Abstract
The use of medicines and medical tests sits at the heart of health systems globally. Whether considered from the perspectives of patient benefits and harms, health expenditure or the most common practices of health professionals, prescribing of medicines and ordering of medical tests are critical behaviours that determine the quality of care, health outcomes and value for money in health systems. A range of interventions to improve prescribing and use of medical tests have been advocated for decades, yet we continue to see suboptimal use of medicines and medical tests. This includes both underuse and overuse of these precious resources against an evidence base that is compelling in demonstrating missed opportunities for benefits, unnecessary exposure to harms and poor value for money when utilization is not appropriate. The arguments for programs that support health professionals and patients to make the best use of medicines and medical tests are based on data from high-, middle- and low-income countries. These data show the variation that cannot be explained by patient and clinical factors alone. Other considerations such as attitudes and beliefs, geography, previous experience, peer norms and socioeconomic factors are important when we seek to improve the use of medicines and medical tests.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Andres, E., Cordero, A., Magan, P., Alegria, E., Leon, M., Luengo, E., … Casasnovas, J. A. (2012). Long-term mortality and hospital readmission after acute myocardial infarction: An eight-year follow-up study. Rev Esp Cardiol (Engl Ed), 65(5), 414–420. https://doi.org/10.1016/j.recesp.2011.09.009.
Anh, H., Kim, H., & Welch, H. (2014). Korea’s thyroid cancer épidemic’ screening and overdiagnsosis. The New England Journal of Medicine, 371, 1765–1767.
Australia. Department of Human, S., & Health. (1995). Manual of indicators to measure the effect of initiatives under the quality use of medicine arm of the National Medicinal Drug Policy. Canberra: A.G.P.S.
Australian Commission on Safety and Quality in Health Care. (2015). The First Australian Atlas of Healthcare Variation. Retrieved from Sydney.
Australian Commission on Safety and Quality in Health Care. (2017). The Second Australian Atlas of Healthcare Variation. Retrieved from Sydney.
Avezum, A., Oliveira, G., & Lanas, F. (2017). Secondary CV prevention in South America in a Community setting: The PURE study. Global Heart, 12, 305–313.
Babar, Z., Kan, S. W., & Scahill, S. (2014). Interventions promoting the acceptance and uptake of generic medicines: A narrative review of the literature. Health Policy, 117, 285–296.
Baigent, C., Blackwell, L., Emberson, J., Holland, L. E., Reith, C., Bhala, N., … Collins, R. (2010). Efficacy and safety of more intensive lowering of LDL cholesterol: A meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet, 376(9753), 1670–1681. https://doi.org/10.1016/s0140-6736(10)61350-5.
Bansilal, S., Castellano, J., & Fuster, V. (2015). Global burden of CVD: Focus on secondary prevention of cardiovascular disease. International Journal of Cardiology, 201(suppl 1), S1–S7.
Barr, E., Magliana, D., Zimmet, P., Polkinghorne, K., Atkins, R., Dunstan, D., … Shaw, J. (2006). AUSDIAB 2005. Australian diabetes, obesity and life style study. Retrieved from Melbourne, Australia: https://www.baker.edu.au/impact/ausdiab/resources.
Bigdeli, M., Laing, R., Tomson, G., & Babar, Z.-U.-D. (2015). Medicines and universal health coverage: Challenges and opportunities. Journal of Pharmaceutical Policy and Practice, 8(1). https://doi.org/10.1186/s40545-015-0028-4.
Bochenek, T., Abilova, V., Alkan, A., Asanin, B., de Miguel Beriain, I., Besovic, Z., … Godman, B. (2018). Systemic measures and legislative and organizational frameworks aimed at preventing or mitigating drug shortages in 28 European and Western Asian Countries. Frontiers in Pharmacology, 8(942). https://doi.org/10.3389/fphar.2017.00942.
Britt, H., Miller, G., & Valenti, L. (2001). ‘It’s different in the bush’ A comparison of general practice activity in metropolitan and rural areas of Australia 1998–2000. Canberra: Australian Government.
Brown, K., Nevitte, A., Szeto, B., & Nandi, A. (2015). Growing social inequality in the prevalence of type 2 diabetes in Canada, 2004–2012. Canadian Journal of Public Health/Revue Canadienne de Santé Publique, 106(3), 132–136.
