Clinical Pharmacology Education Research Articles

From Dose to Exposure: Shifting the Paradigm of Pediatric Clinical Pharmacology Research and Education.

From Dose to Exposure: Shifting the Paradigm of Pediatric Clinical Pharmacology Research and Education.

Learning of clinical pharmacology by future prescribers in Bologna: Teachers' and students' reflections on the way forward.

In this reflection paper, the authors, based on their experience as teachers and students of the courses of Pharmacology at the University of Bologna, reflect on their specific roles towards innovation in the teaching of Clinical Pharmacology. Strengths, weaknesses and challenges are presented as identified during the teaching and learning experience in the currently evolving medical degree programmes of the University in light of current trends in medical education. Keeping in mind the identified challenges together with the features proposed for the model prescriber (knowledgeable, contemporary, communicative and safe), we indicate some ways to improve the students' experience and make sure they develop up-to-date skills in Clinical Pharmacology taking advantage of recent ongoing collaborations at European level. International collaboration is indeed necessary to adequately address the current challenges of teaching clinical pharmacology. Our shared conclusion is that empowering students with a scientifically sound method to retrieve relevant information and developing their skills to communicate in an interprofessional and, wherever possible, international environment is the key to prepare future prescribers and, ultimately, to improve patient safety.

Knowledge, attitude and practices related to drug prescription among postgraduate medical students: A cross sectional study

Pharmacology, being both the basic and applied science of drugs, forms the backbone of rational therapeutics. With an emphasis on learning the facts of medications, traditional pharmacology teaching is mostly teacher-centred. The erroneous prescribing that can result from inadequate understanding can cost a great deal of money and lives. The aim of the present study was to assess doctors' prescription knowledge, attitudes, and practices.The information was gathered from postgraduate students (residents) using questionnaires about their undergraduate training in clinical pharmacology and therapeutics, prescribing practices, frequently used drug information sources, and any perceived shortcomings in their undergraduate clinical pharmacology teaching. There was a calculation of descriptive statistics and a chi-square test.Among the 149 responses, 86 (57.71%) of them were male and 63 (42.28%) were female. Only 33 (22.1%) participants knew the components of a prescription, and 135 (90.6%) participants were aware that prescription writing was taught in their undergraduate course. Around 41 (27.5%) participants were aware of the concept of P drugs. Among them, 89 (59.73%) residents had good knowledge of prescriptions. Only 35 (23.5%) strongly agreed, and 113 (75.8%) agreed that undergraduate pharmacology training taught them to prescribe safely. About 83 (55.7%) participants disagreed, 33 (22.1%) strongly disagreed, and only 10 (6.7%) agreed that undergraduate pharmacology teaching should be improved. According to the patient's needs, 146 (98%) participants were prescribed additional vitamins and irons. Around 52 (34.9%) participants reported having difficulty prescribing during their internship rotation. Among them, 77 (51.67%) residents had good practice of prescription.A majority of postgraduate students believed that additional training should be provided on writing rational prescriptions to make them more confident in their prescribing practices.

Developing an international concept-based curriculum for pharmacology education: The promise of core concepts and concept inventories.

Over recent years, studies have shown that science and health profession graduates demonstrate gaps in their fundamental pharmacology knowledge and ability to apply pharmacology concepts in practice. This article reviews the current challenges faced by pharmacology educators, including the exponential growth in discipline knowledge and competition for curricular time. We then argue that pharmacology education should focus on essential concepts that enable students to develop beyond 'know' towards 'know how to'. A concept-based approach will help educators prioritize and benchmark their pharmacology curriculum, facilitate integration of pharmacology with other disciplines in the curriculum, create alignment between universities and improve application of pharmacology knowledge to professional contexts such as safe prescribing practices. To achieve this, core concepts first need to be identified and unpacked, and methods for teaching and assessment using concept inventories developed. The International Society for Basic and Clinical Pharmacology Education Section (IUPHAR-Ed) Core Concepts of Pharmacology (CCP) initiative involves over 300 educators from the global pharmacology community. CCP has identified and defined the core concepts of pharmacology, together with key underpinning sub-concepts. To realize these benefits, pharmacology educators must develop methods to teach and assess core concepts. Work to develop concept inventories is ongoing, including identifying student misconceptions of the core concepts and creating a bank of multiple-choice questions to assess student understanding. Future work aims to develop and validate materials and methods to help educators embed core concepts within curricula. Potential strategies that educators can use to overcome factors that inhibit adoption of core concepts are presented.

