Drug informatics

Tesemma S
 Introduction
 Drug information provision is an essential part of pharmacy
practice
• As experts on medicines, all pharmacists have a responsibility
to provide information and advice about any medicine supplied
by them or under their authority.
• Health professionals, patients, careers and the public regularly
ask pharmacists for information and advice and it is vital that
this should be reliable, accurate and up to date

• To carry out these roles effectively, pharmacists need to know

how and where to find information
 how to evaluate and
how to interpret it(put in practice)
 Introduction
• In our modern world, information is everywhere
(television, radio, internet, telephones and fax
machines)
• The great challenge is sorting out
the current information from the dated
 the reliable from the questionable
the actual from the imagined
 Introduction
• Accessing, reviewing, analyzing, evaluating, and interpreting
the clinical drug literature are important responsibilities of
health-care practitioners; this is particularly true for
pharmacist, who are the “drug experts”, by doing so, the
pharmacist should:-
differentiating good from poor quality information
identifying the strengths and limitations of the
available information
appropriately applying the information they obtain
to patient care and
recommending to patients high quality web sites
 Introduction
• The types of drug information needed by practicing pharmacists
and other health-care professionals are varied and include, but are
not limited to, information about:-
side/adverse effects and drug interactions
uses, teratogenicity and toxicity
Stability and compatibility
product identification and availability
dosages and administration
pharmacokinetics, pharmacodynamics and pharmacogenomics
 health-related quality of life, and
 pharmacoeconomics, and efficacy, including the comparative
efficacy among drugs in the same chemical or pharmacological
class as well as among drugs from different classes.
 DEFINITION
 Drug informatics: is a technologically advanced version of drug
information. This often denotes the electronic management of
information.
 Drug information: refers to the provision of unbiased, well –
referenced and critically evaluated up-to-date information on any
aspect of drug use.

 Drug information service: A service which provides up-to-date

and unbiased information regarding medicines and their use.

• It is also referred as Drug information centre(DIC) because it

refers to the specialized facility that provides drug information to
those who need it.
 Definition
 pharmacists have the resources to provide drug information.

 Medicine information: sometimes used to highlight that the

service’s function relate to medicinal drug rather than drug of
abuse.

 Poison Information: It refers to a specialized area of drug

information that provides information on the toxic effects of
an extensive range of chemicals, including plant and animal
toxins.
 History
 is the service that encompasses the activities of specially
trained individuals to provide accurate, unbiased, factual
information
 The 1st DIC was established at the University of Kentucky,
USA in 1962.

Aim
 to support, assist and promote rational drug use
 to provide comprehensive information to allow physicians and
dentists to evaluate and compare drugs.
 History
 The 1st specialist DIC was established within hospital pharmacy
departments in 1969 and within 10 years most hospitals had such
a centre.

 The fundamental philosophy of the service was drug

information

 In 2000 the service changed its name, in response to customer

opinion, from Drug Information to Medicine Information

aim to support the safe, effective and quality use of medicines by

the provision of evidence-based information and advice on the
therapeutic use of medicines
 History
In Ethiopia
• HIV/AIDS Twinning Center partners at Addis
Ababa University (AAU) and Howard
University in Washington, DC, celebrated the
opening of a model Drug Information Center
(DIC) May 27, 2009 at Black Lion Hospital.
 TYPES OF DRUG INFORMATION
• Reactive drug information refers to
information or advice given in response to
questions or enquiries about medicines.

• Proactive (active) drug information involves

the preparation of newsletter, bulletins,
websites, etc in an attempt to educate or raise
awareness of key therapeutic issues.
 TYPES OF DRUG INFORMATION
• Solving patient – specific clinical problems
• Critical evaluation/appraisal of the literature

• Effective provision of verbal and written information to the public

• Drug policy management (e.g. formulary management, audit)

• Preparation of bulletins and newsletters

• Managing the entry of new drugs into health care

• Adverse drug reaction/event management

• Continuing professional development
WHO PROVIDES DRUG INFORMATION?

• Specially trained “pharmacist” is responsible

for providing drug information.
• A pharmacist is a “drug expert” who can give
advice regarding safe and effective use of
medication.
ROLE OF PHARMACIST IN DRUG INFORMATION SERVICE

• respond to drug information questions from other health-care

professionals and patients and help resolve drug therapy related problems.

• conducting literature searches to locate complete, up-to-date information

upon which patient-care decisions can be made.

• analyze and evaluate the published literature and develop

recommendations based on the best available date.

• literature retrieval and analysis, adverse drug events, drug use decisions,
educational activities, and clinical research.

