Drug Information Lecture 3 PDF

Drug information Lecture 3 Background question inquiry and reply Should be a dialogue. The sequence and exact wording of each background question must be dependent on the flow of the verbal interaction. 1. Requestors who are intermediaries in the transfer of information present a sp...

Drug information Lecture 3 Background question inquiry and reply Should be a dialogue. The sequence and exact wording of each background question must be dependent on the flow of the verbal interaction. 1. Requestors who are intermediaries in the transfer of information present a special challenge for obtaining background. e.g., medical students, nurses, pharmacists or generally anyone involved in the process that is not truly the end user of the response. 2. In some situations, the intermediary may not have sufficient information to satisfy background questions. 3. When dealing with intermediaries, one must decide: ▪ To work with them (educate them concerning the information needed and why it is needed) OR ▪ Bypass them (interact with the end user of the information directly). Ultimate Question/Categorization of Question  Original Question Ultimate Question The subject that is actually The question is that asked researched by the by the requester responder. If a male asks about the effectiveness of β-blockers in hypertension, and if there are better alternatives; he might actually want to know about their adverse effects (like sexual dysfunction) The real (ultimate) question would be: Do β-blockers cause sexual dysfunction?  Thus, the final response will not agree with the initial question. However, the requestor will be satisfied with the response provided. This demonstrates that refocusing the requestor’s question was useful for drug information requests. The determination of the ultimate question is important for effective use of the modified systematic approach.  If background information is obtained correctly, the ultimate question is easily known. If adequate background information is not obtained, the determination of the ultimate question may not be possible. It is critically important that the requestor confirms the ultimate question prior to categorization and the development of a search strategy.  Once the ultimate question has been decided and acknowledged, the question is categorized. The categorization is useful not only for the initial development of the search strategy, but also for the determination of resources to be maintained. The β‐blocker case, again: When a male asks about the effectiveness of β-blockers in hypertension, and if there are better alternatives; he might actually want to know about their adverse effects (like sexual dysfunction). In this case the ultimate/real question would be: do beta‐blockers cause sexual dysfunction? Thus, the final response will not agree with the initial question. However, the requestor will be satisfied with response provided. Search Strategy 1. The categorization of the ultimate question prompts the resource selection process, e.g., the categorization of a question as "adverse effect" suggests the use of adverse effect-oriented resources. 2. Once resources have been selected, they are prioritized based on the probability of their containing the information or data desired. 3. Without prioritization, resources may be utilized based on ease of access or degree of comfort instead of probable efficiency. Data Evaluation, Analysis, and Synthesis 1. The information retrieved must be objectively critiqued. 2. The techniques and skills for literature evaluation and clinical application of statistical analysis are needed in this step. 3. Application of these skills at this step is one of the opportunities to differentiate the professional from the technician through using the modified systematic approach. 4. The analysis and synthesis must be performed with consideration of the background information, obtained previously, for the response to be pertinent and useful to the requestor. Formulation and Providing Response  Clearly inform the requester when one course of action is more desirable than an alternate action. You must provide a response. Verbal or Written? ✓Most of the cases → verbal ✓Some cases → require a written response, e.g. formal requests. If the literature includes conflicting data that must be presented to the requestor, one may need to use a logical argument. Format for Logical Argument in Response Formulation Step I. Present the competing viewpoints or considerations Step II. State the assessment of the literature or information reviewed and claim the superior viewpoint Step III. Succinctly refute the major strengths and present weaknesses of the inferior viewpoint Step IV. Defend the major weaknesses and promote the strengths of the superior viewpoint Step V. Reiterate the final assessment in support of the superior viewpoint.  Should only one side of the conflict be presented, the requester may not benefit from the complete picture or may mistrust the responder on later learning that another aspect of the conflict was not represented. Despite the setting or circumstances, the formulated response must be concise yet adequately comprehensive.  Follow-Up, Follow-Through, and Documentation To determine the consequence of your advise, this is important and may be possible in clinics and hospitals. Maintain a log book.  Follow up It is the process of verifying the appropriateness, correctness, and completeness of a response following the communication. More professional → gives you higher credibility. It is important for: 1. Ensuring that information was received. 2. Document your drug information questions so you can refer back to them. 3. If you see this question in the future, this will help serve as a reference point. Follow up Feedback can be taken by email, telephone or written format. Certain circumstances mandate follow-up, e.g., patient-specific requests, especially if judgmental (i.e., therapeutic assistance or dosing recommendations). e.g. a patient was asking about the dosing regimen of a drug; and the decision was based on assumptions or “soft” data (weak evidence). So, you do follow‐up to see if the response was adequate. Follow through It is the process of readdressing a request based on the availability of new data or a change in the situation or circumstances that were decisive factors in the synthesis of a response. A new publication Patient developed renal/hepatic failure etc. A good practice (professional) Follow through Examples: a) The basis of a decision to use a novel therapy in a patient may be confirmed or refuted according to a new article. b) The development of renal failure (as a comorbidity) may prompt an update of the original response. Documentation It is essential for 1. Decreasing liabilities 2. Improving service 3. Promoting the development of a continual service Can be very simple or comprehensive (detailed) In all cases, it must include: ultimate question, searched materials, the response, follow‐up and follow‐through procedures