6. DIS.pdf

which is offering more challenges and opportunities for health care professionals. Worldwide, the health care system is undergoing important changes, continued pressure to reduce health care costs, Several factors are driving these changes including new regulations in health care, and need to imp...

which is offering more challenges and opportunities for health care professionals. Worldwide, the health care system is undergoing important changes, continued pressure to reduce health care costs, Several factors are driving these changes including new regulations in health care, and need to improve efficiency, quality, and safety of care. The rational use of medications continues to be an essential element in this process because it represents a significant portion of the health care dollars spent. and a knowledgeable decision maker are integral components of providing a system that supports the safe and appropriate use of medications. The availability of patient, disease, and medication specific information, The term “drug information (DI)” was developed in the early 1960s and used in conjunction with the word “center” and “specialist.” which allows to provide a critical analysis of the literature and have a better understanding of the studies conducted. In 1962, the first drug information center (DIC) was opened at the University of Kentucky Medical Center. Among the skills needed for DIS is a knowledge of drug literature evaluation It is a key component to provide a good quality answer to a requestor. Being able to separate good data from poor data is essential. Knowing the limitation of any study can help in evaluating the usability of its data. Some may use their expertise to promote information not supported by evidence 1. Do the authors have expertise? May need older editions for some information DIC was desired to be a source of comprehensive drug information for health care professionals. DRUG LITERATURE EVALUATION Drug information specialists will often use some standard questions to help in this process. 2. Is this the most recent edition? Drug information specialist/ pharmacist was dedicated mainly to the collation and transfer of quality and up-to-date drug related knowledge, Note: To ensure quality, drug information should be Objective, Unbiased, 3. Are statements of fact supported by citations? Visuals: Present original research and/or new scientific discoveries (i.e. raw date) information or data in a timely way in order to strengthen the promotion of rational use of drug (i.., responding to queries). Scientifically validated, Evidencebased and Up-to-date. As practice progressed, the focus has shifted from just answering queries to include other functions and the term "pharmacoinformatics (or pharmacy informatics)" was found in the year of 1993. The main idea behind the field is to emphasizes the use of technology (IT) and automation as an: integral tool in effectively organizing, analyzing, managing and communicating information on medication use in patients. It refers to the management and integration of medication related data, information, and knowledge that spans across systems and supports the medication use process Provides most current information Often include analysis of data collected in the field or laboratory In 2007, the global Healtheare Information and Management Systems Society (HIMSS) suggested a definition describing pharmacoinformatics as Primary sources / Literature: Original research published as articles in peer-reviewed journals. PHARMACOINFORMATICS (OR PHARMACY INFORMATICS) Conference proceedings & symposia The expectation was that drug information would be stored in the center and retrieved, selected, evaluated, and disseminated by the specialist. INTRODUCTION TO THE CONCEPT OF DRUG INFORMATION "the scientific field that focuses on medication-related data and knowledge within the continuum of healthcare systems — including its acquisition, storage, analysis, use, and dissemination — in the delivery of optimal medication-related patient care and health outcomes." Examples: Technical reports Dissertations Offer analysis or restatement of primary sources. Visuals: Aim to summarize, interpret, reorganize, or otherwise provide an added value to primary sources. Usually broader and less current than primary literature Contain extensive bibliographies → useful for finding more information on a topic. Literature review articles & meta analysis Visuals: DRUG INFORMATION RESOURCES Secondary sources / Literature Answer drug information queries from patients and health care professionals Examples: Books Publish newsletters, journal columns, bulletins Edit written materials for publication Develop medication use policies & Analyse its clinical and economic impact Visuals: Provide information support for other departments Information obtained from primary and secondary source and arranged in a manner to represent a composite of the available information. Manage medication use review (DUR) & other quality assurance activities Sources that index, abstract, organize, compile, or digest primary or secondary sources. Maintain internal data collection/ documentation A. Service Initiate follow-up calls