquity of self-medicationis a barrier to the is step because it is something not controlled by theprovider and patient education on timing specific medication use in order tounderstand the amount and standard of improper use;Whenstudies over the last 50 years were assessed, it showed that an average of24.8% patients was noncompliant and gathered that the greatest compliance camefrom patients with HIV, arthropathy, and cancer, and the lowest were patientswith lunglike diseases, diabetes, and sleep disturbances. This is whyguidelines for adherence by providers is essential a necessary (Clavenna &Bonati, 2012).
If clinics can provide a strong recommendation when it comes tocorrect dosing, administration, and length of antibiotic treatments or othermisused medications this may improve the quality of care and medical issue forthe patient. Various recommendationshave been generated in recent years for health facilities due to the rise ofmultiple drug misuse leading to addictions to opioids and drug-resistantmicrobes in antibiotics. However, the issue with these policies are theirimpact has not been adequately scrutinized concerning cost-effectiveness andbenefits (National Institute on Drug Abuse, 2017). The strong recommendation onadhering to appropriately prescribed antibiotics and other drugs are thepatient is reminded of the positive results of treatment when orders are followed,it provides space for patients to get educational materials, ask questions andprovide feedback but it also gives the facility an opportunity to see theirpatient needs and adjust accordingly. However, it is important to note thatmultifaceted interventions are not shown to be more efficient than just takingone intervention.However,other reviews state that a combination of strategies to improve theimplementation of guidelines is usually more effective than single strategies(Grimshaw, et al.
, 2004). Though all of these steps seem to behelpful to there are many future challenges to stop misuse of medications onmany fronts such as lack of investment, research, experts, and training. Manyof us know now that there is abundant evidence from all over the world on theimpact sustained the inappropriate use of antibiotics, opioids and other drugswould have and even more data on how the issues should be addressed. However,there is little known regarding the effectiveness of these numerous approaches.Many are leery of investing in building an administration information system toobserve medicinal use, especially in regard to opioids, and formulate a publicpolicy that would encourage the suitable application of treatments if they donot know they will be useful and yield positive outcomes. There needs to bemore work done in research to provide more data at a national level and inprivate sectors of healthcare not just what local officials are doing and whatthey can do to chance. Investors want to know if the prescribing anddistribution of antibiotics and other drugs in the private sectors are due toincentives or other means if establishing these expensive quality assurancetools will have therapeutic outcomes and eventually cost them less and if theydo tread the way to break new ground will there be a pulse for change on aglobal scale where their experts on the matter will be needed.
When you look atthe big pictures, there is a lot to give up front for implementation ofpolicies that may not yield fruitful results, because clearly if we had expertsof the matter on inappropriate use of antibiotics, opioids, and otherprescription medication we wouldn’t be in our current situation when opioidaddiction is an epidemic. Encouraging proper use of prescribed medicationdemands a public health approach including a vast array of knowledge from doctors,facility administrators, and patients. When there is a need in our county acall is made to our little team of nurses because to them we are the”experts” on the matter. Expertise regardless of title means havingan accurate perception of both public well-being and needs as well aspharmaceutical issues that cover anything from antibiotic misuse to vaccineissues. However, when you have a more significant public health, there can befragmented subspecialties, where one department knows handles diseaseprevention, health promotion, HIV. We are considered the experts in our countybecause we handle disease prevention, HIV, active and latent tuberculosis,communicable disease, vaccines and a little health promotion in our small area.This gives us the pulse of our community though and provides us with theresource and knowledge we need to help people invest in us and the things weneed (Kitsap Public Health District, 2017).
Inapt use of prescribed medicationsis a worldwide issue that is running unchecked with little action that iscrucially required in order to oppose these issues. The vital future trial willbe to ‘regulating those who are inappropriately prescribing and distributingantibiotics and other prescription medication in health systems. However, toachieve this, legislatures, investors and the global associations will want todevote time and funding to developing the required support and roles needed tomake this happen. In various countries that are more advanced and financiallywell-off, they need to undertake a national analysis of their inappropriate usein order to recognize influential intricacies and resolutions that are requiredand bring to action a coordinated policy to carry out this plan. The lack ofresponse that has been going on regarding fighting the outcomes from antibioticsand other misused prescription medications is a global disgrace with remarkablygrave public health results. We need to take the interventions above as anopening to resist the improper use of all prescribed medications instead ofstaying aloof and leave future generation to pay the price of dissipatedsources, patient impairment, and antimicrobial resistance.
ReferencesAdriaenssens, N., Coenen,S., Versporten, A.
