Drug Information Center

Objective
1. 2. 3. 4. 5. Enhance the image of the career. Gain self-confidence therefore you can play your natural role again in the health system. Promote evidence based practice. Meet the patients needs while providing Pharmaceutical care. Improve the patient adherence.

Definition
Knowledge of facts through reading, study, or practical experience on chemical substance that is used in 1. Diagnosis 2. Prevention 3. Treatment of a disease It covers all types of information including; objective and subjective information as well as information gathered by scientific observation or practical experience.

Drug Information Service

1. It describes the activities undertaken by pharmacists in providing information to optimize drug use. 2. It is those services which cover the activities of specially trained individual to provide accurate, unbiased, factual information in response to patient oriented drug problems that are received from health care professionals. Make Search Strategy and Start the Research You need to know where to look for the kind of information you need. You need also to have a sense of whether or not the information that you find is of good quality

Classification of Scientific Literature

Primary Source Patients Conference Paper Case Report Journal Articles Correspondence Thesis Secondary Source: Bibliography Review Abstracting Index Services

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Tertiary Source:
Text Books 1. Reference books (Applied therapeutics) 2. Review articles 3. Compendia (BNF, AHFS) 4. Practice guidelines Evaluate Tertiary Literature Evaluate the Quality and Credibility: Does the author have sufficient credentials and/or experience? Is this the most recent edition? Are statements of fact appropriately supported by citations? Is the reference easy to use? Advantages of Tertiary literature: Convenient Concise compact Provides much information needed for a common practice.

Drawbacks:
Information may be incomplete. May not be enough detail. Information may be out of date.

Search Strategy
Sometimes a search will require all levels of the pyramid. A tertiary source to familiarize yourself with the topic. Secondary to identify appropriate primary literature.

Carefully evaluated primary literature.

1. 2. 3. 4. Read and evaluate clinical studies. Introduction to clinical studies Introduction to critical appraisal of clinical study

Evaluation of websites that provide health information.

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Drug Information Role

To be a competent pharmacist, you must be able to complete the required task to the defined standard and to do this on every occasion that the task arises. This is why competence standards have been developed, so that there is a measurable standard for each of us to evaluate ourselves. The Competency Standards for Pharmacists in Australia describe eight functional areas covering a broad area of professional performance. 1. Practice pharmacy in a professional and ethical manner 2. Manage work issues and interpersonal relationships in pharmacy practice 3. Promote and contribute to the quality use of medicines 4. Dispense medicines 5. Prepare pharmaceutical products 6. Provide primary health care 7. Provide medicines and heath information and education 8. Apply organizational skills in the practice of pharmacy. Remember your formulated plan should include of the following processes: Having collated the learning objectives on your activity sheets, start preparing your plan List all the possible options to complete your plan Use SMART (Specific, Measurable, Achievable, Relevant, Timely) objectives so that you will be able to assess the value and impact of the learning Be clear about the intention of your plan/s, the timeline and the

