Development and Usage Patterns of a Home-Grown Drug Information Tool.

Drug information tools help avoid medication errors, a common cause of avoidable harm in health care systems. We sought to describe the design, development process and architecture of an electronic drug information tool, as well as its overall use by health professionals. We developed a tool that can be accessed by all health professionals in a tertiary level university hospital. The functionalities of eDrugs are organized into two main parts: Drug Summary sheet, and Prescription Simulator. Most users accessed eDrugs to use the Drug summary sheet. Clinical information and antimicrobial drugs were the most accessed drug information and drug group. The analysis of log data provides insights into the information priorities of health professionals.

Evaluation of inpatient medication guidance from an artificial intelligence chatbot.

PURPOSE: To analyze the clinical completeness, correctness, usefulness, and safety of chatbot and medication database responses to everyday inpatient medication-use questions. METHODS: We evaluated the responses from an artificial intelligence chatbot, a medication database, and clinical pharmacists to 200 real-world medication-use questions. Answer quality was rated by a blinded group of pharmacists, providers, and nurses. Chatbot and medication database responses were deemed "acceptable" if the mean reviewer rating was within 3 points of the mean rating for pharmacists' answers. We used descriptive statistics for reviewer ratings and Kendall's coefficient to evaluate interrater agreement. RESULTS: The medication database generated responses to 194 (97%) questions, with 88% considered acceptable for clinical correctness, 76% considered acceptable for completeness, 83% considered acceptable for safety, and 81% considered acceptable for usefulness compared to pharmacists' answers. The chatbot responded to only 160 (80%) questions, with 85% considered acceptable for clinical correctness, 65% considered acceptable for completeness, 71% considered acceptable for safety, and 68% considered acceptable for usefulness. CONCLUSION: Traditional search methods using a drug database provide more clinically correct, complete, safe, and useful answers than a chatbot. When the chatbot generated a response, the clinical correctness was similar to that of a drug database; however, it was not rated as favorably for clinical completeness, safety, or usefulness. Our results highlight the need for ongoing training and continued improvements to artificial intelligence chatbots for them to be incorporated reliably into the clinical workflow. With continued improvement in chatbot functionality, chatbots could be a useful pharmacist adjunct, providing healthcare providers with quick and reliable answers to medication-use questions.

COVID-19: como informações baseadas em evidências auxiliaram um hospital terciário durante o primeiro ano pandêmico / COVID-19: how evidence-based information supported a tertiary hospital during the first pandemic year

Introdução: Durante a pandemia de COVID-19, a necessidade por uma informação confiável, rápida e precisa desafiou os profissionais de saúde de todo o mundo. O objetivo deste trabalho foi avaliar e comparar as solicitações dos profissionais da saúde realizadas a um Centro de Informação Sobre Medicamentos (CIM) em um ano pré-pandêmico e durante o primeiro ano pandêmico. Métodos: Trata-se de um estudo quantitativo e retrospectivo, que analisou as perguntas realizadas ao CIM do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICHCFMUSP) quanto ao seu assunto, classificação ATC dos medicamentos envolvidos e profissionais solicitantes. Resultados: Os resultados demonstram que, de maneira geral, durante o primeiro ano pandêmico houve um aumento de 454 perguntas (66,13%; p < 0,01). As dúvidas se referiam principalmente a questões de administração, estabilidade/compatibilidade e padronização do medicamento na instituição, sendo o farmacêutico o profissional que realizou maior número de questionamentos. Ao seccionar as perguntas, verificou-se que a maioria das informações solicitadas se referiram a agentes infecciosos, agentes que atuam no sangue/órgãos hematopoiéticos e sistema nervoso. Conclusão: Considerando o cenário pandêmico, com sobrecarga dos serviços de saúde, contratação em massa de novos profissionais e pouca disponibilidade de informações com embasamento científico, as evidências fornecidas pelo CIM, aliadas ao entendimento do quadro clínico de cada paciente, com certeza auxiliaram em um melhor desfecho clínico, bem como foram essenciais no uso racional de medicamentos no combate a pandemia de COVID-19.

