1. Introduction to Drug Information Services Ch.#1

2. A Quick History of Drug Information Services 1864 – 1876: John Shaw Billings, a Civil War surgeon, is put in charge of expanding the Surgeon General’s library. In 1876 he declares that it can now be called the National Library of Medicine (NLM). 1876-1879: Billings begins to catalog the contents of the library by overall medical subject addressed. The term Medical Subject Headings (MeSH) is used to describe the catalog headings. In 1879 the first Index Medicus, the NLM catalog of holdings, is published. It continues to be updated monthly and a new edition circulated annually. Information is catalogued by the overall subject addressed.

3. A Quick History of Drug Information Services 1890s: Billings develops an idea for organizing US Census data by using a series of punched cards. Herman Hollerith, a young engineer, helps him develop the punch card system and a machine for sorting them. They apply this technology to the NLM catalog to facilitate retrieval of medical information. In 1896 Hollerith creates a company called the Tabulating Machine Company, so that businesses can purchase and use the punch card technology. This company is eventually absorbed into a corporation called International Business Machines.

4. A Quick History of Drug Information Services 1900-1960: The number of available drugs and journal articles expands. It becomes more difficult for physicians to keep abreast of the medical literature. After World War II, a need is seen for information retrieval and not just cataloging. Development of such a system begins in the 1950s and uses Boolean search terms AND, OR, and NOT. 1962: The first drug information center opens at the University of Kentucky Medical Center. 1960s: Pharmacist-staffed drug information centers open around the country. Pharmacists are prohibited from giving patients any information about dispensed medications in early part of decade.

5. A Quick History of Drug Information Services Around 1963, the practice act in Washington state is changed to permit pharmacists to provide information about legend drugs. The Medical Literature Analysis and Retrieval System (MEDLARS) is developed by the NLM; this system uses computerized searches but information requests are submitted by telephone and results mailed to the requester. 1971: the ability to transmit information over telephone lines is applied to MEDLARS; the resulting database searching technology is called MEDLARS ON- LINE and soon shortened to MEDLINE. Searches of journal articles published in 1966 and after began to be done via computer/modem by a medical librarian trained to perform the searches 1973: a formal survey counts 54 pharmacist-operated drug information centers in the United States.

6. A Quick History of Drug Information Services 1975: A report issued by an external review board strongly recommends that all pharmacy students be trained to use drug information resources. 1980s and early ‘90s: The number of drug information centers peaks. In 1988, the National Center for Biotechnology Information (NCBI) database of biotechnology is created to facilitate information access for scientists working on the Human Genome Project. mid-‘90s: Formal drug information centers begin to close due to budget cuts. Individual pharmacists take over the role of providing drug information. MEDLINE available after 1992 on the Web through portals such as Grateful Med. but for a fee.

7. A Quick History of Drug Information Services 1997: By congressional decree, Web access to MEDLINE information is made free to the public. The NLM partners with NCBI to develop PubMed, a Web portal to access biomedical information from many databases, not just MEDLINE. Web sites with drug and disease information of varying quality are burgeoning. 2001: Publishers begin increasingly making available the electronic full-text version of medical study reports. 2004: You are beginning your training as a pharmacist. You will be expected to know how to access quality drug information resources and summarize and interpret for patients and health care colleagues the information you find in those resources. This class is the first in a series designed to help you learn these skills, which will allow you to practice evidence-based medicine.

8. This is an introductory course to teach the students basic principles of DI retrieval. Designed to help students : -Understand types of DI available -What sources of information are appropriate to use in a variety of situations

9. Drug Information could be: - patient specific - relative to a patient population with common characteristics DI could be provided as: -printed info. in a reference -verbalized by an individual that pertains to meds.

10. DI specialist/ practitioner/pharmacist/ provider ---> specific individual DI center/ service/ practice ------>place DI functions/ skills----> activities & abilities of individuals

11. Drug Informatics: The use of technology as an integral tool in: -organizing -analyzing &-managing information on medication use in patients.

12. Medication Information Services: 1. Support of clinical services 2. Answering questions 3. P&T committee activity 4. Publications : ( Newsletters, websites,…) 5. Education 6. Medication usage evaluation 7. Investigational med. Control 8. Coordination of reporting programs: ( ADRs,..) 9. Providing poison information

13. Development of DI centers + DI specialists led to the beginning of clinical pharmacy concept. Pharmacists could offer their expertise as consultants on med. therapy using clinical drug literature as a tool. Funding of DI centers is mainly by: hospitals, med. centers, or colleges & univers.

14. Few studies showed that maintaining DIC or related activity in academic institutions or hospitals is cost saving Clinical pharmacy is not only limited to hospital settings but to any other setting where pharmaceutical services are provided with the goal of improving pt. outcomes using medical literature to support their choices.

15. The provision of DI may be: - on one-to-one basis -more structured approach ( presentation) -may participate in precepting students in pt. care or pharmaceutical environment. In any of these roles, pharmacist must use appropriate: 1-Information retrieval &2-Evaluation skills to ensure that most current & accurate info. is provided regarding med. Use decisions.

16. Medication Information Skills: 1.Assess available info. & gather situational data needed to characterize question. 2.Formulate appropriate question(s). 3.Use a systematic approach to find needed info. 4.Evaluate info. critically for validity & applicability. 5.Develop, organize, & summarize response for question. 6.Communicate clearly when speaking or writing considering the audience level. 7.Anticipate other info. Needed.

17. Factors Influencing the Evolution of the Pharmacist’s Role as a DI Provider: 1) The prevention of adverse drug events. 2)Growth of information technology (PDA, internet, intranet)

18. 3)Changes in the health care environment with focus on Evidence-Based Medicine, Drug Policy Development, and the Evaluation of Outcomes. 4)The sophistication of medication therapy. 5)A more knowledgeable patient (the self-care movement).

19. Educating for the Need: -Many areas identified as needed by DI pharmacists are now incorporated in the pharmacy curricula & taught to all pharmacists. -Examples: -Communication skills -Specialty Practice Residencies in DI

20. Opportunities in Specialty Practice: The role of the DI specialist has changed from individual who specially answers questions to one who focuses on medication policies & provides info. on complex medication information questions.

21. A specialist in DI can be involved in multiple activities, i.e.: 1)Contract DI Center ( Fee-for- service ) 2)Medical Informatics 3)Health Maintenance Organizations 4)Pharmacy Benefit ManagementOrganizations 5)Managed Care Organizations

22. 6)Scientific Writing & Medical Communication 7)Poison Control Centers 8)Pharmaceutical Industry 9)Academia