1.Practice Pharmacy in a Professional and Ethical Manner This includes those Competency Units that address the legal, ethical and professional responsibilities of pharmacists. It encompasses the responsibility pharmacists accept as members of a profession to commit to life-long learning and their obligation to maintain accepted standards of behavior and professional practice, including those imposed through legislation. The Units presented in this Functional Area underpin all professional activities undertaken by pharmacists. Pharmacists will derive maximum benefit to their professional practice by reading these Units together with each or any of the professional standards as these Units underpin all professional services and activities Practice legally Practice to accepted standards Pursue life-long professional learning and contribute to the development of others 2. Manage Work Issues and Interpersonal Relationships in Pharmacy Practice This encompasses those competencies that are required to manage problems and interpersonal issues that arise in the course of professional practice. The competencies covered include communication and negotiation skills, problem solving, conflict resolution and assertiveness, all of which are deemed essential to the effective practice of pharmacy. Not surprisingly, there are noticeable interdependencies between the competencies. i. Apply Communication Skills The ability of pharmacists to communicate effectively (i.e. the recipient of the communication receives the intended message) with other pharmacists and health professionals, staff, patients, careers and members of the public individually or in groups. The quality of pharmacists communication and the professional relationships they establish are key factors in determining their effectiveness as health professionals. Effective communication is a critical success factor where pharmacists work as members of multidisciplinary health care teams (e.g. in providing
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medication management review services) because mutual respect and trust must underpin the team relationships for members to work to best effect for their patients. ii. Participate in Negotiations Address Problems Manage Conflict Apply Assertiveness Skills 3. Promote and Contribute to Optimal use of Medicines This is concerned with those aspects of pharmacists activities that are specifically directed to optimizing the use of medicines and therapeutic outcomes. Clinical pharmacy practice seeks to achieve the best possible quality use of medicines with the objective of optimizing patient outcomes that is optimizing the therapeutic benefits and minimizing the risk of harm. Pharmacists have a pivotal role, within an environment characterized by comprehensive, team based models of care, such as medication management reviews and assisted disease state monitoring and management. In this environment pharmacists are becoming increasingly active in contributing to the selection, monitoring and evaluation of medication treatment with a view to promoting therapy. i. Participate in Therapeutic Decision Making This is concerned with the way in which pharmacists work to improve health outcomes by evaluating the medication treatment of individual patients and providing advice and/or recommendations on the preferred medication treatment and/or other treatment options. All pharmacists are capable of contributing (on the basis of scientific, pharmacokinetic and therapeutic evidence) to the selection, monitoring and evaluation of medication treatment. In this role they accept responsibility for making recommendations on and providing relevant information about medicines (including the choice of drug, dosage form and dosing regimen) to other health professionals involved in the care of patients. They also have responsibility for providing medicines information to patients and/or careers that will enhance their understanding and adherence with a view to improving therapeutic outcomes. Whatever the setting, pharmacists have a duty of care to patients to use the information they can access to provide the best possible therapeutic advice for improving the health and well being of patients. This includes obtaining patient histories, review of medication treatment, recommendations on assisting patients with self management and facilitating patient follow up. ii. Provide ongoing Pharmaceutical Management This is concerned with the role pharmacists have in following up individual patients to verify they are achieving the intended benefits and desired outcomes from medication treatment without experiencing unnecessary adverse effects or problems in managing their medication treatment regimen. iii. Promote Rational Drug Use This encompasses the role pharmacists have in monitoring, assessing and contributing to changes in existing and evolving trends in drug use across institutional and/or community based patient populations in order to improve the quality use of medicines. The focuses on the responsibility pharmacists have to be informed about the way in which specific drugs are being used in their area of practice. It also focuses on their responsibility to positively influence trends in usage by examining use in relation to established guidelines, criteria and/or standards and initiating actions to improve use. Apart from the QUM objectives associated with monitoring trends in drug use, pharmacists have a responsibility to stay informed in this area as a means of understanding prescribing patterns and assessing the impact on their own work practices and environment. The way in which particular
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drugs are used across patient populations is also of interest because of their potential to impact on pharmacy workload and costs to both health care institutions and the community. The pharmacists role in promoting QUM is consistent with them working to influence trends in drug use in selected medical conditions or of particular drugs where they identify opportunities for improvement. The degree of formality attached to this process will vary with the work setting. In institutions it is likely to be accomplished through a formal review program under the auspices of a Drug and Therapeutics Committee. In the community it may be achieved through the provision of objective, evidence based clinical information (e.g. via academic detailing or a presentation coordinated through the local Division of General Practice) in association with a clinical audit program of the type offered by the National Prescribing Service. This also includes circumstances where pharmacists have a greater role in investigating and modifying the way in which drugs are used to treat particular conditions or patient groups. In these situations pharmacists will be expected to have a greater knowledge and understanding of the issues associated with the design and conduct of processes such as DUE and clinical audit and of methods proven effective in promoting change. They will have the capacity to identify relevant guidelines, criteria and/or standards and to gain support and commitment for a review. They will also have greater capacity to convince those involved in the prescribing, dispensing and administration of drugs of the need for and benefits to accrue from implementing changes in how drugs are used. 4. Dispense Medicines 5. Prepare Pharmaceutical Products 6. Provide Primary Health Care 7. Provide Medicines and Health Information and Education Retrieve information Evaluate and synthesize information Disseminate information 8. Apply Organizational Skills in the Practice of Pharmacy Plan and manage work time Manage own work contribution Supervise Staff