Brownlee, S., Chalkidou, K., Doust, J., Elshaug, A. G., Glasziou, P., Heath, I., … Korenstein, D. (2017). Evidence for overuse of medical services around the world. The Lancet, 390(10090), 156–168. https://doi.org/10.1016/S0140-6736(16)32585-5.
Brun, S. (2012). Shoulder injuries—Management in general practice. Australian Family Physician, 41(4), 188.
Buchan, H. H., Phillips, S. M., Weekes, L. M., Mackson, J. M., Boyden, A. N., & Tonkin, A. M. (2006). Chronic heart failure: Time to optimise methods of diagnosis in the community. -letter. Medical Journal of Australia, 184(8), 423–424.
Buchbinder, R., Staples, M., Shanahan, E., & Roos, J. (2013). General practitioner management of shoulder pain in comparison with rheumatologist expectation of care and best evidence: An Australian National Survey. Plos One, 8(4), e61243. https://doi.org/10.1371/journal.pone.0061243.
Busfield, J. (2015). Assessing the overuse of medicines. Social Science and Medicine, 131, 199–206. https://doi.org/10.1016/j.socscimed.2014.10.061.
Butler, C., Rollnick, S., Pill, R., Maggs-Rapport, F., & Scott, N. (1998). Understanding the culture of prescribing: A qualitative study of general practitioners’ and patients’ perceptions of antibiotics for sore throats. British Medical Journal, 317, 637–642.
Byrne, C. J., Walsh, C., Cahir, C., Ryan, C., Williams, D. J., & Bennett, K. (2018). Anticholinergic and sedative drug burden in community-dwelling older people: A national database study. BMJ Open, 8(7). https://doi.org/10.1136/bmjopen-2018-022500.
Cameron, A., Mantel-Teeuwisse, A. K., Leufkens, H. G. M., & Laing, R. O. (2012). Switching from originator brand medicines to generic equivalents in selected developing countries: How much could be saved? Value in Health, 15(5), 664–673. https://doi.org/10.1016/j.jval.2012.04.004.
Chua, K.-P., Schwartz, A. L., Volerman, A., Conti, R. M., & Huang, E. S. (2016). Use of low-value pediatric services among the commercially insured. Pediatrics, 138(6). https://doi.org/10.1542/peds.2016-1809.
Clark, A., & Sanderson, C. (2009). Timing of children’s vaccinations in 45 low-income countries: An analysis of survey data. Lancet, 373, 1543–1549.
Cooper, J. A., Cadogan, C. A., Patterson, S. M., Kerse, N., Bradley, M. C., Ryan, C., & Hughes, C. M. (2015). Interventions to improve the appropriate use of polypharmacy in older people: A Cochrane systematic review. BMJ Open, 5(12). https://doi.org/10.1136/bmjopen-2015-009235.
Cramer, J. (2004). A systematic review of adherence with medications for diabetes. Diabetes Care, 27(5), 1218–1224.
Daley, J. (2013). Budget pressures on Australian governments. Retrieved from Canberra.
Dartnell, J. G. A. (2001). Understanding, influencing and evaluating drug use. North Melbourne: Therapeutic Guidelines.
Deedwania, P., Acharya, T., Kotak, K., Fonarow, G. C., Cannon, C. P., Laskey, W. K., et al. (2017). Compliance with guideline-directed therapy in diabetic patients admitted with acute coronary syndrome: Findings from the American Heart Association’s get with the Guidelines-Coronary Artery Disease (GWTG-CAD) program. American Heart Journal, 187, 78–87. https://doi.org/10.1016/j.ahj.2017.02.025.
Del Mar, C. (2016). Antibiotics for acute respiratory tract infections in primary care. British Medical Journal, 354. https://doi.org/10.1136/bmj.i3482.
Devillers, L., Sicsic, J., Delbarre, A., Le Bel, J., Ferrat, E., & Saint Lary, O. (2018). General practitioner trainers prescribe fewer antibiotics in primary care: Evidence from France. Plos One, 13(1). https://doi.org/10.1371/journal.pone.0190522.
Dodet, B., Durrheim, D. N., & Rees, H. (2014). Rabies: Underused vaccines, unnecessary deaths. Vaccine, 32, 2017–2019.
Dolk, F. C. K., Pouwels, K. B., Smith, D. R. M., Robotham, J. V., & Smieszek, T. (2018). Antibiotics in primary care in England: which antibiotics are prescribed and for which conditions? Journal of Antimicrobial Chemotherapy, 73(suppl_2), ii2–ii10. https://doi.org/10.1093/jac/dkx504.