The European List of Key Medicines for Medical Education: A Modified Delphi Study.

Rational prescribing is essential for the quality of health care. However, many final-year medical students and junior doctors lack prescribing competence to perform this task. The availability of a list of medicines that a junior doctor working in Europe should be able to independently prescribe safely and effectively without supervision could support and harmonize teaching and training in clinical pharmacology and therapeutics (CPT) in Europe. Therefore, our aim was to achieve consensus on such a list of medicines that are widely accessible in Europe. For this, we used a modified Delphi study method consisting of three parts. In part one, we created an initial list based on a literature search. In part two, a group of 64 coordinators in CPT education, selected via the Network of Teachers in Pharmacotherapy of the European Association for Clinical Pharmacology and Therapeutics, evaluated the accessibility of each medicine in his or her country, and provided a diverse group of experts willing to participate in the Delphi part. In part three, 463 experts from 24 European countries were invited to participate in a 2-round Delphi study. In total, 187 experts (40%) from 24 countries completed both rounds and evaluated 416 medicines, 98 of which were included in the final list. The top three Anatomical Therapeutic Chemical code groups were (1) cardiovascular system (n = 23), (2) anti-infective (n = 21), and (3) musculoskeletal system (n = 11). This European List of Key Medicines for Medical Education could be a starting point for country-specific lists and could be used for the training and assessment of CPT.

Educating Medical Students on How to Prescribe Anti-Hyperglycaemic Drugs: A Practical Guide

In the light of the rapidly increasing global incidence of, and therapeutic arsenal for, diabetes type 2, this brief report underscores the need for advancements in clinical pharmacology and therapeutics (CPT) education with regard to diabetes type 2. We advocate for the comprehensive training of medical students and junior doctors in line with current guidelines, and emphasize the importance of teaching how to draw up individualized treatment plans based on patients’ specific risk factors and conditions, such as cardiovascular risks, weight, and risk of hypoglycaemia. Within the curriculum, traditional teaching approaches should be replaced by innovative methods such as problem-based learning, which has been shown to be more effective in developing prescribing knowledge and skills. The inclusion of real-world experience and interprofessional learning via so-called student-run clinics is also recommended. Subsequently, innovative assessment methods like the European Prescribing Exam and objective structured clinical examinations (OSCE) are highlighted as essential for evaluating knowledge and practical skills. By adopting these educational advances, medical education can better equip future practitioners to adequately manage the complex pharmacological treatment of diabetes.

The impact of a summative national prescribing assessment and curriculum type on the development of the prescribing competence of junior doctors

PurposeThe primary aim of this study was to investigate the effect of including the Dutch National Pharmacotherapy Assessment (DNPA) in the medical curriculum on the level and development of prescribing knowledge and skills of junior doctors. The secondary aim was to evaluate the relationship between the curriculum type and the prescribing competence of junior doctors.MethodsWe re-analysed the data of a longitudinal study conducted in 2016 involving recently graduated junior doctors from 11 medical schools across the Netherlands and Belgium. Participants completed three assessments during the first year after graduation (around graduation (+ / − 4 weeks), and 6 months, and 1 year after graduation), each of which contained 35 multiple choice questions (MCQs) assessing knowledge and three clinical case scenarios assessing skills. Only one medical school used the DNPA in its medical curriculum; the other medical schools used conventional means to assess prescribing knowledge and skills. Five medical schools were classified as providing solely theoretical clinical pharmacology and therapeutics (CPT) education; the others provided both theoretical and practical CPT education (mixed curriculum).ResultsOf the 1584 invited junior doctors, 556 (35.1%) participated, 326 (58.6%) completed the MCQs and 325 (58.5%) the clinical case scenarios in all three assessments. Junior doctors whose medical curriculum included the DNPA had higher knowledge scores than other junior doctors (76.7% [SD 12.5] vs. 67.8% [SD 12.6], 81.8% [SD 11.1] vs. 76.1% [SD 11.1], 77.0% [12.1] vs. 70.6% [SD 14.0], p < 0.05 for all three assessments, respectively). There was no difference in skills scores at the moment of graduation (p = 0.110), but after 6 and 12 months junior doctors whose medical curriculum included the DNPA had higher skills scores (both p < 0.001). Junior doctors educated with a mixed curriculum had significantly higher scores for both knowledge and skills than did junior doctors educated with a theoretical curriculum (p < 0.05 in all assessments).ConclusionOur findings suggest that the inclusion of the knowledge focused DNPA in the medical curriculum improves the prescribing knowledge, but not the skills, of junior doctors at the moment of graduation. However, after 6 and 12 months, both the knowledge and skills were higher in the junior doctors whose medical curriculum included the DNPA. A curriculum that provides both theoretical and practical education seems to improve both prescribing knowledge and skills relative to a solely theoretical curriculum.