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Requirements for Drug Information Centers Summary

All countries should provide drug information services either independently or as part of a regional network. The service should include collecting, reviewing, evaluating, indexing and distributing information on drugs to health workers. Drug and poisons information centers are best established within major teaching hospitals. This allows access to clinical experience, libraries, research facilities and educational activities. Drug and poisons information centers should be supported by government authorities. They require clinically trained staff with access to specialist support. In some cases drug information services can be provided in conjunction with toxicology services and Pharmacovigilance programs.

INTRODUCTION Access to authoritative and independent information is fundamental for the rational and effective use of drugs. Information must be available in a format suitable for health practitioners and relevant to current clinical practice. WHO recognizes independent drug information centers as a core component of national programs to promote the rational use of drugs? This document outlines the aims and functions of drug information centers which primarily provide support for healthcare professionals. The application of these principles will vary with location, resources and regional health policies. To be effective, drug information centers must be integrated with clinical services and provided with adequate support for resources and training. The FIP Pharmacy Information Section supports the development of drug information centers and will continue to encourage communication and cooperation between drug information practitioners. BACKGROUND Drug information is the process of providing information on the safe and effective use of therapeutic and diagnostic pharmaceuticals. The term medicines information is also used and has the same meaning as drug information in this context. All countries require drug information support to optimize the use of pharmaceuticals. Internationally there are many disparities in access to drugs and the knowledge needed to use them appropriately. There are significant deficiencies in the use of drugs even in countries with well developed regulatory authorities, local manufacture and sophisticated health delivery systems. In most countries the pharmaceutical market encourages the development and sale of drugs for profit. While this model has created many innovative therapies and efficient production processes its output does not necessarily correspond with overall health needs. For example, the inappropriate use of antimicrobials can lead to resistance and expenditure can be wasted on drugs to control diseases which could be better controlled by improvements in diet or lifestyle. Poor adherence to prescribed therapy is a major problem, particularly in chronic conditions. There is also a substantial use of herbal and traditional remedies in many countries. This raises issues of efficacy and safety especially when these therapies are combined with conventional drugs. The supply of drugs to a community must be balanced by access to impartial information which supports national healthcare priorities. Drug information is essential to the use of drugs. Inappropriate use is a waste of precious resources and increases the risk of avoidable drug-related toxicity. Governments should recognize this requirement and provide financial support for organizations which offer independent drug information to healthcare workers and the general community.

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Pharmacists and other healthcare workers routinely provide drug information to the community. Dispensed drugs should always be accompanied by appropriate directions for consumers, and pharmacists should have the skills and resources to provide basic information to other health professionals. These functions can be described as drug information services and can be distinguished from the more specialized activities of a drug information centre. Adequate pharmaceutical education and clinical training is required for pharmacists to provide drug information services. Drug information centers support the functions of healthcare professionals to deliver high quality drug use. They focus resources and specialist, staff to answer complex questions, provide education and training in drug information practices, and assist with other public health initiatives. Drug information centers can function locally or regionally and should liaise with other centers to maximize the use of resources and share expertise. Interactions between drug information practitioners can be within geographical regions, within specialist areas of practice or between centers which share common interests or languages. Communication between a centre and its clients is of paramount importance. The appropriate form of this communication will depend on local practices and infrastructure. For drug information centers, adequate communication via the Internet is essential for access to resources and international exchange of information and support. Before establishing a new centre, a senior member of staff should visit established centers to determine the range of resources which are most appropriate for the new service. Training in an established centre should be considered for staff developing a new centre, Different levels of drug information are required by healthcare providers and recipients. Medical practitioners and pharmacists need access to the information required by regulatory authorities for new drugs. Healthcare workers who have limited prescribing authority require a subset of this information together with protocols for diagnosis and treatment. All health providers require information resources for therapeutic decision support, implementation and monitoring of outcomes. People receiving medication need instructions for use of prescribed and over-thecounter medicines. Additional information may be necessary for high-risk groups (e.g. pediatrics, geriatrics, pregnancy and breastfeeding) and in some diseases (e.g. diabetes, kidney and liver dysfunction). Strategies to promote adherence include once-daily dosing, and drug selection and dosing to minimize adverse effects. FUNCTIONS The primary function of a drug information centre is to respond to enquiries on therapeutic drug use. Most centers provide services to health professionals and some also offer a service to the public. In some cases toxicology information is also provided. Where patient care is the primary focus, drug information practitioners must have adequate clinical training and experience to complement their information retrieval skills. Every enquiry should be handled within a reasonable period of time and at a level appropriate to the nature of the enquirer. A drug information centre must be geared to the needs of its users. Information must be dependable, timely, and of the highest possible standard. The centres expertise should be readily accessible to all potential users. Standard operating procedures should include an approach to categorizing enquiries and maintaining search patterns for common types of questions. This facilitates the optimum use of available resources.

