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Learning Goals To understand the magnitude of drug information available today To understand the differences between primary, secondary, and tertiary resources To be able to classify questions as background or foreground • There are three categories (types) of drug information resources based upon their proximity to the original source of information: 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 • This type of resource is considered to be the most current source of information and forms the basis for the practice of evidence-based medicine • evidence-based medicine, which is defined as the conscientious, explicit, and judicious use of current best evidence along with clinical expertise and patients’ values in making clinical decisions about the care of individual patients 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 serve as gateways to primary drug information resources • These include indexing services, which provide bibliographic citation information, and abstracting services, which—along with the bibliographic citation information—provide a brief synopsis of each article. • Most of these services are available in an electronic format Tertiary Resources Compilations of knowledge in the field E.g. Textbooks, handbooks, online drug compendia Good for background questions Scope is broad • summarize and interpret the primary literature • the most common types of references pharmacist will utilize. • good starting point when researching a drug information question • excellent sources for gaining an understanding of a new topic. • include textbooks, review articles, and other general data. • time associated with publication, which may be as long as one to two years . or some of the information may be outdated, particularly if new guidelines or new material has been released since the time of publication of the reference • the information provided may be incomplete due to space limitations or because of incomplete literature searches performed by the author(s) of • consider when utilizing these resources are the expertise of the author, purpose of the book, edition and year of publication, references cited, ease of use, and format in which the information is being obtained. 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 Tertiary Resources Drug Facts and Comparisons Epocrates Lexi-Comp Clinical Pharmacology Micromedex 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? Lab session • Use internet to locate – One primary reference – One secondary reference – One tertiary reference • Write title and brief description of each one on your logbook.