Dunstan, D., Zimmet, P., Welborn, A. T., Sicree, R., Armstrong, T., Atkins, R., … Chadban, S. (2001). Diabesity and associated disorders in Australia 2000. The Australian diabetes, obesity and lifestyle study (AusDiab). Retrieved from Melbourne: https://www.baker.edu.au/impact/ausdiab/resources.
Durando, P., Crovari, P., Ansaldi, F., Sticchi, L., Sticchi, C., Turello, V., … Icardi, G. (2009). Universal childhood immunisation against Streptococcus pneumoniae: The five-year experience of Liguria Region, Italy. Vaccine, 27(25), 3459–3462. https://doi.org/10.1016/j.vaccine.2009.01.052.
Easton, K., Weston, C., Williamson, M., Fung-Coady, N., Cadden, A., & Simmonds, J. (2011). Formative research. Diabetes. Sydney, Australia.
Elliott, R. A., & Booth, J. C. (2014). Problems with medicine use in older Australians: A review of recent literature. Journal of Pharmacy Practice and Research, 44(4), 258–271. https://doi.org/10.1002/jppr.1041.
Elshaug, A., Watt, A., Mundy, L., & Willis, C. (2012). Over 150 potentially low-value health care practices: An Australian study. Medical Journal of Australia, 197, 556–560.
Elshaug, A. G., Rosenthal, M. B., Lavis, J. N., Brownlee, S., Schmidt, H., Nagpal, S., … Saini, V. (2017). Levers for addressing medical underuse and overuse: Achieving high-value health care. The Lancet, 390(10090), 191–202. https://doi.org/10.1016/S0140-6736(16)32586-7.
Falchook, A., Salloum, R., Hendrix, L., & Chen, R. (2014). Use of bone scan during initial prostate cancer workup, downstream procedures and associated Medicare costs. International Journal of Radiation Oncology Biology Physics, 89, 243–248.
García-Pérez, L.-E., Álvarez, M., Dilla, T., Gil-Guillén, V., & Orozco-Beltrán, D. (2013). Adherence to therapies in patients with Type 2 diabetes. Diabetes Therapy, 4(2), 175–194. https://doi.org/10.1007/s13300-013-0034-y.
Glasziou, P., Straus, S., Brownlee, S., Trevena, L., Dans, L., Guyatt, G., … Saini, V. (2017). Evidence for underuse of effective medical services around the world. The Lancet, 390(10090), 169–177. https://doi.org/10.1016/S0140-6736(16)30946-1.
Gnavi, R., Migliardi, A., Demaria, M., Petrelli, A., Caprioglio, A., & Costa, G. (2007). Statins prescribing for the secondary prevention of ischaemic heart disease in Torino, Italy. A case of ageism and social inequalities. European Journal of Public Health, 17(5), 492–496. https://doi.org/10.1093/eurpub/ckm005.
Gorup, E., Rifel, J., & Petek Ster, M. (2018). Anticholinergic burden and most common Anticholinergic-acting medicines in older general practice patients. Zdrav. Varst, 57(3), 140–147. https://doi.org/10.2478/sjph-2018-0018.
Gray, A. (2014). Medicines shortages-unpicking the evidence from a year in South Africa. Australasian Medical Journal, 7(5), 208–212. https://doi.org/10.4066/amj.2014.1932.
Gray, A., & Manasse, H. R. (2012). Shortages of medicines: A complex global challenge. Bulletin of the World Health Organization, 90, 158.
Hann, A. F. (1999). Resurgence of diphtheria in the newly independent states of the former Soviet Union: A reminder of risk. Journal of Neurology, Neurosurgery and Psychiatry, 67(4), 426. https://doi.org/10.1136/jnnp.67.4.426.
Heeley, E., Anderson, C., Patel, A., Cass, A., Peiris, D., Weekes, A., & Chalmers, J. (2012). Disparities between prescribing of secondary prevention therapies for stroke and coronary artery disease in general practice. International Journal of Stroke, 7(8), 649-654. doi:10.1111/j.1747-4949.2011.00613.x
Hill, S., Bero, L., McColl, G., & Roughead, E. (2015). Expensive medicines: Ensuring objective appraisal and equitable access. Bulletin of the World Health Organization, 93, 4–4A.
Hillman, B. J., & Goldsmith, J. C. (2010). The uncritical use of high-tech medical imaging. The New England Journal of Medicine, 363(1), 4–6. https://doi.org/10.1056/NEJMp1003173.