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Drug Evaluation Assessment of therapeutic drugs is an important function of a drug information centre. The centre must have access to the principal medical and pharmaceutical journals. The staff should be capable of critically assessing the medical literature, and information from industry and media sources. Critical analysis of published research includes an interpretation of the results in terms of relevance to local practice. Therapeutic Advice Many centers offer patient-related drug information as their primary activity. This requires an adequate understanding of disease states and therapy. It also requires access to appropriate resources for rapid support in situations where response time is an important factor in delivering optimum therapy. Therapeutic advice includes factors such as efficacy, optimum dosage, interactions, adverse effects, mode of administration, effects of other disease states, and strategies to promote adherence in chronic conditions. Pharmaceutical Advice Most other enquiries will relate to pharmaceutical preparations generally and include issues of availability, formulation, cost, storage and stability. Education and Training Educational activities are important to support the quality use of drugs. Providing information to health professionals and the public is part of continuing health education. A drug information centre can also support national and regional authorities responsible for drug use programs. Training graduate and undergraduate students is an important aspect of overall clinical training. Healthcare practitioners need to understand the scope and functions of drug information centers in order to utilize the services they offer. Dissemination of Information Drug information centers can disseminate information in the form of drug monographs, bulletins and websites. Editorial skills are important for these functions. The International Society of Drug Bulletins (ISDB) runs training courses for editors and, together with WHO, is preparing a manual for developing independent drug bulletins. Research Drug information centers should be involved in research activities including pharmacoepidemiology, e.g. drug utilization studies and Pharmacovigilance. The nature of enquiries received can be used to plan educational programs within the centre or provided to organizations responsible for improving the quality of drug use. Specialist centers should also assess the quality and relevance of commonly used information resources. ANCILIARY ACTIVITIES Pharmacovigilance Drug information centers often have a role in programs which monitor adverse drug reactions. Enquiries about a potential adverse reaction can lead to reports of suspected reactions and research may be required to assess the likelihood that a drug has contributed to a reaction or for subsequent patient management. Some centers may serve as adverse drug reaction monitoring sites for hospitals or regions. Centers with regional responsibilities should be a member of the WHO Programmed for International Drug Monitoring.

