Transcript Introduction to Drug Info Tools

Drug Information
Resources
Joe Pozdol, MLIS
Norris Medical Library
[email protected]
Learning Goals
To understand the magnitude of health information
available today
To be able to classify questions as background or
foreground
To understand the differences between primary,
secondary, and tertiary resources
To be able to determine ultimate questions and
classify them by drug information type
To be able to use Drug Facts and Comparisons,
Epocrates, Lexi-Comp, Micromedex, and
Clinical Pharmacology
The Growth of Medical Information
Indexed Citations Added to MEDLINE (i.e. PubMed) by Fiscal Year
??
U.S. National Library of Medicine. National Institutes of Health. Reviewed 25 March 2009.
http://www.nlm.nih.gov/bsd/stats/cit_added.html#1
How does one navigate the information overload
without getting overwhelmed and confused?
Partner Introductions
Pair Activity: Assessing What You Already Know
For a drug information question, which would you consult?
List a pro and a con for each resource.
Journal
Textbook
Background v. Foreground Questions
Background Questions
Question is broad in scope
Answer is general knowledge in field
Can best be addressed with tertiary resources
E.g. Is a drug available in the U.S.?
What is a drug’s mechanism of action?
When is a drug contraindicated?
Foreground Questions
Question is narrow in scope
Answer may require examining new or conflicting evidence
Can best be addressed with secondary and primary resources
E.g. How effective is a new drug when compared to
drugs that are already on the market?
Are there clinical trials supporting an off-label use of a
drug in a specific population?
Resource Types:
Primary
Secondary
Tertiary
Primary Resources
Scientific journals
Provide original studies or reports
E.g. Clinical trial, case series, case report
Good for foreground questions
Scope is narrow
Good when topic is new or new data has
been published
Primary Resources
Pros:
Most current evidence
Provide data on new drugs
Can personally assess validity of studies
Cons:
May not lead one to best decision because of limited scope
Data can be poor or controversial
Every study has limitations
Too complex for patients
Secondary Resources
Bibliographic databases that provide abstracts or
full-text of studies
Good for foreground questions
Secondary Resources
Pros:
Can construct searches to find specific information
at high granularity
Cons:
Often require more expertise to use than primary or tertiary
resources
Retrieved references must be filtered for quality
Must track down resources before looking for answers
Too complex for patients
Tertiary Resources
Compilations of knowledge in the field
E.g. Textbooks, handbooks, online drug compendia
Good for background questions
Scope is broad
Tertiary Resources
Pros:
Provide comprehensive information
Information reflects views of multiple experts in field
Fast, easy to use, and may be good for patients
Cons:
Usually at least 2 years out of date by publication
High dependency on interpretation of authors**
**Pharmacists can address this by consulting at least
2 tertiary resources to find corroborating information
When trying to answer a clinical question, the best strategy is often to
consult resources in the following order:
Tertiary, Secondary, Primary
Tertiary resources are good when:
The answer to a question is basic factual knowledge in the field
The question was studied extensively and a conclusion was made
Many experts have addressed the question and agree on answer
Secondary and primary resources are good when:
A question is new and has never been studied
There is no consensus among experts; various opinions abound
There is conflicting evidence and the question needs further study
Resource Table
JAPhA
JAMA
Pharmacotherapy
Primary
Resources New England Journal of Medicine
Annals of Internal Medicine
AJHP
Secondary PubMed/Ovid MEDLINE
Resources Cochrane Database of Systematic Reviews
DARE
TRIP
National Guideline Clearinghouse
Access Pharmacy
UpToDate
Tertiary
Resources Drug Facts and Comparisons
Epocrates
Lexi-Comp
Clinical Pharmacology
Micromedex
Determining the Ultimate Question
Real Estate Agent Last Dec.
44 y.o. male
High blood pressure
Rx ACE inhibitor
Develops dry cough
Ultimate Question:
Is cough a side effect of ACE inhibitors?
Question Type:
Background
Resource Type:
Tertiary
Major Concepts
(i.e. search terms):
ACE inhibitors, side effects, cough
Categorizing the Ultimate Question
**Adverse effects
Availability
Compatibility/stability
Compounding
**Dosing/administration
**Drug interaction
Herbal
Identification
Pharmacokinetics
Pharmacology
Poisoning/toxicology
Pregnancy/lactation
**Therapeutic use
**Especially relevant for Medication Therapy Review assignment
Pair Activity
List 3 facts about Ambien (Zolpidem Tartrate) OR Insomnia
Drug Facts and Comparisons
Search for information about Ambien (Zolpidem Tartrate)
www.usc.edu/nml
Pair Activity
List 3 facts about Proventil (Albuterol Sulfate) OR Asthma
Epocrates
Search for information about Proventil (Albuterol Sulfate)
www.usc.edu/nml
Pair Activity
List 3 facts about Zoloft (Sertraline Hydrochloride) OR Depression
Lexi-Comp
Search for information about Zoloft (Sertraline Hydrochloride)
www.usc.edu/nml
Pair Activity
List 3 facts about Aricept (Donepezil Hydrochloride) OR Dementia
Micromedex
Search for information about Aricept (Donepezil Hydrochloride)
www.usc.edu/nml
Pair Activity
List 3 facts about Zyrtec (Cetirizine Hydrochloride) OR Allergies
Clinical Pharmacology
Search for information about Zyrtec (Cetirizine Hydrochloride)
www.usc.edu/nml
Topic Recap
Excess of Medical Info
Background v. Foreground
Tertiary, Secondary, Primary
Ultimate Questions
Drug Facts and Comparisons
Epocrates
Lexi-Comp
Micromedex
Clinical Pharmacology
The Big Picture
Addressing a Drug Info Need
1.
2.
3.
4.
5.
Obtain background info/understand context
Determine ultimate question
Select and search appropriate resources
Evaluate and analyze information found
Draw conclusion and formulate response
Medication Therapy Review Assignment
Due Dec. 4
References used to support recommendation:
WRONG Student 1
RIGHT Student 2
Google
Wikipedia
Drug Facts and Comparisons
Lexi-Comp
Please fill out an evaluation:
Class: Drug Info Resources
Date: 9/11/09
Instructor: Joe Pozdol