Systematic Approach for Answering a Drug Information

7/30/2019 Systematic Approach for Answering a Drug Information

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Systematic Approach forAnswering a Drug

InformationRequest:


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An essential component within pharmacypractice is the ability to effectively answerquestions posed by health care professionals and

the lay public.

In 1975, Watanabe et al. presented a systematicapproach for responding to drug informationrequests


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Systematic Approach (1975)

Step I. Classification of the request

Step II.Obtaining background information

Step III.Systematic search Step IV.Response

Step V.Reclassification


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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


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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 therequestor's sophistication and knowledge regarding the subjectmatter. However, it is important to more directly determine therequestor's position, training, and anticipated knowledge.


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Background Questions

(clarifying the question)

The ability to obtain background information to develop a morecomplete picture of the question is essential for effectively using

the modified systematic approach.

To make you able to answer the question "Why is therequestor asking for this information?


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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 careprofessional

The requestor's frame of reference (i.e., title, profession oroccupation, 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 medicalinformation

The urgency of the request (i.e., negotiate the time response)


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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 withpharyngitis or 2 grams as a single dose one hour prior to dental procedures forbacterial endocarditis prophylaxis.

Other issues to consider are dose adjustment for renal impairment and

interactions with concomitant medications.


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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 alogical progression process

An all-inclusive resource with data to answer every drug informationquestion 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 searchstrategy

Selecting the resource with the highest probability of containing thedesired information can decrease the time requirement and increase theaccuracy 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 amoxicillinrequest 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 CareProfessional

Drug Interaction Facts

Hansten and Horn's Drug Interactions Analysis andManagement


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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 theliterature hierarchy

Begin with the established knowledge located within the tertiaryliterature (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 primaryliterature (e.g., controlled clinical trails, letters to the editor)


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Perform Evaluation, Analysis, and

Synthesis

Confirm information with other references toassure consistency between various resources

The analysis and synthesis must be performed

with consideration of the backgroundinformation, obtained previously, for theresponse to be pertinent and useful to therequestor.

authors, editors, and publishers attempt to assure the reliability of the

information published, most resources include a disclaimer statementsince errors do occur occasionally


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Formulate and Provide Response

Restate the question and any pertinentbackground 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 tothe comprehensive search conducted

Compose the response at the requestor's comprehension level


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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


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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

Documents

Systematic Approach for Answering a Drug Information