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Toxicology Most countries have one or more dedicated poisons information centers. However, there may be economic or personnel advantages in combining a drug information service with a toxicology service. Toxicology services provide information and advice on the diagnosis and treatment of poisonings. Suitable information should be available to health professionals and the general public. Personnel need to be specifically trained in toxicology. They must be able to respond to requests for information on the acute management of poisoning and know when to refer potentially severe cases. Toxicology services are best located within hospitals where there is liaison with clinicians who treat patients with poisoning. This provides an opportunity for staff to enhance their clinical understanding of poisoning and its management. A poisons information centre should also provide a public health service through educational programs to reduce the incidence of poisoning. Centers should systematically collect data on the circumstances leading to poisonings and the outcome of specific cases. This can form the basis for research in the epidemiology of human toxicology. RESOURCES Drug information centers should be organized on a cooperative model involving a multidisciplinary team. Where possible, existing resources such as a libraries, computers and databases should be used. Personnel The number of personnel required will depend on the range of activities offered and the hours of service. A centre should aim to provide a direct service during periods of major demand by its clients. For patient-related enquiries this is likely to be when clinic consultations occur and during peak periods for hospital functions. The professional staff should include a full-time clinical pharmacist or a clinical pharmacologist. Clinical training and experience is essential for effective communication with clinicians. Other important attributes are computer skills, literature analysis, and editing and library management. Management is an important component of a successful drug information centre. All pharmacists provide drug information services to some extent during dispensing and consultation services; however, a centre specializing in drug information requires coordination, monitoring and promotion. The managers responsibilities include: Establishing and maintaining a viable financial base Staff recruitment and coordination Training Promoting the service Identifying and maintaining appropriate resources Data management and reporting Quality assurance and improvement Liaison with colleagues, professional organizations. Strategic development. The manager of a drug information centre should have experience with service delivery as well as managerial skills. Medical and non-medical specialists may be required as additional resource personnel. As the centre expands, it may be necessary to include some of these specialists as advisers on a part-time basis. It is also necessary to have secretarial assistance and support staff for maintaining equipment and cleaning. There should be a career structure for all professional staff with the possibility of additional training and advancement. Twinning arrangements between established

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centers and developing centers can facilitate the exchange of staff for education, training and sharing of experience. Texts and Databases The centre should maintain its own library of commonly used resources. Additional books and other publications should be accessible in hardcopy or electronically from external sources. Data can be extracted from textbooks, databases, data sheets, reports and scientific journals. Information from previous enquiries can also be used. An adequate literature search requires an understanding of available sources and their limitations, and training in the use of indexing terms and functions. Access to the full text of medical and pharmaceutical journals is necessary to assess the value and relevance of research. Primary information sources provide unique data which has not been previously published. This includes the results of research studies and descriptions of unexpected clinical experience such as adverse drug reactions. Summaries or further analysis of primary information (secondary or tertiary sources) aim to make the primary literature more accessible and easier to apply to practice. Formats include literature reviews, databases and textbooks. The most appropriate type of information will depend on available resources and the time available for access. Many patient-related questions can be answered from basic textbooks. General questions of optimum drug use or safety will require access to primary sources. Facilities Basic equipment required for a centre includes: Furniture (desks, chairs, shelving) Communications (telephones, facsimile, internet access ) Computers (including external data backup, printer) Software (for word processing, spreadsheets, databases and presentations) Photocopier Textbooks and electronic information resources. TRAINING Specific training is required for drug information practice. In addition to clinical knowledge and experience, drug information practitioners require: Communication skills to receive and comprehend enquiries Knowledge of all available resources Literature searching skills Capacity for critical analysis Writing skills Ability to summaries complex or conflicting data. New staff should receive dedicated training or validation based on a standard operating procedure. A program of continuing education should include clinical topics and techniques used specifically in drug information. QUALITY ASSURANCE The activities of the drug information centre should be carefully documented. Standard forms or electronic databases can facilitate recording of enquiries. An effective retrieval system is essential to locate previous enquiries, monitor workload and categories the types of enquiries received. It can also facilitate quality assurance programs based on analysis of selected enquiries and failed

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deadlines. The recording process should provide secure, long-term storage and the confidentiality of enquirers should be respected. Drug information centers have a responsibility to provide the highest possible standard of service. This will include an assessment of staff, regular review of calls taken and answers provided, and periodic review of resources and procedures. The process should continuously identify potential improvements and document progress towards implementation. Direct output can be monitored through peer review of enquiries. A random selection of enquiries can be regularly reviewed and feedback sought from enquirers. Where possible, the peer review process should include comments from one or more external experts, e.g. a drug information pharmacist or clinical pharmacologist. NETWORKING Cooperation between drug information centers can help to optimize limited resources and enhance overall service levels. Networking can involve two or more centers, and includes regional, national and international links. Networks provide opportunities for Sharing resources and experience Establishing standard operating procedures Quality assurance programs with external review Inter-site training Increased awareness of practice in different locations and cultures.

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