• preventing, detecting, and reporting of adverse events. Pharmacists are one

of the major groups of health-care professionals who report adverse drug
events.
ROLE OF PHARMACIST IN DRUG INFORMATION
SERVICE
• implement systems
 to prevent drug misadventures (such as errors in the prescribing,
dispensing, and administration of medications) and
 to enhance patient compliance.

• report medication errors.

• involved in many different drug information educational activities that

are conducted for other health-care professionals and patients.

• Provision of verbal and written information to patients about their

medications.

• Participating in clinical research trials

 Establishing
Drug Information Centre (DIC)

Definition

Drug Information Center:
–
A center designed for receiving, collecting, analyzing, and
providing unbiased, accurate and up-to-date information
about drugs
 Requirements

– The services to be offered by the centre

– Justification of the need for a centre

– Resources, Facilities, Personnel

– The budget
 Services
• Support for clinical services
– Answering questions
– Developing criteria/guidelines for drug use evaluation

• Drug and Therapeutics committee activity

– Drug selection
– Formulary management

• Publications: DI bulletin, newsletters, ….

• Education: in-service for [Link], students, mass media education
• Coordination of reporting programs-e.g., adverse drug reaction,
medication errors
• Poison information
 Minimum standard DIC

• Requires a Registered Pharmacist

– Education and Training
• Formal DI training
• Computer-based information System
• Experience – min. 2 yrs experience, ward and clinical-
based experience is particularly desirable
 Skill of a DIC specialist
o Competence in evaluation, selection and utilization of the
Professional literature

o Good written and verbal communication skills

o Knowledge of clinical drug use and therapeutics

o Knowledge and acceptance of the legal and ethical responsibilities

o Maintenance of drug information skills

 FACILITIES
• Space
 Sufficient for storage of reference collection
 provision of service
 A minimum of 20m2

• Office Equipments
 Computer
 Photocopier
 Access to a facsimile machine
 Telephone
 Filing cabinets
 Shelving
 Desks, chairs
 Journal display rack
 A tel. answering machine
 Access to a Med. Lib.
 Internet access
Resources

 Ref. materials appropriate to the scope and nature of the

service provided

 The centre must have access to:

 Appropriate computer-based information services
 Specialists in various fields for consultation
 Other DI centres
Location

 Readily accessible to all prospective users

 Located within
 The Hospitals
 Medical or Pharmacy association
 Drug regulatory Authority
 Ministry of Health

 Located to have ready access to a good medical library

and facilities
 Direct access to other DI centres
 DIC in Ethiopia
• National DI Center
– Location: DACA, DI Division

• Services provided:
– Training
– Continuous Education
– Publication: Guidelines, formularies, manuals, lists….
– Research

• Responsibilities:
– provide drug information services
– Coordinate other DICs’ activity
 Established DICs

Black Lion
Armed force Tigray, RHB

DACA
Zewditu
St. Paul

Minillik Police

26
RECEIVING AND CLASSIFYING DRUG
INFORMATION REQUEST
 Systematic Approach for Answering a Drug Information Request

The Seven Steps

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 6: Formulate and Provide Response

Step 7: Conduct Follow-Up, Follow through and Documentation

 Step 1: Secure Demographics of Requestor

• Obtain initial question

• Secure requestor demographics
 The requestor's "profession" (e.g., physician,
pharmacist, nurse, lay person) should indicate
educational experience and knowledge base

• Determine a method for delivery of the response

 Gather information from the requestor that will allow
you to reply to the request. Examples of information to
gather include the following: the requestor's address,
phone number, pager number, and fax number.
 Example

 If a patient and a physician inquired about how the new medication Prandin® works

(i.e., pharmacology), the depth of the response would differ for each individual .

 For example, a pharmacist should not inform a lay person that the new medication is

the first agent approved in the meglitinide class and is a non-sulfonylurea insulin

releasing oral hypoglycemic agent for type 2 diabetes mellitus.

 This would not be an appropriate response because the lay person would be

unfamiliar with this terminology.

 Similarly, the pharmacist would not communicate to the physician that the new

medication "acts by improving the way your body processes sugar." The physician

would require a more scientific description of the product .

 Request background information
 Background information aids in clarifying the question
and is a critical step in the process

 The question may not be stated concisely or the

requestor may not know how to ask the question

 To formulate an acceptable response, both the caller and

researcher must have a clear understanding of the
ultimate question

• Determine if the question is patient specific or academic and

gather information that further defines the question
 Example

• A pharmacist is asked,
"What is the dose of amoxicillin?"
Answers
quickly (and potentially inaccurately) by stating that the normal
dosage as 500 mg every eight hours.
by gathering background information concerning the origin of
the question. 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 in 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, or
chewable tablets).
 Based on background information
amoxicillin may not be the best agent to select for the
infection.
The dose of amoxicillin can be
500 mg every eight hours for a severe infection or
2 grams as a single dose one hour prior to dental
procedures for bacterial endocarditis prophylaxis.