Educational Interventions for Medical Students to Improve Pharmacological Knowledge and Prescribing Skills: A Scoping Review.

Medication-related errors place a heavy financial burden on healthcare systems worldwide, and mistakes are most likely to occur at the stage of prescribing. Junior doctors are more likely to make prescribing errors, and medical graduates also lack confidence and preparedness towards prescribing. Thus, this review aimed to evaluate the existing educational approaches to improve pharmacological knowledge and prescribing skills among medical students. CENTRAL, CINAHL, ERIC, Ovid Embase, Ovid MEDLINE, Ovid PsycINFO, and Scopus were searched with keywords related to "pharmacological knowledge", "prescribing skills", "educational interventions" for articles published since 2016. 3595 records were identified, and 115 full-text articles were assessed for eligibility. Eighty full-text articles were eligible and included in this review. Thirty-seven studies focused on improving prescribing skills, whilst 43 targeted pharmacological knowledge. A broad range of interventions was implemented, including e-learning, case-based, interprofessional, and experiential learning. Pharmacological knowledge and prescribing skills were measured in various ways, and all studies reported one or more positive findings at Kirkpatrick level 1 or 2. No study reported outcomes at Kirkpatrick levels 3 and 4. The World Health Organisation's Good Guide to Prescribing was the foundation of the development of prescribing educational interventions. Emerging interventions such as experiential and interprofessional learning should be incorporated into the prescribing curriculum. Innovative approaches such as game-based learning can be considered for clinical pharmacology teaching. However, there was a lack of outcomes at Kirkpatrick levels 3 and 4. Robust methodology and reliable outcome measures are also needed in future studies.

Pharmacology actual teaching aesthetics

Pharmacology is one of the most interesting common subjects of studies to pharmaceutical sciences or pharmacy, medicine and some life sciences and biomedical sciences undergraduates, postgraduates, doctorates, and Post doctorates. The art of teaching Pharmacology and Clinical Pharmacology lies in the in-depth knowledge of the tutor or the in-charge professor. This editorial deals with actual teaching aesthetics of teaching Pharmacology and Clinical Pharmacology right away from the basics and in advance science. The article will be useful for all the tutors and professors in pharmaceutical sciences or pharmacy, medicine, and biomedical sciences to implement effective teaching and learning in pharmacology and clinical pharmacology.

Knowledge, attitude and practices related to drug prescription among medical officers and postgraduate residents in B. P. Koirala Institute of Health Sciences