Hoebert, J. M., van Dijk, L., Mantel-Teeuwisse, A. K., Leufkens, H. G. M., & Laing, R. O. (2013). National medicines policies—A review of the evolution and development processes. Journal of Pharmaceutical Policy and Practice, 6(1). https://doi.org/10.1186/2052-3211-6-5.
Hood, V. L., & Weinberger, S. E. (2012). High value, cost-conscious care: An international imperative. European Journal of Internal Medicine, 23(6), 495–498. https://doi.org/10.1016/j.ejim.2012.03.006.
Imkampe, A. K., & Gulliford, M. C. (2011). Increasing socio-economic inequality in type 2 diabetes prevalence—Repeated cross-sectional surveys in England 1994–2006. European Journal of Public Health, 21(4), 484–490. https://doi.org/10.1093/eurpub/ckq106.
International Diabetes Federation. (2017). IDF Diabetes Atlas, 8th Edition. Retrieved from Brussels, Belgium: http://www.diabetesatlas.org.
Jin, X. W., Lipold, L., Sikon, A., & Rome, E. (2013). Human papillomavirus vaccine: Safe, effective, underused. Cleveland Clinic Journal of Medicine, 80(1), 49. https://doi.org/10.3949/ccjm.80a.12084.
Jones, L. G., Zhang, Y., Ahmed, M. I., Ekundayo, O. J., Akhter, S., Sawyer, P., … Ahmed, A. (2010). Understanding the reasons for the underuse of pneumococcal vaccination by community-dwelling older African Americans. Journal of the American Geriatrics Society, 58(12), 2323. https://doi.org/10.1111/j.1532-5415.2010.03181.x.
Jung, H.-Y., Vest, J. R., Unruh, M. A., Kern, L. M., & Kaushal, R. (2015). Use of health information exchange and repeat imaging costs. Journal of the American College of Radiology, 12(12), 1364.
Kata, A. (2012). Anti-vaccine activists, Web 2.0, and the postmodern paradigm—An overview of tactics and tropes used online by the anti-vaccination movement. Vaccine, 30(25), 3778–3789. https://doi.org/10.1016/j.vaccine.2011.11.112.
Kotwani, A., & Holloway, K. (2014). Antibiotic prescribing practice for acute, uncomplicated respiratory tract infections in primary care settings in New Delhi, India (Report), 19(7), 761. https://doi.org/10.1111/tmi.12327.
Laing, R. O., Hogerzeil, H. V., & Ross-Degnan, D. (2001). Ten recommendations to improve use of medicines in developing countries. Health Policy and Planning, 16(1), 13–20.
Lattanzio, F., Corica, F., Schepisi, R., Amantea, D., Bruno, F., Cozza, A., … Corsonello, A. (2018). Anticholinergic burden and 1‐year mortality among older patients discharged from acute care hospital. Geriatrics & Gerontology International, 18(5), 705–713. https://doi.org/10.1111/ggi.13234.
Lattanzio, F., Onder, G., La Fauci, M. M., Volpato, S., Cherubini, A., Fabbietti, P., … Corsonello, A. (2018). Anticholinergic burden is associated with increased mortality in older patients with dependency discharged from hospital. Journal of the American Medical Directors Association. https://doi.org/10.1016/j.jamda.2018.06.012.
Law, M. R., Morris, J. K., & Wald, N. J. (2009). Use of blood pressure lowering drugs in the prevention of cardiovascular disease: Meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. British Medical Journal, 338, b1665. https://doi.org/10.1136/bmj.b1665.
Lim, S. S., Stein, D. B., Charrow, A., & Murray, C. J. (2008). Tracking progress towards universal childhood immunisation and the impact of global initiatives: A systematic analysis of three-dose diphtheria, tetanus, and pertussis immunisation coverage. The Lancet, 372(9655), 2031–2046. https://doi.org/10.1016/S0140-6736(08)61869-3.
Martins, C. (2016). Overuse of medical tests: A new health risk factor? Acta Médica Portuguesa, 29(9), 497–498. https://doi.org/10.20344/amp.7748.
McGlynn, E., Asch, S., Adams, J., Keesey, J., Hicks, J., DeCristofaro, A., et al. (2003). The quality of health care delivered to adults in the United States. New England Journal of Medicine, 348, 2635–2645.
McManus, P., Hammond, M., Whicker, S., Primrose, J., Mant, A., & Fairall, S. (1997). Antibiotic use in the Australian community, 1990–1995. Medical Journal of Australia, 167, 124–127.
