Drug Information Query

• The provision of drug information is the most fundamental responsibility of clinical pharmacists. The information may be specific to an individual patient as an integral part of pharmaceutical care, or relative to a group of patients, such as in the context of a disease management program.  The term medicine is used to highlight the services related to medicinal drugs rather than drugs of abuse.
• The term drug information was developed in the early 1960s. The first drug information center was established at the University of Kentucky in 1962. However, in India, drug information services and centers are still in their infancy and have only a few services that qualify as drug information centers.
• Pharmacists have a unique range of knowledge and skills that are required for drug information practice. These include knowledge of pharmaceutics, pharmacology, pharmacokinetics, and pharmacotherapy. All of these are required to optimize the use of drugs in the treatment and prevention of disease.

DEFINITION

• Drug information refers to the provision of unbiased, well-referenced, and critically evaluated up-to-date information on any aspect of drug use.
• The drug information service (DIS) refers to activities that are part of the overall pharmacy service or pharmaceutical care process.
• A drug information center (DIC) refers to a specialized facility that provides drug information to those who need it.
• A drug information specialist refers to a new breed of pharmacist who is an expert in drug information monitoring.

OBJECTIVES

1. To uplift the profession of pharmacy.
2. To improve patient compliance and therapeutic outcome.
3. To advise and educate patients for the proper use of drugs.
4. To advise and educate patients regarding drug addiction, alcoholism, smoking hazards, and other socio-medical problems.
5. Advise on self-medication for minor complaints.
6. Advise on public health issues.
7. Other activities like publishing newsletters or bulletins, conducting seminars, group discussions, campaigns etc.

PROVIDERS OF DRUG INFORMATION

• Knowledgeable about data storage and retrieval methods
• Able to objectively evaluate scientific literature
• Able to apply information to the specific patient situation
• An effective communicator with patients, health care professionals, administrators and the media.

METHOD TO ANSWER A DRUG INFORMATION ENQUIRY

There are many types of drug information requests. The most common relates to therapeutics, adverse drug reactions, dosage and administration, drug interaction, and use of drugs in pregnancy and lactation. Other questions may concern aspects of drug pharmacokinetics, pharmaceutical stability, compatibility, poisoning, toxicity, and drug availability.

There are seven steps to answering an inquiry.

STEP 1: Secure the demographics of the requester

The requester’s name, position, training, and anticipated knowledge are important to determine the approach and final response to the question.

For example, an elderly patient and a cardiovascular specialist may each enquire about the availability of an investigational medication; however, each brings a different frame of reference to the request.

STEP 2: Obtain background information

The ability to obtain background information is essential for a systematic approach. This has been the most difficult step. Sufficient background information must be obtained in a limited time period. The background questions should be specific to the nature of the request. 

Background information includes the patient’s age, weight and sex. In addition, the patient’s diagnosis, other medication such as co-morbidities, and hepatic and renal function are often important to assess. It is also advisable to find out if the requester has checked any resources previously so as to avoid duplication of work. Finally, the urgency of the request should be ascertained.

STEP 3: Determine and categorize the ultimate question

The ultimate question may differ significantly from the original question if the requester posed a general question, and the pharmacist has used his expertise to obtain background information. Adequate background information is needed to determine the ultimate question.

For example: if a doctor is concerned about the safety of prescribing Metronidazole to a patient taking Simvastatin, the question can be categorized as a drug interaction query.

STEP 4: Develop a search and conduct a search

The information resources are selected based on the probability of containing the desired data. For example, given in step 3, standard references on drug interactions are first-line resources as both simvastatin and metronidazole have been in clinical use for many years. If

one of the drugs was a recently introduced drug, a Medline search would be more appropriate. 

The resources may be used based on ease of access or the pharmacist’s familiarity with particular resources. The resources used in answering the question should be documented and this will help in understanding the usefulness of various resources at times of budget allocation.

STEP 5: Perform evaluation, analysis, and synthesis

The information retrieved must be critically reviewed. Application of the techniques and skill for literature evaluation and knowledge of statistical analysis may be used. For the response to be relevant and useful to the requester, the information must be analyzed and synthesized with consideration of the background information obtained previously. 

The analysis involves the critical assessment of the nature and merit of factors that may be relevant to the question. Synthesis involves the careful integration of critical information about the patient, disease and medication along with pertinent background information to arrive at a judgment or conclusion. Analysis and synthesis together assist in forming opinions, arriving at judgment, and ultimately drawing conclusions.

STEP 6: Formulate and provide a response

This involves a series of steps that must be performed completely, objectively and in a logical sequence. Patient factors, disease factors, medication history and other relevant background information and special circumferences should be considered. Once this data is collected and carefully assembled it must be critically analyzed and evaluated before providing the final response. The way in which answers are communicated plays a major role in determining how drug information is accepted by physicians. 

The response to a question must include restarting the request and clearly identifying the problems, issues, and circumstances that are relevant to the question. Specify recommendations must be scientifically sound and clearly justified. In the hospital setting the majority of questions will be answered verbally and responses should be brief, concise and accurate, and provided in a timely manner.

STEP 7: Conduct follow-up and documentation

Follow-up is the process of verifying the appropriateness, correctness, and completeness of a response after it has been given. When recommendations are made, follow-up should always be done in a timely manner. This allows the pharmacist to know if the recommendations

were accepted and implemented. Patient-specific requests generally provide opportunities for follow-up. In a hospital setting, this may involve visiting the ward and offering additional advice and information. This type of follow-up provides opportunities for pharmacists to become involved in direct patient care, independently of ward round participation or routine patient counseling. 

Documentation of the DI query is essential for purposes of quality assurance, budget allocation, and promotions of the DI service and to minimize liability. The documentation may be as a simple form or an extensive review and summary of all processes completed.  

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