Background: Pharmacology, being both basic and applied science, forms the backbone of rational therapeutics. Traditional teaching of pharmacology is teacher centered with emphasis on learning the facts on drugs. Inadequate knowledge may cause irrational prescribing which leads to huge loss of lives and money. Objective was to evaluate the knowledge, attitude and practices among doctors regarding prescription. Methods: A semi-structured questionnaire was used among medical officers and postgraduate residents to collect the data regarding their undergraduate training in clinical pharmacology and therapeutics, prescribing habits, commonly consulted drug information sources and any perceived deficiencies in their undergraduate clinical pharmacology teaching. Descriptive statistics were calculated. Results: Out of 116 respondents, 69 were males and mean age was 28.8±2.3 years. Ninety-eight (84.5%) participants were aware about teaching of prescription writing in their undergraduate course and 101 (87.1%) participants knew the parts of prescription. One hundred (86.2%) participants considered safety as the most important aspects of prescribing a drug. One hundred and four (89.7%) participants thought that undergraduate pharmacology training taught them to prescribe safely. One hundred and eleven (95.7%) thought that the undergraduate pharmacology teaching should be improved. Out of 116 participants, 84 (72.4%) had encountered problems while prescribing during their internship. Sixty-eight (58.6%) participants used internet as a source of information about safety, efficacy and cost of drugs for prescription. Ninety-five (81.9%) participants prescribed supplemental vitamins and irons according to patient need. Conclusions: Majority of participants felt that they do have good knowledge in prescribing medicines and the training on prescription writing should be reinforced.

The Dutch list of essential drugs for undergraduate medical education: A modified Delphi study.

Prescribing errors among junior doctors are common in clinical practice because many lack prescribing competence after graduation. This is in part due to inadequate education in clinical pharmacology and therapeutics (CP&T) in the undergraduate medical curriculum. To support CP&T education, it is important to determine which drugs medical undergraduates should be able to prescribe safely and effectively without direct supervision by the time they graduate. Currently, there is no such list with broad-based consensus. Therefore, the aim was to reach consensus on a list of essential drugs for undergraduate medical education in the Netherlands. A two-round modified Delphi study was conducted among pharmacists, medical specialists, junior doctors and pharmacotherapy teachers from all eight Dutch academic hospitals. Participants were asked to indicate whether it was essential that medical graduates could prescribe specific drugs included on a preliminary list. Drugs for which ≥80% of all respondents agreed or strongly agreed were included in the final list. In all, 42 (65%) participants completed the two Delphi rounds. A total of 132 drugs (39%) from the preliminary list and two (3%) newly proposed drugs were included. This is the first Delphi consensus study to identify the drugs that Dutch junior doctors should be able to prescribe safely and effectively without direct supervision. This list can be used to harmonize and support the teaching and assessment of CP&T. Moreover, this study shows that a Delphi method is suitable to reach consensus on such a list, and could be used for a European list.

Teaching resources for the European Open Platform for Prescribing Education (EurOP2E)—a nominal group technique study

The European Open Platform for Prescribing Education (EurOP2E) seeks to improve and harmonize European clinical pharmacology and therapeutics (CPT) education by facilitating international collaboration and sharing problem-based, online, open educational resources. The COVID-19 pandemic forced teachers to switch to virtual modalities, highlighting the need for high-quality online teaching materials. The goal of this study was to establish the online problem-based teaching resources needed to sustain prescribing education during the pandemic and thereafter. A nominal group technique study was conducted with prescribing teachers from 15 European countries. Results were analyzed through thematic analysis. In four meetings, 20 teachers from 15 countries proposed and ranked 35 teaching materials. According to the participants, the most necessary problem-based-online teaching materials related to three overarching themes. Related to learning outcomes for CPT, participants proposed creating prescription scenarios, including materials focusing on background knowledge and resources on personalized medicine and topical/ethical issues such as the prescription’s impact on planetary health. Second, related to teaching, they proposed online case discussions, gamification and decision support systems. Finally, in relation to faculty development, they recommend teacher courses, a repository of reusable exam questions and harmonized formularies. Future work will aim to collaboratively produce such materials.

