Drug Information Dr Grace Ann Varghese

1. Drug InformationDr Grace Ann Varghese

2. PROTOCOL • DEFINITION • NEED FOR DRUG INFORMATION • OBJECTIVES • SYSTEMATIC APPROACH • STANDARD QUESTIONS • DRUG INFORMATION RESOURCES • TYPES OF ENQUIRIES • GENERAL GUIDELINES • REFERENCE

3. Drug Information “Provision of unbiased, well referenced, and critically evaluated up-to-date information on any aspect of drug use” or “Any objective, scientifically derived and documented data or knowledge involving the pharmacological, toxicological and therapeutic use of drugs”

4. Drug information service “Activities that are part of the overall pharmacy service or pharmaceutical care service” Drug information centre “ A specialized facility that provides drug information to those who need it”

5. NEED FOR DRUG INFORMATION • Complex drug therapy • Drug literature is vast & complex • Drug literature & literature on clinical experience is growing rapidly • EBM needs current clinical research evidence (training programs) • Development and implementation of therapeutic guidelines • Drug use evaluation • Consumer awareness

6. OBJECTIVES • To promote safe, effective & economic use of drugs • To achieve rational use of drugs • DUR • To decrease the incidence of ADRs • To select Formulary Drugs • To conduct continual training and educational programs

7. SYSTEMATIC APPROACH Step 1. Secure demographics of the requestor Step 2. Obtain background information Step 3. Determine & categorize the ultimate question Step 4. Develop search strategy & conduct search Step 5. Perform evaluation, analysis & synthesis Step 6. Formulate & provide response Step 7. Conduct follow-up & documentation

8. REQUESTOR DEMOGRAPHICS • First step in the modified systematic approach is to accept the initial question • Secure requestor demographics • Name, Telephone number, fax no email id & address or location are important facts to obtain regarding the requestor • For eg: an elderly patient & a CV specialist may each enquire about the availability of an investigational medication;

9. BACKGROUND QUESTIONS • Develop a more complete picture of question • Must be appropriate • General information should be obtained • Important item to obtain : what resources have been checked or used by the requestor.

10. ULTIMATE QUESTION • May be the same as the original question • The question is not patient specific. • The requestor must confirm the ultimate question before categorization & development of a search strategy • Once identified & acknowledged the question is categorized

11. SEARCH STRATEGY • The resource selection process. • They are prioritized based on probability of containing the information or data desired • Without prioritization, resources may be used based on ease of access or degree of comfort, instead of probable efficiency. • For eg: the categorization of a question as adverse effect suggests the use of adverse effects oriented resources.

12. DATA EVALUATION, ANALYSIS & SYNTHESIS • The information retrieved must be objectively critically reviewed • The techniques & skills for literature evaluation & clinical application of statistical analysis are applied

13. FORMULATION & PROVISION OF RESPONSE • Involves a series of steps • Relevant background information should be considered • Must be critically analyzed & evaluated • The response to a question must include • Restating the request • Clearly identifying the problems, issues & circumstances that are relevant to the questions. • Conflicting viewpoints should be clearly stated. • Responses should be brief, concise & accurate • Provided in a timely manner

14. FOLLOW UP & DOCUMENTATION • Process of verifying the appropriateness, correctness & completeness of a response following the communication • Documentation is essential • The method of documentation may be a simple form or an extensive review • summation of process completed.

15. STANDARD QUESTIONS FOR OBTAINING BACKGROUND INFORMATION FROM REQUESTORS • The requestors name • The requestors location • The requestors frame of reference • The resources the requestor has already consulted • Whether the request is patient specific or academic • The patient’s diagnosis & other medications • The urgency of the request

16. DRUG INFORMATION RESOURCES • Primary resource • Secondary resource • Tertiary resource

17. PRIMARY RESOURCE • Consists of research studies or clinical experience which has not been previously published. • Includes clinical trials, short reports, case reports & letters to the editors. • The term primary literature refers to the type of article rather than the source of publication For eg: The result of a clinical trial of a new antihypertensive drug published in a medical journal available online • Available electronically. • Most up to date resources for information Eg: British Medical Journal Community Medicine www.nih.gov www.freemedical journals.com

18. PRIMARY RESOURCES DRUG SEARCH

19. ADVANTAGE Learn how a second clinician handles a particular problem Keep us with new development Distinguish useful from useless therapy Enhance communication with other health care professionals DISADVANTAGES Journals enhance creditability of information contained in an article, this doesn’t guarantee that the article is accurate Many article possess inadequacies PRIMARY RESOURCES

20. SECONDARY RESOURCES • Provides an over view of previously published works & include indexing & abstracting services of primary literature Eg: abstracting service & indexing service • An indexing system provides only bibliographic information • An abstracting service provides content • Accessing more than one secondary resource may therefore allow more thorough information retrieval. • Secondary resources are available both online & CD ROM format, • Examples: IDIS;CDROM; Index Records Micromedex

21. MICROMEDEX

22. MICROMEDEX Download

23. SECONDARY RESOURCES ADVANTAGES Provides sufficient information to serve as references for answering drug information requests Indexing & abstracting services are valuable tools for quick & selective screening of primary literature DISADVANTAGES Describes only articles & clinical studies from journals Abstracts are used as primary source of information

24. TERITIARY RESOURCES • Consists of General literature including text books & full text computer databases • Review articles included in biomedical journals • General review articles contain back ground information on the subject discussed along with a comprehensive review of literature • Eg:Physician Desk Reference • Ross & Wilson

25. ADVANTAGE Most commonly used resource Easy to use Convenient Concise & compact DISADVANTAGE May not be complete Even new textbooks may be several years out dated Topics may be presented in insufficient details due to space limitation of text books. TERITIARY RESOURCES

26. Evaluating tertiary resource • Expertise & experience of the author • Currentness of literature • Appropriateness of citations used • Clarity, conciseness & ease of use of the literature

27. OTHER SOURCES • Internet, • list server • local & national professional & government organizations • Pharmaceutical manufacturers • Drug information websites include: www.clinicalevidnece.com www.freemedicaljournal.com www.nih.gov

28. Types of enquiries • Dose • dose interval • Route of administration • ADR • Drug-drug interaction • Duration of therapy • Formulations • Cost • Drug • lab test interaction • Teratogenesis • Pharmaceutical incompatibility

29. GENERAL GUIDELINES FOR RESPONSES TO DRUG INFORMATION REQUESTS • Do not guess • Consider ethical issues • Organize information • Inform the inquirer where the information was found • Use more than abstracts • Alert the inquirer of a possible delay • Ask if the information provided answers the enquirer’s questions • Ask if the enquirer wishes to have reprints of articles or written response