Drug Information & Evidence-Based Practice 2024 PDF

DRUG INFORMATION & EVIDENCE-BASED PRACTICE Kristin M. Janzen, PharmD, BCPS Clinical Associate Professor & Division Head | Pharmacy Practice 27 August 2024 1 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 COURSE OVERV...

DRUG INFORMATION & EVIDENCE-BASED PRACTICE Kristin M. Janzen, PharmD, BCPS Clinical Associate Professor & Division Head | Pharmacy Practice 27 August 2024 1 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 COURSE OVERVIEW 2 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 INTRODUCTION TO COURSE TA’S & AAA’S TAs AAAs Lakshya Brianna Earskine Sakthisivabalan Erica Jermain Ayobami Aiyeolemi 3 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 FLIPPED CLASSROOM Pre-class In-class ◼ Pre-recorded lecture videos ◼ In-class quiz ◼ Most ~30 min long ◼ Questions about pre-class videos ◼ Must be watched prior to class ◼ One quiz will be dropped – must have ◼ Some weeks have assigned pre-class taken quiz activities ◼ In-class activities ◼ Eg, drug info resource review, read clinical ◼ Usually group assignments – due dates trial noted on syllabus 4 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 CLASS SCHEDULE 9-9:30am: optional Q&A 9:30-9:40am: break 9:40-9:50am: in-class quiz 9:50-10:50am: in-class activities 5 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 ATTENDANCE POLICY ◼ Course attendance is required  you will be working in groups throughout ◼ In-class activities will be graded through a variety of means: ◼ Instapoll questions ◼ Large group discussions ◼ Written team reports ◼ You will not get credit for any activities that you are not present for unless specifically excused 6 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 GROUPS ◼ You will identify a group of 4-5 students to be your team in this course AND OTCs ◼ Several rules: ◼ You must have the same group in both classes ◼ You will not be able to change during the semester ◼ You must sit with your group in both courses ◼ Sign up by deadline of 8/30 at 5pm – after this time, you will be randomly assigned 7 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 IN-CLASS ASSIGNMENTS ◼ Written reports ◼ Complete during class as a group ◼ Turn in by Wednesday at 5pm after class ◼ Instapoll ◼ Completed during class after/during group discussion ◼ Individual answers ◼ DO count for credit  some will have correct answers, others will be participation 8 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 MAJOR ASSIGNMENT – JOURNAL CLUB ◼ This assignment (written journal club handout + presentation) will encompass 30% of your grade – 15% for each component ◼ Timeline ◼ The handout will be due on Wednesday, 10/30 at 5pm ◼ You will have two class sessions that the primary goal will be to work on your handout – use this time wisely! ◼ Presentations will occur during class on weeks of 11/5 and 11/12 ◼ Will only attend during dedicated time slot for your group 9 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 INTRODUCTION TO EVIDENCE-BASED PRACTICE 10 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 OBJECTIVES 1. Describe the pharmacists’ patient care process (PPCP) 2. Identify the three components of evidence-based medicine (EBM), and how EBM is related to evidence-based practice (EBP) 3. Explain the role of evidence-based practice in PPCP 4. Describe the steps involved in the systematic approach to responding to drug information requests. 11 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 OBJECTIVES CONT’D 5. List the types of drug information requests pharmacists commonly encounter 6. Compare and contrast the three types of resources (primary, secondary, and tertiary) and explain their advantages and disadvantages and hierarchy 7. Develop a strategy to locate evidence using the most appropriate and reliable tertiary resources given specific drug information requests. 12 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 PHARMACISTS’ PATIENT CARE PROCESS (PPCP) ◼ PPCP is a patient-centered approach in collaboration with other providers on the health care team to optimize patient health and medication outcomes ◼ (Joint Commission of Pharmacy Practitioners, 2014; https:// www.pharmacist.com/sites/default/ files/files/PatientCareProcess.pdf) 13 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 14 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 EVIDENCE-BASED MEDICINE (EBM)? Original The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual Definition patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research : (Sackett D, 1996) Working The integration of best available evidence with clinical expertise Definition and patient values into the decision making process for patient care (Sackett D, 2002) : 15 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024  COMPONENTS OF EBM Evidence Information retrieval: knowledge and skills Evaluate and interpret Best Synthesize the evidence Available Patient Values Evidence Patient preferences & concerns: cultural influences; religious/spiritual influences; psychosocial issues; age- Clinical Expertise related issues Competent practitioner: clinical skills, past Patient Clinical Other issues: insurance status; experiences, knowledge of disease & therapy Values Expertise access to care Knowledge of patient: