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E-DRUG: Re: Training on rational use of drugs

>Dear Vincente
>We are in the planning stage of the same 
>training project and would appreciate any course material 
>(in English), if available.

Dear Marius,

I am sorry,we have not any material available in English,but I am working
for traslating some parts of our quality of prescribing practice course to

The little course is indicators-oriented,in the same way that the documents
of the National Commission of Quality of Prescription.This course is adapted
to the spanish circumstances,with a big market of me-too-drugs and also a
big number of drugs with a not well established efficacy and/or safety.

Ours goals are:

1.To change individual prescription from drugs of low intrinsic value(with
not well established safety ,efficacy or both) to drugs of high intrinsic
value,if needed.From 1992,we have classified all the 10.000 pharmaceutical
drugs enabled to be prescribed in two categories:VIE(valor intrinseco
elevado=High intrinsic value) and VINE(valor intrinseco no elevado=not high
intrinsic value).Next month,we will make an update of the list.I am
traslating now to English the whole catalog of intrinsic value.

2.To change prescription from drugs of "high level of choice" to drugs of a
"low level of choice".Lowest level of choice is "drugs of first choice in
primary care" and  highest is "drugs of hospitalary choice".

3.To change individual prescription from drugs of a low potential of use to
drugs with a high potential of use.

We are working to define the catalog of the two last indicators:levels of
choice and potential of use applied to all the drugs availables in the
spanish market.I am the regional coordinator for this purpose.

In parallel,the course is developped in three steps:

1.Intrinsic value:At the end of the session all the doctors can be able to
recognize drugs of not intrinsic value in a list of the most prescribed
drugs in his area(the list is made with social security facilities data).We
explained the reasons to cataloge each drug and discussed with them.As we
have a gold standard(2),this issue is a not controversial question.

2.Level of choice:At the same time that intrinsic value we discussed with
doctors the three proposed levels of choice for all drugs in the list.

3.To choice the best drug:With a very easy methodologie based on a score
asigned to each propriety(efficacy,safety,compliance,suitability and cost)
and a score-weight to the proprieties of each active substance,we proposed
to select a drug from a group using published data(original works including
good and bad publications,consistent and not consistent scientific
evidences).This exercise is addresed in the way of improve the skills for
doing a good choice,as the Groningen University Group with the
problems-oriented course....and to remember some importants questions about
efficacy and safety,specially of the new and currently me-too-drugs.

>From october,I have done four courses implemented with problems as the De
Vries one.As I have write before,we have some didactic questions to resolve
for incorporate it permanently to our teaching modules,but I think that are
a positive task.

We have get changes in prescribing practice in some areas of Andalucia,not
only dues to course.Under my viewpoint,the course make an interest(expressed
some days after,via e-mail,i.e.) and a "be aware" that can be estimulated in
the wished address by local authorities and specially the pharmacist of
Health District.

Un abrazo,

Vicente M.Asencio Garcia
Assesor of the Regional Health Authorities
Member of the National Commission of Quality of Prescription of the Ministry
of Health
Promotor of the Regional Commision Of Quality of Prescription
Editor of Farm West,a drug therapeutic bulletin-like
Malaga Spain


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