Systematic Approach for Answering a Drug Information Request:

Objectives When presented with a drug information question and given requestor demographics, determine pertinent background information. On determining and soliciting the most important background information, categorize the ultimate question and develop an efficient search strategy. On evaluating the drug information and literature obtained from a search, formulate a response appropriate for the sophistication of the requestor.

An essential component within pharmacy practice is the ability to effectively answer questions posed by health care professionals and the lay public. In 1975, Watanabe et al. presented a systematic approach for responding to drug information requests

Systematic Approach (1975) Step I. Classification of the request Step II.Obtaining background information Step III.Systematic search Step IV.Response Step V.Reclassification

Modified Systematic Approach (1987) Step 1: Secure Demographics of Requestor Step 2: Obtain Background Information Step 3: Determine and Categorize the Ultimate Question Step 4: Develop Strategy and Conduct Search Step 5: Perform Evaluation, Analysis, and Synthesis Step 6: Formulate and Provide Response Step 7: Conduct Follow-Up and Documentation

Demographics of Requestor The requestor's "profession“, or educational background (e.g., physician, pharmacist, nurse, patient) The presentation of the initial question provides insight to the requestor's sophistication and knowledge regarding the subject matter. However, it is important to more directly determine the requestor's position, training, and anticipated knowledge.

Background Questions (clarifying the question) The ability to obtain background information to develop a more complete picture of the question is essential for effectively using the modified systematic approach. To make you able to answer the question "Why is the requestor asking for this information?“

General Questions for Obtaining Background Information The requestor's name The requestor's location and/or contact information The requestor's affiliation (institution or practice) if a health care professional The requestor's frame of reference (i.e., title, profession or occupation, and rank) The resources that the requestor already consulted Whether the request is patient specific or academic The patient's diagnosis, other medications, and pertinent medical information The urgency of the request (i.e., negotiate the time response)

Background Questions Example: If you were asked “What is the dose of amoxicillin?” It is inaccurate to answer quickly that the normal dosage is 500 mg every eight hours. gathering background information is crucial The dose of this antibiotic depends upon a number of factors Determine if the question is in regard to a specific patient or general research for the treatment of a disease state. If the question is patient specific, important information to acquire would include the patient's age, weight, allergies, type of infection, concurrent disease states, other medications, and preferred dosage form (e.g., oral suspension, capsules, chewable tablets). the dose of amoxicillin can be 500 mg every eight hours for adults with pharyngitis or 2 grams as a single dose one hour prior to dental procedures for bacterial endocarditis prophylaxis. Other issues to consider are dose adjustment for renal impairment and interactions with concomitant medications.

Determine and Categorize the Ultimate Question Categorization of the question (request) A vital step in the systematic approach Allows for efficient use of the resources by providing the foundation of a logical progression process An all-inclusive resource with data to answer every drug information question does not exist References contain specific types of information Numerous topic specific resources are available (e.g, drug interactions, infectious disease, internal medicine) Classification of a request aids in developing a more effective search strategy Selecting the resource with the highest probability of containing the desired information can decrease the time requirement and increase the accuracy of the response

Examples of question classifications Adverse Drug Reaction Contraindication Availability Dose Drug compatibility/stability Drug interaction Drug therapy Pharmacy practice Pharmacology

In the previous example above, the amoxicillin request pertains to a dose examples of references that provide this information: American Hospital Formulary Service (AHFS) Facts and Comparisons USP Drug Information (USPDI) for the Health Care Professional

Develop Strategy and Conduct Search Select and prioritize resources based on: probability of locating the desired information. Availability of resources. Conduct a systematic search Be familiar with the three types of information sources in the literature hierarchy Begin with the established knowledge located within the tertiary literature (e.g., textbooks) due to the condensed, easy-to-use format of the information presented Progress through the secondary literature (e.g., MEDLINE, International Pharmaceutical Abstracts [IPA]) to the primary literature (e.g., controlled clinical trails, letters to the editor)

Perform Evaluation, Analysis, and Synthesis Confirm information with other references to assure consistency between various resources 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. authors, editors, and publishers attempt to assure the reliability of the information published, most resources include a disclaimer statement since errors do occur occasionally

Formulate and Provide Response Restate the question and any pertinent background information This allows the requestor to be informed of the question and focused on the impending response Provide the information and recommendation (if applicable) In addition, a brief review of the search strategy and references reviewed may be included in the response as a confirmation to the comprehensive search conducted Compose the response at the requestor's comprehension level

Conduct Follow-Up and Documentation Methods of follow-up Mail survey Phone call Written communication Reasons for follow-up Provide the requestor with additional information that supports or changes a prior recommendation Obtain feedback concerning the quality of the service

Methods of documentation (examples) Paper form Logbook Computer database Reasons for documentations (examples) Justification of pharmacist's professional value to the institution Future reference for repetitive drug information requests Protective measure against legal liability

Quiz In your logbook write the 7 steps of the modified systematic approach

Lab session Exploring drug information online resources: 1: Medscape 2: Epocrates