1. RATIONAL USE OF MEDICINES, EVIDENCE BASED MEDICINE, ESSENTIAL MEDICINES LIST, STANDARD TREATMENT GUIDELINES (STGS)

RATIONAL USE OF MEDICINES & EBM

Medicines are powerful tools to treat diseases, but they must be used correctly to get the best results and avoid harm. Rational Use of Medicines means giving the right drug, in the right dose, for the right duration, and at the lowest possible cost according to the patient’s needs.

In this guide, we explain key concepts in pharmacotherapeutics: Rational Use of Medicines, Evidence-Based Medicine (EBM), Essential Medicines List, and Standard Treatment Guidelines (STGs).

Rational Use of Medicines (RUM):

What is Rational Use of Medicines?

Rational use of medicines means patients receive medications appropriate to their clinical needs, in doses that meet their individual requirements, for an adequate period, and at the lowest cost to them and the community.

Reasons for Irrational Use of Drugs:

• Lack of knowledge or training among healthcare providers
• Poor communication between doctors and patients
• Patient pressure or self-medication
• Lack of diagnostic facilities
• Substandard drug supply and weak regulation
• Aggressive promotion by pharmaceutical companies

Common Types of Irrational Use:

• Polypharmacy (too many medicines)
• Inappropriate use of antibiotics
• Overuse of injections
• Not following clinical guidelines
• Self-medication

WHO Interventions to Promote Rational Use:

• National medicine policy and coordinating body
• Use of clinical guidelines and essential medicines list
• Drug and Therapeutics Committees in hospitals
• Problem-based training in medical education
• Regular supervision, audit, and feedback
• Independent drug information and public education

Evidence-Based Medicine (EBM):

What is Evidence-Based Medicine?

Evidence-Based Medicine is a systematic approach that integrates the best available research evidence with clinical expertise and patient values to make the best decisions for patient care.

Five-Step Model of EBM:

1. Ask — Convert the clinical problem into a clear, answerable question
2. Acquire — Search for the best available evidence
3. Appraise — Critically evaluate the evidence for validity and usefulness
4. Apply — Integrate the evidence with clinical expertise and patient preferences
5. Assess — Evaluate the performance and outcomes

Importance of EBM:

• Helps clinicians stay updated with best practices
• Improves quality, safety, and value of care
• Promotes transparency and accountability
• Leads to better patient outcomes

Essential Medicines List (EML):

What are Essential Medicines?

According to WHO, essential medicines are those that satisfy the priority healthcare needs of the population. They are selected based on disease prevalence, efficacy, safety, and cost-effectiveness.

Key Features:

• Must be available at all times in adequate quantities
• In correct dosage forms with assured quality
• At a price affordable to individuals and the community

Advantages of Essential Medicines List:

• Better procurement, storage, and distribution
• Focused training and drug information
• Improved availability and balanced use of drugs
• Cost-effective therapy

India’s National List of Essential Medicines (NLEM) 2021 includes many anti-cancer, anti-diabetic, and antiretroviral drugs.

Standard Treatment Guidelines (STGs):

What are Standard Treatment Guidelines?

STGs are systematically developed statements to help healthcare providers choose the most appropriate treatment for specific clinical conditions. They promote evidence-based and high-quality care.

Key Features of Good STGs:

• Simple and practical
• Credible (developed by experts)
• Applicable at all levels of healthcare
• Regularly updated
• User-friendly

Advantages of STGs:

• Ensures consistent, cost-effective, and quality care
• Improves patient compliance and outcomes
• Helps in medicine supply planning
• Supports monitoring and evaluation