Pilot Study Using An Online Platform “EPrescribe” in the Training and Assessment of 4th Year Medical Students’ Competency in Prescribing

PURPOSEThe Association of American Medical Colleges has delineated 13 Entrustable Professional Activities (EPAs) that entering residents should be expected to perform on day 1 of residency without direct supervision. EPA4, Enter and discuss orders and prescriptions, describes an activity that all recent medical graduates (Interns) spend a great deal of time daily on.Additionally, with the ever‐increasing numbers of pharmaceuticals and biologics, there is a need for clinical pharmacology education in the curriculum to help students achieve EPA4. The Department of Medical Education at GCSOM partnered with the BPS to use their online platform in a two‐week clinical pharmacology elective for 4th year medical students. The hypothesis of this study was that completion of the program modules will enhance student learning and satisfaction with respect to prescribing.METHODSWe used the BPS Assessment platform which provides prescribing skills modules for learners, which they access through a cloud‐based, content‐rich online assessment environment, with real‐time feedback. The assessments were reconciled to the US context insuring they were relevant to our students. Mean scores before and after completing the modules were compared using a paired t‐test. Students also completed a satisfaction questionnaire.RESULTSTo date, 6 students have completed the program. The average scores (±SD) after completing the modules increased significantly (Before: 42%±14%; After: 74%±10%; p=0.001). This represented a normalized gain of 54%. Students tended to Agree/Strongly Agree to the 6 items related to the eLearning sessions, interface and assessment in the satisfaction questionnaire.CONCLUSIONSThe results indicate that students’ knowledge and skills in prescribing increased as a result of their study of the modules. Their high ratings of the program suggest that students found it useful. In conclusion, the BPS program facilitates students’ abilities in prescribing therapies or interventions beneficial to patients and will be helpful in meeting the expectations of EPA4 as students enter residency.

COVID-19 pandemic-related adaptations of medical education in clinical pharmacology - impact on students and lecturers at a German university.

In medical studies, pharmacology is a subject with a high teaching and study load. The COVID-19 pandemic–related switch to distance learning implies challenges for students and teachers. To identify changes of behavior, attitudes, and needs among students and teachers in clinical pharmacology during the pandemic, regular surveys were conducted at Ulm University, Germany. Overall, 884 students and 5 teachers answered the survey. Over time, students’ usage of learning materials in print form and further literature (textbooks, guidelines) constantly decreased. In turn, most students used digital materials provided via a learning management system. Attitudes and opinions of students and teachers significantly differed regarding (i) the benefit of certain teaching formats and learning materials, (ii) open-mindedness towards e-learning, and (iii) future visions. Most students and lecturers stated that they spent more time on study or teaching-related activities, respectively, and had less contact with fellow students or colleagues in comparison to pre-pandemic times. Furthermore, the subjective teaching load for most lecturers (80%) increased during the pandemic. To identify determinants of learning success, the survey data were correlated with students’ gradings in the written exams of clinical pharmacology. In the first online semester (summer term 2020), the use of paper-based learning scripts was correlated with better exam grades. No correlation with grade was found for any other learning materials. Age was inversely correlated with exam grading. Striking a balance between the future visions and needs of students and teachers implies a particular challenge for the educational system of the next years.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00210-022-02225-3.

EurOP2E \u2013 the European Open Platform for Prescribing Education, a consensus study among clinical pharmacology and therapeutics teachers

PurposeSharing and developing digital educational resources and open educational resources has been proposed as a way to harmonize and improve clinical pharmacology and therapeutics (CPT) education in European medical schools. Previous research, however, has shown that there are barriers to the adoption and implementation of open educational resources. The aim of this study was to determine perceived opportunities and barriers to the use and creation of open educational resources among European CPT teachers and possible solutions for these barriers.MethodsCPT teachers of British and EU medical schools completed an online survey. Opportunities and challenges were identified by thematic analyses and subsequently discussed in an international consensus meeting.ResultsData from 99 CPT teachers from 95 medical schools were analysed. Thirty teachers (30.3%) shared or collaboratively produced digital educational resources. All teachers foresaw opportunities in the more active use of open educational resources, including improving the quality of their teaching. The challenges reported were language barriers, local differences, lack of time, technological issues, difficulties with quality management, and copyright restrictions. Practical solutions for these challenges were discussed and include a peer review system, clear indexing, and use of copyright licenses that permit adaptation of resources.ConclusionKey challenges to making greater use of CPT open educational resources are a limited applicability of such resources due to language and local differences and quality concerns. These challenges may be resolved by relatively simple measures, such as allowing adaptation and translation of resources and a peer review system.