Introduction: During the COVID-19 pandemic the need for reliable, fast and accurate information challenged healthcare professionals around the world. The aim of this study was to evaluate and compare the requests made by health professionals to a Drug Information Center (DIC) in a pre-pandemic year and during the first year of the pandemic. Methods: This is a quantitative and retrospective study that analyzed the solicitations made to the DIC of the Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICHCFMUSP) regarding its subject, ATC classification of drugs involved and requesting professionals. Results: The results show that, in general, during the first pandemic year there was an increase of 454 questions (66.13%; p < 0.01). The questions referred mainly to issues of administration, stability/compatibility and standardization of the medicines in the institution, being the pharmacist the professional who asked the most number of questions. When sectioning the questions, it was found that most of the information requested referred to infectious agents, agents that act on the blood/hematopoietic organs and the nervous system. Conclusion: Considering the pandemic scenario, with an overload of health services, large number of hires of new professionals and lack of availability of scientifically based information, the evidence provided by the DIC, combined with the understanding of clinical condition of each patient, certainly helped in a better outcome for each patient, as well as being essential in the rational use of medicines in the fight against the COVID-19 pandemic.

Preference and usage pattern of mobile medical apps for drug information purposes among hospital pharmacists in Sarawak, Malaysia.

INTRODUCTION: Pharmacists are frequent users of mobile medical apps (MMA) for drug information (DI) and clinical decision-making purposes. However, the wide range of available MMA may be of variable credibility and results in heterogeneous recommendations. The need for subscription may also influence choice of apps. OBJECTIVE: The objective of this study was to determine the usage pattern of MMA among hospital pharmacists, including their perceptions and factors affecting their choice of apps. METHODS: This cross-sectional study required respondents to fill in an online questionnaire. The questionnaire included sections on respondents' demographic data, MMA usage pattern, perceived usefulness and opinion on subscription fees. Items were adapted from available literature and validated locally. It was made accessible for 6 weeks starting November 2019 for all pharmacists working in the 23 public hospitals in Sarawak to response (universal sampling). Collected data were analysed using descriptive and inferential statistics. RESULTS: A response rate of 37.2% was achieved (n = 162). Respondents were heavily reliant on MMA, with 78.4% accessing them multiple times daily. The majority also agreed that MMA contain correct and up-to-date information. A median of 5 apps were downloaded, suggesting an ultimate app catering for all DI needs was lacking. The Malaysian Drug Formulary was the most downloaded app (88.3%), whereas Lexicomp® was the most "well-rounded" in terms of functionality. Clinical pharmacists were significantly more likely to purchase MMA, in particular UpToDate® (p < 0.01) due to their need to access clinical updates. Respondents highly recommended institutional access for either UpToDate® or Lexicomp® be made available. Pre-registration pharmacists should be guided on judicious MMA usage, as they downloaded significantly more apps and were more likely to indicate not knowing which DI recommendation to follow (both p < 0.01). CONCLUSION: MMA has become an indispensable tool for hospital pharmacists, however there was a tendency to download multiple apps for DI needs. Institutional access can be considered for credible apps identified to ensure accuracy and uniformity of DI recommendations, with purchase decision made after surveying the needs and preferences of end users.

Information Needs and Counseling Preferences among Potential Users of the Future Teratology Information Service in Belgium: A Cross-Sectional Study Involving the Public and Healthcare Professionals.

A Teratology Information Service (TIS) does not exist in Belgium yet but will hopefully be established soon. To prepare for this, we aimed to provide insight into the information needs and counseling preferences of the Belgian public and healthcare professionals (HCPs) regarding medication use in pregnancy and breastfeeding. A cross-sectional study using two anonymous, online surveys disseminated via social media, websites, and newsletters addressing Dutch and French-speaking individuals (≥18 years) and licensed HCPs was performed between June and September 2020. Ethics approval and informed consent were obtained. In total, 1508 public survey respondents (98% women) and 702 HCPs participated. Information needs on perinatal medication use were ubiquitous among both groups, and for which they often relied on patient information leaflets or the product information and online fora. Conflicting information on this topic regularly occurs and complicates HCPs' duties. Women and HCPs assigned an important role to a TIS, both in terms of providing evidence-based information (via a website or app) and being accessible to be contacted in case of questions (by phone or via e-mail or chat). In conclusion, a TIS would be warmly welcomed by women and HCPs in Belgium and should ideally be established soon to address current information needs regarding perinatal medication use and to contribute to research in this field.