Good place to look up facts or get a general overview of a subject. Tertiary sources / Literature MAIN SCOPE OF DIS ACTIVITIES Scan and evaluate literature ❑ Dictionaries Develop and update drug formularies and therapeutic guidelines ❑Handbooks ❑ Databases Coordinate pharmacy and therapeutics committee (PTC/DTC) activities Examples: ❑ Manuals Handle product complaints ❑ Encyclopaedias Initiate or mediate drug recalls Participate in regulatory affairs Report and monitor adverse drug reactions (ADRs) Serve as preceptors for students or residents PHARMACY DATABASES Train representatives and personnel Need to consider how crucial the information is to patient care when deciding how far to search B. Education / Training Proving a negative is more difficult – you need to know when to stop How many sources to search for drug information: Delivers seminars, presentations, or lectures Try to find the same answer in 2 to 3 independent sources, so you can be confident about it Conduct research (in a supportive role) Present all viewpoints Present the reasons the other viewpoints are weak Present the reasons for the superior viewpoint Conduct research as principal investigator How to formulate your response in case of contradicting references or different viewpoints: USE LOGICAL ARGUMENT Provide consultancy and contracts on drug information projects C. Research Evaluate new products Restate the concluding statement to support the superior viewpoint Perform quality assurance activities Consider getting your answer checked Perform drug-use evaluations Administrative support Think about the enquiry from a different perspective Use the basic chemistry, pharmacology or pharmaceutics of the medicine in question Coordinate continuing education (CME) programs / CPD (continuing pharmaceutical development) Allocation of time Try to work it out from basic principals (Especially useful for new medicines) DIS Only answer if you feel competent Financial support DI Library Training What to do if you can’t find an answer: Refer your enquirer elsewhere if needed Workload Consider getting your answer checked Lack of resources for basic communication infrastructure FACTORS INFLUENCING SCOPE OF ACTIVITIES OF DIS CENTER Don’t be afraid to ask for advice Main problem in DIS DIS Document who you spoke to and what they said Poor access⛔to reliable information, especially at the periphery Biased flow of information (public health vs commercial interest) Timely Basic facilities Critical success factors for DIS exchange Current Accurate CHARACTERISTICS OF EFFECTIVE RESPONSE Complete Concise Contact points/persons Drug information sources Consistency and commitment Many studies have described the economic benefit of maintaining a drug information center or related activity in medical institutions or hospitals. Well Referenced Clear and logical Objective and balanced One study examined the economic impact of drug information services responding to patient specific requests. Do not guess. ECONOMIC BENEFIT OF A DRUG INFORMATION CENTER Patient privacy must be maintained. Response is not necessary if the inquirer intends to misuse or abuse the information that is provided. Another study examined the drug cost avoidance and revenue associated with the provision of drug information services, Organize information before attempting to communicate the response to the inquirer The annualized drug cost avoidance plus revenue was 2.6 million dollars. knowledge in research design, methodology and biostatistics GENERAL GUIDE WHEN RESPONDING TO ENQUIRIES Tailor the response to the inquirer’s background. The resultant cost benefit ratio was found to be 2.9:1 to 13.2:1. Most of the cost savings resulted from decreased need for monitoring (e.g., laboratory tests) or decreased need for additional treatment related to an adverse effect. Expert in critical appraisal and evaluating clinical literature for validity and applicability. Tell the inquirer where the information was found. Should be aware of the most up to date sources of information Alert the inquirer of a possible delay when it takes Longer than anticipated to answer the question. Ability to use a systematic approach to find needed information. Ask if the inquirer’s question is answered by the information provided. Ability to edit information to facilitate decision making. SKILLS / QUALIFICATION OF PHARMACIST TO RUN DIS Search the facts & gather information about the question from reliable resources. Should have good communication skills. Computer literate. List the relevant facts and information accurately. Organize the information (Introduction, body, conclusion). Should be a member of pharmacy and therapeutics committee (PTC/ DTC) RESPONDING ORALLY TO ENQUIRIES Pharmacotherapeutics Practice giving the oral report. Speak clearly and deliberately. DI Pharmacists must be trained about: Document the enquiries and the answer. Literature sources Systematic approach and techniques of searching Literature appraisal Poison information is a specialized area of drug information. A specialist in poison information requires expertise in clinical toxicology to be able to obtain a complete history that correctly assesses the potential severity of