 Other issues to consider with the antibiotic are dose

adjustment for renal impairment and interactions with
concomitant medications
 Step 3: Determine and Categorize the Ultimate Question

• Appropriate background information allows the exact question to

be determined

• The requestor's purpose for the information must be understood to

effectively use the systematic approach and adequately answer the
question

• Restate the request to confirm the question with the caller

• Develop a time line for response

 Completely understanding the scope of the "true" question also
aids in developing a realistic estimate of the time required to
compose a response
 Step 3….....
• Categorize the question

 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
 Otherwise, unnecessary time and energy may be expended on searching references
unable to produce the needed facts
Examples of question classifications
– Adverse Drug Reaction/Contraindication
– Availability
– Dose
– Drug compatibility/stability
– Drug interaction
– Drug therapy
– Identification
– Pharmacy practice
– Pharmacology
1. In the previous example, the amoxicillin request pertains to a
dose. Therefore, this question would be classified as Dose.
Examples of references:- American Hospital Formulary Service
(AHFS), or Facts and Comparisons.

2. If the inquiry concerned the potential of concomitant

administration of warfarin (Coumadin®) and aspirin to
increase the International Normalized Ratio (INR), the
question would be classified as a Drug Interaction and a
logical starting point would be these two references.
 Drug Interaction Facts and
 Hansten and Horn's Drug Interactions Analysis and
Management are textbooks specific for drug interactions.
 Step 4: Develop Strategy and Conduct Search

• Develop a search strategy

• Select and prioritize resources based on the probability of locating
the desired information
 Without prioritization, resources may be used based on ease of access or degree of
comfort instead of probable efficiency

• 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., Pub Med, International
Pharmaceutical Abstracts [IPA]) to the primary literature (e.g., controlled
clinical trails, letters to the editor)
 Examples

• As mentioned previously, if the question is classified as a Drug

Interaction, then a logical and efficient search would begin with a text
specific for drug interactions (e.g., Hansten and Horn's Drug Interactions
Analysis and Management, Drug Interaction Facts and Comparisons).
• If a text specific for drug interaction is not available, other references
likely to contain the desired information (e.g., Drug Facts and
Comparisons, American Hospital Formulary Service, Micromedex)
should be selected as opposed to references with a decreased probability
of containing the information e.g., Drug Topics Red Book.
 Step 5: Perform Evaluation, Analysis, and Synthesis

• Objectively and thoroughly evaluate located information

• Confirm information with other references to assure consistency between

various resources
– While authors, editors, and publishers attempt to assure the reliability of the
information published, most resources include a disclaimer statement since
errors do occur occasionally

• Performing a comprehensive search is an important part of this process to

ensure recommendations are based on all of the current evidence
available

• Derive an answer by professional judgment after critically analyzing the

available information when resources do not provide a direct answer
 Step 6: 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

• Submit the response to the requestor in a timely fashion to assure

quality service and preserve professional respect
 Step 7: Conduct Follow-Up, Follow through and Documentation

• Follow up :-is the process of verifying the appropriateness,

correctness, and completeness of the communication.

• Follow through :-is the process of readdressing a request based

on the availability of new data or a change in the situation or
circumstances that were decisive factors in the synthesis of a
response.
 Step 7………………….

• Document the question and response, and conduct follow-up

• Methods of documentation
Paper form
Logbook
Computer database
• Reasons for documentation
Justification of pharmacist's professional value to the
institution
Future reference for repetitive drug information requests
Protective measure against legal liability
 Step 7………………….

• Follow-up is the final portion of the process

• Methods of follow-up
Mail survey
Phone call
Written communication

• Reasons of follow-up
Provide the requestor with additional information that
supports or changes a prior recommendation
Obtain feedback concerning the quality of the service
 Step 7………………….
Example
 a prescriber inquires about the relationship between elevated homocysteine levels
and coronary heart disease (CHD).
 The caller also requests information concerning prescribing folic acid to decrease
homocysteine levels.
 After following the modified systematic approach, evidence that documented a
relationship between elevated homocysteine levels and CHD was located.
 In addition, preliminary therapeutic trial information supported daily
supplementation of folic acid to lower homocysteine levels.
 A few weeks later, additional information that further established the efficacy of folic
acid in lowering homocysteine levels was published.
 Follow-up should be provided to the prescriber due to the recent information
affirming the prior response.