Descripción de la disponibilidad y normas para el uso de las benzodiacepinas en algunos países de América Latina, 2022 / Description of benzodiazepines availability and regulation in several countries of Latin America, 2022 / Descrição da disponibilidade e regulamentação para o uso de benzodiazepínicos em alguns países da América Latina, 2022

Resumen: Introducción: las benzodiacepinas constituyen un grupo farmacológico de amplia prescripción a nivel mundial desde su aparición en la década de 1960. El objetivo del presente estudio fue identificar la disponibilidad, las modalidades de prescripción y dispensación de benzodiacepinas en diferentes países de América Latina, según reglamentación vigente en cada país participante del estudio. Materiales y métodos: estudio observacional, descriptivo y transversal, realizado con los datos disponibles al año 2022 de todos los países miembros de la Red de Centros de Información de Medicamentos de LatinoAmérica y el Caribe (Red CIMLAC) que fueron parte del estudio. Se utilizaron las bases de datos de las agencias regulatorias, la reglamentación vigente y otros documentos necesarios para obtener la información sobre la dispensación y prescripción en cada país. Resultados: doce de los 20 países de la Red CIMLAC completaron el estudio. El total de benzodiacepinas disponible en cada país varió entre 6 y 12 (media: 9). De ellas, en promedio 5 estaban incluidas en listados de medicamentos esenciales nacionales. La mayoría de los países cuentan con combinaciones a dosis fijas con benzodiacepinas. En todos los países se realiza la prescripción por receta especial. Más de la mitad de los países cuentan con recomendaciones nacionales. Conclusiones: la amplia disponibilidad de benzodiacepinas comercializadas, la existencia de combinaciones a dosis fijas y la falta de recomendaciones nacionales pueden ser factores que contribuyan al uso irracional de este grupo terapéutico.

Summary: Introduction: benzodiazepines constitute a widely prescribed group of drugs around the world, since they appeared in the sixties. This study aims to identify the availability, prescription modalities and dispensing of benzodiazepines in different countries around Latin America, as per the legal provisions in force in each of the countries participating in the study. Method: observational, descriptive, transversal study based on the information available in 2022 about all the member countries of the Network Medicines Information Centers of Latin America and the Caribbean (CIMLAC Network) that were part of the study. The databases of regulatory authorities were used and the legal provisions in force and relevant documents were consulted in order to obtain information on benzodiazepines dispensing and prescription in each country. Results: twelve out of the 20 CIMLAC Network member countries completed the study. The total number of benzodiazepines available in the study ranged from 6 to 12 (mean was 9), and 5 of them on average were included in the national essential medications lists. Most countries have benzodiazepines fixed dose combinations and in all countries a special medical prescription is needed. More than half of the countries have national recommendations. Conclusions: the wide availability of benzodiazepines in the market, the existence of fixed-dose combinations and the lack of national recommendations may constitute factors that contribute to the irrational use of this group of drugs.

Resumo: Introdução: os benzodiazepínicos constituem um grupo farmacológico amplamente prescrito em todo o mundo desde seu surgimento na década de 1960. O objetivo deste estudo foi identificar a disponibilidade, prescrição e modalidades de dispensação de benzodiazepínicos em diferentes países da América Latina, de acordo com as regulamentações vigentes em cada país participante do estudo. Materiais e métodos: estudo observacional, descritivo e transversal, realizado com os dados disponíveis até o ano de 2022 dos países membros da Rede de Centros de Informação sobre Medicamentos da América Latina e do Caribe (Red CIMLAC) que faziam parte do estudo. As bases de dados das agências reguladoras, normas vigentes e outros documentos necessários foram utilizados para obter informações sobre dispensação e prescrição em cada país. Resultados: doze dos 20 países da Rede CIMLAC completaram o estudo. O número total de benzodiazepínicos disponíveis em cada país variou entre 6 e 12 (média: 9). Destes, uma média de 5 foram incluídos nas listas nacionais de medicamentos essenciais. A maioria dos países tem combinações de dose fixa com benzodiazepínicos. Em todos os países é necessário prescrição especial. Mais da metade dos países têm recomendações nacionais. Conclusões: a ampla disponibilidade de benzodiazepínicos comercializados, a existência de combinações em doses fixas e a falta de recomendações nacionais podem ser fatores que contribuem para o uso irracional desse grupo terapêutico.

The role of drug information centers to improve medication safety in Saudi Arabia - a study from healthcare professionals' perspective.