, Muller, A., Vankerckhoven, V., & Goossens, H. (2011,December 01). European Surveillance of Antimicrobial Consumption (ESAC):quality appraisal of antibiotic use in Europe | Journal of AntimicrobialChemotherapy | Oxford Academic. Retrieved December 09, 2017, fromhttps://academic.oup.com/jac/article/66/suppl_6/vi71/680457Albrich, W.
C.,Monnet, D. L.
, & Harbarth, S. (2004, March). Antibiotic Selection Pressureand Resistance in Streptococcus pneumoniae and Streptococcus pyogenes.Retrieved December 08, 2017, fromhttps://www.ncbi.
nlm.nih.gov/pmc/articles/PMC3322805/Clavenna, A.,& Bonati, M.
(2012, November 10). Drug prescriptions to outpatientchildren: a review of the literature. Retrieved December 09, 2017, fromhttps://hal.archives-ouvertes.fr/hal-00534972/documentGarfield, S.,Barber, N.
, Walley, P., Willson, A., & Eliasson, L. (2009, September 21).Quality of medication use in primary care – mapping the problem, working to asolution: a systematic review of the literature. Retrieved December 09, 2017,from https://bmcmedicine.biomedcentral.com/articles/10.
1186/1741-7015-7-50Grimshaw, J. M.,Thomas, R.
E., MacLennan, G., Fraser, C., Ramsay, C. R.
, Vale, L., . . .Donaldson, C.
(2004, February). Effectiveness and efficiency of guidelinedissemination and implementation strategies. Retrieved December 09, 2017, fromhttps://www.ncbi.nlm.
nih.gov/pubmed/14960256Holloway, K. A.,& Henry, D.
(2014). WHO Essential Medicines Policies and Use in Developingand Transitional Countries: An Analysis of Reported Policy Implementation andMedicines Use Surveys. PLoS Medicine, 11(9), 1-169.doi:10.1371/journal.pmed.1001724Howard, R.
L.,Avery, A. J., Slavenburg, S., Royal, S.
, Pipe, G., Lucassen, P., &Pirmohamed, M. (2007). Which drugs cause preventable admissions to hospital? Asystematic review. British Journal of Clinical Pharmacology, 63(2),136-147. doi:10.1111/j.
1365-2125.2006.02698.xKarandikar, Y.,Chaudhari, S., Dalal, N., Sharma, M., & Pandit, V.
(2013). Inappropriateprescribing in the elderly: A comparison of two validated screening tools. Journalof Clinical Gerontology and Geriatrics, 4(4), 109-114.doi:10.1016/j.
jcgg.2013.04.004Kitsap PublicHealth District.
(2017). HARBORVIEW MADISON CLINIC. Retrieved December 09,2017, from https://www.kitsappublichealth.org/CommunityHealth/hs_madison.phpLivermore, D. M.(2003, January 15).
Bacterial Resistance: Origins, Epidemiology, and Impact |Clinical Infectious Diseases | Oxford Academic. Retrieved December 08, 2017,from https://academic.oup.com/cid/article/36/Supplement_1/S11/301524National Instituteon Drug Abuse. (2017, May). How Much Does Opioid Treatment Cost? RetrievedDecember 09, 2017, fromhttps://www.
drugabuse.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-much-does-opioid-treatment-costRemesh, A., Balan,A., & Gnanadurai, A. (2014). A cross-sectional study of surveillance ofadverse drug reactions in inpatient departments of a tertiary care hospital. Journalof Basic and Clinical Physiology and Pharmacology, 25(1), 303-308.doi:10.
1515/jbcpp-2012-0077Roosmalen, M. S.,Braspenning, J. C.
, P A G M De Smet, & Grol, R. P. (2007, April).Antibiotic prescribing in primary care: first choice and restrictiveprescribing are two different traits. Retrieved December 09, 2017, fromhttps://www.ncbi.nlm.nih.
gov/pmc/articles/PMC2653145/Smolinski, M. S.,Hamburg, M. A., & Lederberg, J. (2003).
Microbial threats to healthemergence, detection, and response. Washington, D.C.: National AcademiesPress.White, T. J.,Arakelian, A., & Rho, J.
P. (1999). Counting the Costs of Drug-RelatedAdverse Events. PharmacoEconomics, 15(5), 445-458.
doi:10.2165/00019053-199915050-00003World HealthOrganization. (2003).
Adherence to Long-Term Therapies: Evidence for Action. RetrievedDecember 08, 2017, from http://www.who.
int/hiv/pub/prev_care/lttherapies/en/World HealthOrganization . (2002, September). Promoting Rational Use of Medicines: CoreComponents – WHO Policy Perspectives on Medicines. Retrieved December 08, 2017,from http://apps.who.int/medicinedocs/en/d/Jh3011e/