Drug Information Services Systematic approach to answering drug information requests

Modified Systematic Approach (1987) 1- Accept the initial question & secure demographics of requestor

Requestor Demographics The initial question shows the requestor's knowledge regarding the subject matter But It is important to more directly determine the requestor's position, education, and anticipated knowledge.

Requestor Demographics It is imperative to secure a mechanism for delivery of the response, regardless of the medium.

Modified Systematic Approach (1987) 1- Accept the initial question & secure demographics of requestor

Modified Systematic Approach (1987) 2- Obtain background information

Background information The requestor's name The requestor's location and contact method 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)

Background information 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 information. Why? Background information aids in clarifying the question and is a critical step in the process The question may not be stated concisely or the requestor may not know how to ask the question To formulate an acceptable response, both the caller and researcher must have a clear understanding of the ultimate question

Background information

Modified Systematic Approach (1987) 2- Obtain background information

Modified Systematic Approach (1987) 3- Ultimate Question/Categorization of Question

Ultimate Question/Categorization of Question Refocusing the requestor's question is useful

Ultimate Question/Categorization of Question A survey of drug information questions answered by the DIS at the Medical College of Virginia Hospitals Shows Original Question is frequently different than Ultimate One

A survey of drug information questions answered by the DIS at the Medical College of Virginia Hospitals Shows Response would not have agreed with the initial question Ultimate Question/Categorization of Question

A survey of drug information questions answered by the DIS at the Medical College of Virginia Hospitals Shows The requestor was satisfied with the response provided !!!!! Ultimate Question/Categorization of Question

Develop a time line for response Completely understanding the scope of the "true" question also aids in developing a realistic estimate of the time required to compose a response Ultimate Question/Categorization of Question

e.g. Therapeutic Alternatives If you were asked about ACE inhibitors use for a CKD Patient Your final response might be about Ca++ Channel Blockers Ultimate Question/Categorization of Question

If the Question is academic the original and the ultimate question might be the same (e.g. Management of hypertension of CKD patients)

Ultimate Question/Categorization of Question Once the ultimate question has been decided and acknowledged, the question is categorized. The categorization is useful for the initial development of the search strategy and for the determination of resources and staff training to be maintained.

Ultimate Question/Categorization of Question Allows for efficient use of the resources. An all-inclusive resource with data to answer every drug information question does not exist.

Ultimate Question/Categorization of Question Selecting the resource with the highest probability of containing the desired information can decrease the time requirement and increase the accuracy of the response

Ultimate Question/Categorization of Question Examples of question classifications Adverse Drug Reaction/Contraindication Availability Dose Drug compatibility/stability Drug interaction Pharmacology

Ultimate Question/Categorization of Question

Modified Systematic Approach (1987) 3- Ultimate Question/Categorization of Question

Modified Systematic Approach (1987) 4- Search Strategy

Search Strategy - Categorization of the ultimate question prompts the resource selection process -e.g. if the ultimate question is about drug interactions ---> drug interaction oriented reference (Stockley or Lexi-interact)

Search Strategy Without prioritization, resources may be utilized based on ease of access or degree of comfort instead of probable efficiency.

Modified Systematic Approach (1987) 5- Data Evaluation, Analysis, and Synthesis

Data Evaluation, Analysis, and Synthesis Skills for literature evaluation and clinical application of statistical analysis are applied 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

Formulation and Provision of Response Modified Systematic Approach (1987) 6- Formulation and Provision of Response

Formulation and Provision of Response 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 briefly 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. Formulation and Provision of Response

Modified Systematic Approach (1987) 6- Formulation and Provision of Response

Formulation and Provision of Response Modified Systematic Approach (1987) 7- Follow-Up, Follow-Through, and Documentation

Follow-Up, Follow-Through, and Documentation Follow-up is the process of verifying the appropriateness, correctness, and completeness of a response following the communication

Follow-Up, Follow-Through, and Documentation Follow-through 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.

The ultimate question (as verified by the requestor), the materials searched (with pertinent findings noted), the response, and follow-up (or follow- through, if applicable) should be documented. Follow-Up, Follow-Through, and Documentation

Documentation is essential for reducing liability and potentially promoting the development of a continual service Follow-Up, Follow-Through, and Documentation