Switching from a traditional undergraduate programme in (clinical) pharmacology and therapeutics to a problem-based learning programme

PurposeThe pharmacology and clinical pharmacology and therapeutics (CPT) education during the undergraduate medical curriculum of NOVA Medical School, Lisbon, Portugal, was changed from a traditional programme (i.e. discipline-based, lectures) to a problem-based learning (PBL) programme (i.e. integrated, case-based discussions) without an increase in teaching hours. The aim of this study was to investigate whether this change improved the prescribing competencies of final-year medical students.MethodsFinal-year students from both programmes (2015 and 2019) were invited to complete a validated prescribing assessment and questionnaire. The assessment comprised 24 multiple-choice questions in three subdomains (working mechanism, side-effects and interactions/contraindications), and five clinical case scenarios of common diseases. The questionnaire focused on self-reported prescribing confidence, preparedness for future prescribing task and education received.ResultsIn total, 36 (22%) final-year medical students from the traditional programme and 54 (23%) from the PBL programme participated. Overall, students in the PBL programme had significantly higher knowledge scores than students in the traditional programme (76% (SD 9) vs 67% (SD 15); p = 0.002). Additionally, students in the PBL programme made significantly fewer inappropriate therapy choices (p = 0.023) and fewer erroneous prescriptions than did students in the traditional programme (p = 0.27). Students in the PBL programme felt more confident in prescribing, felt better prepared for prescribing as junior doctor and completed more drug prescriptions during their medical training.ConclusionChanging from a traditional programme to an integrated PBL programme in pharmacology and CPT during the undergraduate medical curriculum may improve the prescribing competencies of final-year students.

Harmonizing and improving European education in prescribing: An overview of digital educational resources used in clinical pharmacology and therapeutics.

AimImprovement and harmonization of European clinical pharmacology and therapeutics (CPT) education is urgently required. Because digital educational resources can be easily shared, adapted to local situations and re‐used widely across a variety of educational systems, they may be ideally suited for this purpose.MethodsWith a cross‐sectional survey among principal CPT teachers in 279 out of 304 European medical schools, an overview and classification of digital resources was compiled.ResultsTeachers from 95 (34%) medical schools in 26 of 28 EU countries responded, 66 (70%) of whom used digital educational resources in their CPT curriculum. A total of 89 of such resources were described in detail, including e‐learning (24%), simulators to teach pharmacokinetics and/or pharmacodynamics (10%), virtual patients (8%), and serious games (5%). Together, these resources covered 235 knowledge‐based learning objectives, 88 skills, and 13 attitudes. Only one third (27) of the resources were in‐part or totally free and only two were licensed open educational resources (free to use, distribute and adapt). A narrative overview of the largest, free and most novel resources is given.ConclusionDigital educational resources, ranging from e‐learning to virtual patients and games, are widely used for CPT education in EU medical schools. Learning objectives are based largely on knowledge rather than skills or attitudes. This may be improved by including more real‐life clinical case scenarios. Moreover, the majority of resources are neither free nor open. Therefore, with a view to harmonizing international CPT education, more needs to be learned about why CPT teachers are not currently sharing their educational materials.

Simulation as a Tool to Illustrate Clinical Pharmacology Concepts to Healthcare Program Learners.

Purpose of ReviewThis article provides an overview of simulation as an effective and evolving tool for teaching clinical pharmacology within the health professions. Further, opportunities for positioning this methodology to meet current educational challenges are presented.Recent FindingsClinical pharmacology is an essential core competency for all health professionals, correlating with ability to appropriately and safely prescribe, administer, or optimize medication regimens. Computer-assisted learning became the earliest form of simulation applied to pharmacology teaching, arising from increasing pressure to deviate from animal and tissue experiments in undergraduate education in the 1990s. In the last decade, high fidelity patient simulation, using manikin technology, has demonstrated benefit in building connectivity between knowledge and clinical application within patient care. Serious games, or computer-based educational games, provide an alternative method for creating context, with potential realized for newer technologies like augmented reality. These tools, while beneficial, are not applied in a uniform manner across programs. We advocate for routine incorporation of these tools as they offer significant opportunities to address the challenges faced in today’s healthcare education, particularly with the need for continued social distancing and limitations on in-person educational engagement during coronavirus. Partnership with faculty utilizing simulation in other areas of the curriculum will assist in overcoming potential barriers to implementation.SummarySimulation provides various methods that have significant potential to address the challenges in today’s provision of clinical pharmacology education, especially with new directives for social distancing and limitations for in-person educational engagement.