Morgan, T., Williamson, M., Pirotta, M., Stewart, K., Myers, S., & Barnes, J. (2012). A national census of medicinesuse: A 24 hour snapshot of Australians aged 50 years and older. Medical Journal of Australia, 196, 50–53.
Music, S. (2005). Towards universal childhood immunization: Why we must and how we might. Vaccine, 23(48), 5474–5477. https://doi.org/10.1016/j.vaccine.2005.07.044.
Narayan, S., Hilmer, S., Horsburgh, S., & Nishtala, P. (2013). Anticholinergic component of the drug burden index and the anticholinergic drug scale as measures of anticholinergic exposure in older people in new zealand: A population-level study. Drugs and Aging, 30(11), 927–934. https://doi.org/10.1007/s40266-013-0111-y.
NPS MedicineWise. (2016). Acute knee pain presentations in middle-aged patients: what is the role of MRI? MedicineWise News. Retrieved from: https://nps.org.au/news/acute-knee-pain-presentations-in-middle-aged-patients-what-is-the-role-of-mri.
O’Neill, J. (2016). Tackling drug-resistant infections globally: Final report and recommendations. National Health Service. London.
Odegard, P., & Capoccia, K. (2007). Medication taking and diabetes: A systematic review of the literature. Diabetes Education, 33(6), 1014–1029.
OECD. (2015). Pharmaceutical expenditure. In OECD (Ed.), Health at a glance 2015: OECD indicators. https://doi.org/10.1787/health_glance-2015-65-en. Paris: OECD Publishing.
Pan, Y., Henderson, J., & Britt, H. (2006). Antibiotic prescribing in Australian general practice: How has it changed from 1990–91 to 2002–03? Respiratory Medicine, 100(11), 2004–2011. https://doi.org/10.1016/j.rmed.2006.02.015.
Panasiuk, L., Lukas, W., Paprzycki, P., Verheij, T., Godycki‐Ćwirko, M., & Chlabicz, S. (2010). Antibiotics in the treatment of upper respiratory tract infections in Poland. Is there any improvement? Journal of Clinical Pharmacy and Therapeutics, 35(6), 665–669. https://doi.org/10.1111/j.1365-2710.2009.01136.x.
Parekh, A. K., Galloway, J. M., Hong, Y., & Wright, J. S. (2013). Aspirin in the secondary prevention of cardiovascular disease. The New England Journal of Medicine, 368(3), 204–205. https://doi.org/10.1056/NEJMp1213380.
Phillips, P. (2009). Pitfalls in interpreting laboratory results. Australian Prescriber, 32(2), 43–46.
Pratt, N. L., Kalisch Ellett, L. M., Sluggett, J. K., Ramsay, E. N., Kerr, M., Leblanc, V. T., … Roughead, E. E. (2015). Commitment questions targeting patients promotes uptake of under-used health services: Findings from a national quality improvement program in Australia. Social Science & Medicine, 145, 1–6.
Regional Office for Europe of the World Health Organization. (2015). Access to new medicines in Europe: Technical review of policy initiatives and opportunties for collaboration and research. Retrieved from Denmark.
Roehr, B. (2011). Defensive medical practices consume 35% of orthopaedic imaging costs. BMJ: British Medical Journal, 342(7794), 404–405.
Saini, V., Garcia-Armesto, S., Klemperer, D., Paris, V., Elshaug, A. G., Brownlee, S., … Fisher, E. S. (2017). Drivers of poor medical care. The Lancet, 390(10090), 178–190. https://doi.org/10.1016/S0140-6736(16)30947-3.
Sharma, M., Nazareth, I., & Petersen, I. (2016). Trends in incidence, prevalence and prescribing in type 2 diabetes mellitus between 2000 and 2013 in primary care: A retrospective cohort study. BMJ Open.
Simmons, R. K., Carlsen, A. H., Griffin, S. J., Charles, M., Christiansen, J. S., Borch‐Johnsen, K., … Lauritzen, T. (2014). Variation in prescribing of lipid‐lowering medication in primary care is associated with incidence of cardiovascular disease and all‐cause mortality in people with screen‐detected diabetes: Findings from the ADDITION‐Denmark trial. Diabetic Medicine, 31(12), 1577–1585. https://doi.org/10.1111/dme.12574.