exposure Poison control centers must be prepared to provide information on management of any poison situation, including household products, poisonous plants and animals, medications, and other chemicals. POISON INFORMATION / CONTROL SERVICES EXAMPLES OF DI ENQUIRIES ( The responsibility DIS pharmacists extends beyond simply providing an answer to a question. Because of the type of information that the specialist provides, nearly all requests for information to a poison control center are urgent. Knowledge of pharmacotherapy alone does not ensure success. In case you’re asked the same question again. Document every stage, Why? Enquirer’s details and contact information. All the details about the question, drug history, PMH and Patient details (if the enquiry is patient related). ! Although the type of requestor, query, and setting can vary, the process of formulating an effective responses remains consistent. THE IMPORTANCE OF DOCUMENTATION This determines the type of response that will be given. Document where did you search (e.g., titles, edition numbers, page numbers, URLs), search terms used & what was found. Step 1 (Secure demographics of the requestors): The absence of sufficient background information and pertinent patient data can greatly impair the process of information synthesis and the ability to formulate effective responses. What to document? Document your answer exactly as given to the enquirer. Even questions that are not related to patient care must be viewed in their proper context Document who you fed back to and when. Requestors of information are typically vague in verbalizing their needs and generally provide adequate information only when specifically asked and/or thoughtfully prompted. Keep copies of e-mails, letters etc. Any ethical concerns and why you took the action you did. Third party enquiries It’s not always appropriate to answer an enquiry – e.g: Requestor'sname,profession,andaff iliation Howcantherequestorbecontacted(e. g.,pager,email,verbal)? Record if you find nothing. Protect the patient’s relationship with other professionals Moreover, isolated information is not sufficient for formulating responses to questions or ensuring proper patient management. Responses and recommendations must often be thoughtfully synthesized using information and knowledge gathered from a number of diverse sources. “If it’s not written down, it didn’t happen” If you seek advice from expert as part of your research, document who you spoke to and what they said. Rather, it is to assist in resolving therapeutic dilemmas or managing patients’ medication regimens for their entire therapeutic outcome. ! In fact, it is uncommon to find comprehensive answers in the literature that completely and effectively address specific situations or circumstances that clinicians encounter in their daily practices. Other colleagues can see what advice you’ve given. To demonstrate that the advice you gave was correct and up-to-date at that time. ) Is it always appropriate to answer an enquiry ? Although these requestors may seem confident about their perceived needs, they may be less certain after further probing. THINK ABOUT ETHICAL ISSUES Illicit drugs FORMULATING AN EFFECTIVE RESPONSE Step 2 (Obtain background information): Requestors, regardless of background, are often uncertain about the nature and extent of information that should be disclosed in order to derive the most optimal assistance. Critical information that defines the problem and elucidates the context of the question is not readily volunteered but must be expertly elicited. Good communication skills (both listening and questioning) are essential for gathering relevant information, discerning the real question, and identifying the genuine needs of the requestor. ✓ Does the question pertain to a specific patient? Before attempting to formulate responses, one must consider several important questions to ensure that they understand the context of the query and the scope of the issue or problem. ✓ Has pertinent patient history and background information been obtained? ✓ What are the unique circumstances that generated thequery? ✓ When is the information needed and in what format (e.g., verbal, written)? ✓ How will the information provided be used or applied? Step 3 (Determine and categorize the ultimate question): Step 4 (Develop strategy and conduct research): Step 5 (Perform evaluation, analysis & synthesis): Step 6 (Formulate and provide response): Step 7 (Conduct follow-up and documentation): Putting the pieces of information together to form ultimate question and once it has been determined, the next step is to categorize the question Strategies should be developed with a typical algorithm with three essential components; Provider should take time to evaluate the information, analyze and then synthesize it into a good reply. An outline should be established to help formulate a response to the drug info request. Its important to have; introduction, body and conclusion Checking with the requestor to make sure his/her question has been sufficiently and completely answered Of vital importance is to document all the steps taken in this process. tertiary- secondary-primary literature