Multidisciplinary health care monitoring and training program: impact on antibiotic use

Aim. To develop a program for monitoring the use of antibacterial agents and training in their rational use using the information on consumption and expenses in a multidisciplinary healthcare institution.&#x0D; Methods. From 2011 to 2014, a group of clinical pharmacologists developed and implemented a monitoring program for the use of antibacterial agents using the ATC/DDD and ABC/VEN methodology in SBIH Penza Regional Clinical Hospital named after N.N. Burdenko. Hospital doctors were trained in the principles of rational use of drugs and antibiotics as part of continuing education in clinical pharmacology using monitoring results analysis of the costs and consumption of antibacterial agents.&#x0D; Results. Over the four years of monitoring and three years of educational activities, the most pronounced changes have occurred in the use of fluoroquinolones, aminoglycosides, macrolides and carbapenems. Fluoroquinolones consumption reduced 2 times, and it cost of purchase reduced 6 times (of total). Aminoglycosides consumption increased 3 times, primarily due to amikacin 5 times consumption increase. Macrolides consumption reduced 3 times, primarily due to clarithromycin decrease in consumption. At the same time, the antibacterial agents of the cephalosporin group leading in consumption, with their cost had decreased 2-fold. However, carbapenems consumption increased 3 times, with their costs increase 7 times.&#x0D; Conclusion. Over the three years of the program, expenses and consumption of antibacterial agents of the fluoroquinolone and macrolide group were reduced, with an increase in the consumption of aminoglycosides and carbapenems without changes in the consumption of cephalosporins; costs of cephalosporins and carbapenems led to an increase in overall antibiotic costs; further efforts and studies are needed to study the use of antibacterial agents.

Совершенствование формирования Казахстанского национального лекарственного формуляра для повышения рационального использования лекарственных средств

Kazakhstan national drug formulary form is defined as - a list of medicines with proven clinical safety and efficacy, as well as orphan (rare) drugs, which is a mandatory basis for the development of medicinal formularies of medical organizations and formation of lists of procurement of medicines within the guaranteed volume of free medical care and in the system of compulsory social health insurance in the Code “On public health and health care system”. Health research data show that in 18% of cases, non-KNF drugs were prescribed in Nur-Sultan medical organizations, 86% of healthcare organizations did not analyze rational use of financial costs for medicines and analyzes of drug consumption, 90% of medicines are assigned by trade name. At the same time, polypharmacy, excessive prescription of antibiotics and injection drugs are noted. The lack of a systematic understanding of the role of CNF in the rational use of drugs reduces the effectiveness of the measures taken. The value of the Kazakhstan National Drug Formulary for the health care of the Republic of Kazakhstan is enormous, for example, for clinicians it is a public resource for doctors and serves as a reference book on medicines and pharmacotherapy based on evidence-based medicine, as well as a guide to integrate Kazakhstan's usual clinical practice into international best practice, in addition to educational a guide providing continuing education in clinical pharmacology and a restrictive list of drugs recommended for routine use in routine clinical practice. For the population, it plays the role of a guideline in the provision of medicines within the guaranteed volume of medical care and in the system of compulsory social health insurance, as well as guidance on involving civil society in the process of monitoring the rational use of medicines. This policy brief shows three policy options and visions for implementing policy options. At the same time, the existing legislative framework of Kazakhstan has all the necessary conditions to support the implementation of the proposed policy options, however, the main barriers to the implementation of policy options may be a lack of human resources, unethical promotion of medicines on the market, lack of support from the authorized body in the field of health, and there is also a lack of understanding by medical workers and the public of the role of the Kazakhstan national formulary in the rational use of medicines