Society of Hospital Pharmacists of Australia. Committee of Specialty Practice in Drug Usage, E. (1998). Australian drug usage evaluation starter kit. South Melbourne, VIC: The Society of Hospital Pharmacists of Australia, Committee of Specialty Practice in Drug Usage Evaluation.
Stone, M. A., Charpentier, G., Doggen, K., Kuss, O., Lindblad, U., Kellner, C., … Khunti, K. (2013). Quality of care of people with Type 2 diabetes in eight European countries. Findings from the Guideline Adherence to Enhance Care (GUIDANCE) Study, 36(9), 2628–2638. https://doi.org/10.2337/dc12-1759.
Tanamas, S., Magliano, D., Lynch, B., Sethi, P., Willenberg, L., Polkington, K., … Shaw, J. (2013). AUSDIAB 2012. The Australian Diabetes, Obesity and Lifestyle Study. Retrieved from Melbourne Australia: https://www.baker.edu.au/impact/ausdiab/resources.
Teng, C., Tong, S., Khoo, E., Lee, V., Zailinawati, A., Mimi, O., … Nordin, S. (2011). Antibiotics for URTI and UTI prescribing in Malaysian primary care settings. Australian Family Physician, 40, 325–329.
The World Bank. (2017). Drug resistant infections—A threat to our economic future. Final report. Retrieved from: http://documents.worldbank.org/curated/en/323311493396993758/pdf/114679-REVISED-v2-Drug-Resistant-Infections-Final-Report.pdf.
Therapeutic Guidelines. (2018). Cardiovascular guidelines version 7. Melbourne: Therapeutic Guidelines Inc.
Toth, E. L., Majumdar, S. R., Guirguis, L. M., Lewanczuk, R. Z., Lee, T. K., & Johnson, J. A. (2003). Compliance with clinical practice guidelines for type 2 diabetes in rural patients: Treatment gaps and opportunities for improvement. Pharmacotherapy, 23(5), 659. https://doi.org/10.1592/phco.23.5.659.32203.
Vinagre, I., Mata-Cases, M., Hermosilla, E., Morros, R., Fina, F., Rosell, M., … Mauricio, D. (2012). Control of glycemia and cardiovascular risk factors in patients with Type 2 diabetes in primary care in Catalonia (Spain). Diabetes Care, 35(4), 774–779. https://doi.org/10.2337/dc11-1679.
West, T., Pruchnicki, M. C., Porter, K., & Emptage, R. (2013). Evaluation of anticholinergic burden of medications in older adults. Journal of the American Pharmacists Association, 53(5), 496–504. https://doi.org/10.1331/JAPhA.2013.12138.
Williams, M., Greene, G., Naik, G., Hughes, K., Butler, C., & Hay, A. D. (2018). Antibiotic prescribing quality for children in primary care: An observational study. British Journal of General Practice, 68(667), E90–E96. https://doi.org/10.3399/bjgp18X694409.
World Health Organization. (1993). How to investigate drug use in health facilities (selected drug use indicators). Retrieved from Geneva.
World Health Organization. (2002). WHO policy perspectives on medicines—Promoting rational use of medicines. Retrieved from Geneva.
World Health Organization. (2012). The pursuit of responsible use of medicines: Sharing and learning from country experiences. Technical report prepared for the Ministers Summit on The benefits of responsible use of medicines: Setting policies for better and cost-effective health care. Retrieved from Geneva.
World Health Organization. (2015). Global action plan on antimicrobial resistance.
World Health Organization. (2017). Cardiovascular Disease (CVDs) fact sheet.
World Health Organization. (2018). Exploration of inequality: Childhood immunization. Retrieved from: http://www.who.int/gho/health_equity/explorations-of-inequality-childhood-immunization.
Yusuf, S., Islam, S., Chow, C. K., Rangarajan, S., Dagenais, G., Diaz, R., … Teo, K. K. (2011). Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): A prospective epidemiological survey. Lancet, 378(9798), 1231–1243. https://doi.org/10.1016/s0140-6736(11)61215-4.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Weekes, L.M. (2020). Introduction: Why Is Improving Use of Medicines and Medical Tests Important?. In: Weekes, L. (eds) Improving Use of Medicines and Medical Tests in Primary Care. Springer, Singapore. https://doi.org/10.1007/978-981-15-2333-5_1
Download citation
DOI: https://doi.org/10.1007/978-981-15-2333-5_1
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-15-2332-8
Online ISBN: 978-981-15-2333-5
eBook Packages: MedicineMedicine (R0)