Transcript File

Systematic Approach for
Answering a Drug
Information
Request:
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.
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An essential component within pharmacy
practice is the ability to effectively answer
questions posed by health care professionals and
the lay public.
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In 1975, Watanabe et al. presented a systematic
approach for responding to drug information
requests
Systematic Approach (1975)
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Step I. Classification of the request
Step II.Obtaining background information
Step III.Systematic search
Step IV.Response
Step V.Reclassification
Modified Systematic Approach (1987)
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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
Demographics of Requestor
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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.
Background Questions
(clarifying the question)
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The ability to obtain background information to develop a more
complete picture of the question is essential for effectively using
the modified systematic approach.
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To make you able to answer the question "Why is the
requestor asking for this information?“
General Questions for Obtaining Background
Information
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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)
Background Questions
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Example: If you were asked “What is the dose of amoxicillin?”
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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.
Determine and Categorize the Ultimate
Question
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Categorization of the question (request)
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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
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Examples of question classifications
Adverse Drug Reaction
 Contraindication
 Availability
 Dose
 Drug compatibility/stability
 Drug interaction
 Drug therapy
 Pharmacy practice
 Pharmacology
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In the previous example above, the amoxicillin
request pertains to a dose
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examples of references that provide this
information:
American Hospital Formulary Service (AHFS)
 Facts and Comparisons
 USP Drug Information (USPDI) for the Health Care
Professional
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Develop Strategy and Conduct Search
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Select and prioritize resources based on:
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probability of locating the desired information.
Availability of resources.
Conduct a systematic search
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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)
Perform Evaluation, Analysis, and
Synthesis
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Confirm information with other references to
assure consistency between various resources
authors, editors, and publishers attempt to assure the reliability of the
information published, most resources include a disclaimer statement
since errors do occur occasionally
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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.
Formulate and Provide Response
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Restate the question and any pertinent
background information
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This allows the requestor to be informed of the question and
focused on the impending response
Provide the information and recommendation
(if applicable)
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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
Conduct Follow-Up and Documentation
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Methods of follow-up
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Mail survey
Phone call
Written communication
Reasons for follow-up
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Provide the requestor with additional information that supports
or changes a prior recommendation
Obtain feedback concerning the quality of the service
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Methods of documentation (examples)
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Paper form
Logbook
Computer database
Reasons for documentations (examples)
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Justification of pharmacist's professional value to the
institution
Future reference for repetitive drug information requests
Protective measure against legal liability
Quiz
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In your logbook write the 7 steps of the
modified systematic approach
Lab session
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Exploring drug information online resources:
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1: Medscape
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2: Epocrates