health status, risk factors, personal values & expectations Knowledge of support services/network What do you do with the evidence? Translate evidence into practice ➔ evidence-based practice (EBP) Integrate EBP into every stage of the PPCP 16 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 SYSTEMATIC RESPONSES TO DRUG INFORMATION QUESTIONS 17 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024  Step 1: Obtain basic demographic information of requester You Receive the Step 2: Collect appropriate background information Question Step 3: Determine ultimate question and classify question Step 4: Develop strategy and conduct a systematic search of the literature You Search for Data Step 5: Evaluate and synthesize data Step 6: Formulate the response You Communicate Step 7: Evaluate your response the Response Step 8: Provide response and follow-up 18 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 RECEIVING THE QUESTION ◼ Who is asking the question matters  healthcare provider vs patients will have different focus ◼ Language, baseline knowledge ◼ Background information  Patient-specific? General knowledge? ◼ Pregnancy status, renal function ◼ Determine question & categorize Step 1: Obtain basic demographic information of requester You Receive the Step 2: Collect appropriate background information Question Step 3: Determine ultimate question and classify question 19 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 CLASSIFICATION OF DRUG INFORMATION REQUESTS General Categories Other Types of Questions adverse drug event general prescribing information bioequivalence OTC products availability identification (U.S. product) inactive ingredients in products discontinued products compounding/ formulation identification (foreign product) FDA-approved indications orphan drugs cost/ pharmacoeconomics IV compatibility/stability off-label uses (aka unlabeled investigational drugs dietary supplement/herbals lactation/breastfeeding uses) dosing (general) method of administration pharmacy practice veterinary information dosing for specific populations pharmacokinetics telephone/ address directory disease states (children, elderly, renal dysfunction, hepatic dysfunction) patient counseling medical/ pharmacy news consumer information legal-related issues drug-drug interaction pharmacology What is the focus of the drug-food interaction (includes poisoning/ toxicology interaction with alcohol) question being asked? drug-herb interaction/drug- pregnancy supplement interaction What type of information are drug therapy tablet/ capsule identification you locating? 20 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 SEARCH FOR THE DATA ◼ Search strategy ◼ Start with tertiary  secondary  primary literature ◼ This will lead you from summary/compilation data to trials & original research ◼ Not every question will need a full search of all components! ◼ Evaluate and synthesize data ◼ Ensure resources are reliable and well-done ◼ Consider the context of your question Step 4: Develop strategy and conduct a systematic search of the literature You Search for Data Step 5: Evaluate and synthesize data 21 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 STEP-WISE APPROACH Tertiary Difficulty of Secondar Lag Time Use y Primary 22 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 TERTIARY LITERATURE ◼ Tertiary literature - resources that collate and evaluate/interpret primary literature from multiple sources into a more concise, and frequently more usable or practical format (e.g., textbooks, compendia, review articles, full-text computer databases) Advantages Disadvantages easy and convenient access to the consider lag time majority of drug information information may not be complete requested possibility of bias usually contains references to original work review of literature often by experts on the topic 23 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 SECONDARY RESOURCES ◼ Secondary resources - bibliographic services designed to help retrieve journal articles (e.g. MEDLINE) Advantages Disadvantages quick access to the primary number of journals covered literature scope of coverage review a select segment of consider lag time the primary literature some sources require training to use effectively 24 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 PRIMARY RESOURCES ◼ Primary resources - published or unpublished works of original research and new discoveries that introduce new knowledge or enhance existing knowledge (e.g., clinical trials), usually published in biomedical journals ◼ Includes unpublished reports/information (e.g., new information or research results presented at a meeting of a professional society); frequently referred to as primary “information” ◼ Not all journal articles are primary literature (e.g., review articles, policy statements, position papers) Advantages Disadvantages current resource difficult to access directly foundation upon which other types information available is limited to the of information are based study described reader must have good skills in evaluating the literature 25 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 RESPONDING TO THE QUESTION ◼ Formulate the response ◼ Provide a recommendation, evidence, and important considerations ◼ Acknowledge alternative views ◼ Should be referenced! ◼ Evaluate your response ◼ Did you use appropriate language (patient vs provider?) ◼ Is it clear & concise? Step 6: Formulate the response ◼ Deliver your response!! You Communicate Step 7: Evaluate your response the Response Step 8: Provide response and follow-up 26 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 BREAK TIME! 27 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 TERTIARY RESOURCES 28 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 TERTIARY RESOURCE OBJECTIVES 1. List the more commonly used tertiary resources in pharmacy practice 2. Categorize each resource by its scope of coverage (e.g., general drug compendia, drug therapy, drug interactions, etc.) 3. For resources within the same category, compare and contrast their similarities and differences according to the guidelines for evaluating tertiary literature 4. Identify the most appropriate resource(s) for a specific drug information request 5. Demonstrate familiarity and efficient use of each resource 29 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 TERTIARY LITERATURE ◼ Tertiary literature - resources that collate and evaluate/interpret primary literature from multiple sources into a more concise, and frequently more usable or practical format (e.g., textbooks, compendia, review articles, full-text computer databases) Advantages Disadvantages easy and convenient access to the consider lag time majority of drug information information may not be complete requested possibility of bias usually contains references to original work review of literature often by experts on the topic 30 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 DETERMINING RELIABILITY AND APPROPRIATENESS Frequency of Editor(s) and/or publication Author credentials editorial board Use the most current credentials editions References Content Access/lack of references Scope of coverage: Look at the reputation general vs. specialty of the author/institution U.S. products? Foreign drugs? Prescription? OTC? Herbals? 31 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 KEY ONLINE TERTIARY RESOURCES * SEE HANDOUTS ON ONLINE TERTIARY DATABASES AND TUTORIAL (2A., 2B., 2C.) Facts and Clinical UptoDate Access Micromedex Comparisons Pharmacology Lexidrug Pharmacy eAnswers Access PharmacyLibra Medicines Stat!Ref ClinicalKey Medicine ry Complete Which specific resources/tool are you using within each database? 32 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 WHICH IS BETTER? 1. Which is better? A. A resource with concise summarized information (less on detail) B. A resource with detailed information 2. Which is better? A. Package insert B. Another general tertiary database 33 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 PEARLS Be selective with your choice of resources… not all are created equal Resources may have conflicting information Resources may have errors Reference at least 2-3 resources to answer a question Use the most appropriate resources, given a questions category Evidence-based practice = using the ‘best available resources” Not the most convenient resource 34 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 WHEN WORKING ON A QUESTION… 1. Analyze the question 2. Assign a question category 3. Start with tertiary resources: which ones? Remember EBP: “best available evidence/resource” 35 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 HANDOUT REVIEW Question Categories Tertiary Resource Table 2a. Tertiary resources overview 2b. Tertiary resources by category 2c.Tertiary resources – online databases 36 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 PRE-CLASS ACTIVITY (DUE BEFORE CLASS ON 9/3 – 9AM) Assignment on Canvas Compare and contrast the two resources ◼ Select two of the following online tertiary addressing the following: databases for review: 1. Identify five helpful features for each resource 2. Choose five different question categories for Facts and Comparisons ClinicalKey which you will compare and contrast the two eAnswers resources Micromedex AccessPharmacy ◼ Refer Question Category Handout on Canvas Clinical Pharmacology AccessMedicine ◼ Address the following: UpToDate LexiDrug ◼ Ease of locating the evidence ◼ Depth of the evidence provided 3. Rate your review 4. Include optional comments, observations, thoughts 37 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 HELPFUL HINTS: ◼ Your handouts on Canvas are helpful tools ◼ Follow the simple tutorial provided in your class handout ◼ Conduct sample searches. Here are some topics you may want to search, or find your own topics: ◼ Medications: lovastatin, fluoxetine, captopril, risperidone, glyburide ◼ Disease state: hypertension, hyperlipidemia, schizophrenia, chronic kidney disease,, type 2 diabetes, heart failure ◼ Be cognizant of what specific tertiary databases you are actually using ◼ Lexi-Drugs Online from UpToDate LexiDrug ◼ AHFS from Lexi-Comp ◼ DrugDex from Micromedex (aka in-depth answers) ◼ Drug interaction tool from Clinical Pharmacology 38 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024 DRUG INFORMATION & EVIDENCE-BASED PRACTICE Kristin M. Janzen, PharmD, BCPS Clinical Associate Professor & Assistant Division Head | Pharmacy Practice 27 August 2024 39 Drug+Information+-+Week+1+2024+-+Student+Copy - August 27, 2024