1. Systematic Approach for Answering a Drug Information Request:

2. 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.

3. 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

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

5. 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

6. 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.

7. 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?“

8. 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)

9. 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.

10. 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

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

12. 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

13. 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)

14. 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

15. 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

16. 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

17. 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

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

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