Background and objective: The primary function of the Drug Information Center (DIC) is to provide drug-related information to healthcare professionals. The purpose of this research was to assess the use of drug information centers by health care the professionals to improve medication safety in Saudi Arabia. Methods: A retrospective study was carried out at King Khalid University Hospital's drug and poison information center (DPIC). During the study period, requests received by drug information specialists were saved in the DPIC questions' bank. Patients' demographic, type of drug information request, caller information, number of references used, medications, class of medication, medication error type and subclass were assessed and analyzed using descriptive analysis. Medication error types were captured based on nature of questions. Results: A total of 243 drug information inquiries were assessed. Most of the inquiries were about adult population (n = 168; 69.1%). Most drug information inquiries were received from pharmacists (n = 117; 48.1%), followed by physicians (n = 94; 38.7%), then nurses (n = 23; 9.5%). Prescribing error were the most type of medication error prevented by drug information specialists (n = 214; 88.1%) followed by dispensing errors (n = 11; 4.5%). Approximately half of the medication errors in this study were near-misses (n = 110; 45.3%), followed by potential near misses (n = 84; 34.6%). Only, (n = 49; 20.2%) were identified as errors. Conclusion: This study highlights the role of drug information specialists in providing evidence-based information and helps in preventing possible medication errors which will enhance the safety of the services provided to the patients.

Use of an Innovative Pharmaceutical Class Scoring Tool for Prioritized Annual Formulary Review.

Background: Though The Joint Commission requires health systems perform annual formulary review, guidance for how to perform this review is lacking. Published methods include comprehensive review of all pharmaceutical classes; however, this approach may not be the most efficient or effective option for a health system with a large formulary. Objective: To create a prioritization system for annual formulary review through development of a pharmaceutical class scoring tool. Methods: Drug information pharmacists developed the scoring tool, which used external and internal data to score pharmaceutical classes in 4 categories: safety, efficacy, cost, and utilization. The primary outcome, number of formulary changes resulting from pharmaceutical class review, was compared between the highest-scoring and lowest-scoring class to assess the tool's ability to prioritize high-yield class reviews. Results: The tool calculated scores for 91 pharmaceutical classes, altogether containing 962 medications. After review of the highest-scoring class, corticosteroids, 2 formulary changes were made: one dosage form was removed from formulary, and one medication was restricted to outpatient use only. Zero formulary changes resulted from review of the lowest-scoring class, pharmaceutical adjuvants. Conclusions: The tool described in this study prioritized annual formulary review efforts by identifying a pharmaceutical class with meaningful formulary optimization opportunities as the highest-scoring class, while correctly identifying a class with no optimization opportunities as the lowest-scoring class.

Identifying Training Needs and Active Information Opportunities in Primary Care Through the Analysis of Drug Information Requests.

INTRODUCTION: Drug information (DI) services should work toward efficiency by identifying knowledge gaps and actively creating resources to address those needs. The aim was to identify training needs and active information opportunities in primary care by analyzing DI requests and to calculate labor cost associated with DI requests addressable with training or active information. METHODS: DI requests received in 2016 and 2017 by ambulatory care pharmacists were independently classified by 2 authors into: training (i.e., delivery of content meant to be retained as knowledge and used when needed); active information (i.e., resources created preemptively and consulted when needed); or passive information (i.e., not addressable with training or active information). Inter-rater reliability was calculated using Cohen's Kappa. Median time spent by category and across practice settings/professional types was compared using bivariate analysis. Thematic analysis categorized specific training and active DI requests and labor costs were calculated. RESULTS: Of 2,041 DI requests, 330 (16.2%) were classified as training, 454 (22.2%) active information, and 1257 (61.6%) passive information (kappa = 0.769). Median (IQR) time to resolve requests was 5 (2-10) mins for training, 5 (3-11) active information, and 10 (4-15) passive information. Pharmacists spent 132.1 hrs = $8,956.98 answering questions addressable with training or active information. Areas warranting training or active information included: controlled substances, immunizations, patient assistance programs, policy/regulations, medication preparation/administration, storage/stability, disposal, availability/ordering medications, and patient-related resources. CONCLUSION: Several opportunities for training and active information were identified. Despite the single-institution nature, the method described can serve as an example for other institutions.

Regional drug information center disseminates educational materials related to the COVID-19 pandemic.

BACKGROUND: Drug information centers (DIC) play an important role in providing correct and scientifically supported information on medicinal products. In the pandemic scenario, this action is considered fundamental to the process of health education. OBJECTIVE: To describe and identify the dissemination of educational materials and their acceptance regarding the COVID-19 pandemic by a regional drug information center (RDIC) linked to a Brazilian public university. METHOD: The educational materials were disseminated in the communication channels (social media) of the RDIC and university. Seventeen educational notices were produced and disclosed from May to August 2020. The measure of reach was considered to be the number of "likes", sharing and number of people reached. RESULTS: Overall, 28.9% (n = 4071) of the online visitors "liked" the material about vaccines tested for COVID-19, followed by 12.9% (n = 1824) "likes" of the material about ivermectin for COVID-19 treatment, and 8.9% (n = 1250) "likes" of the material that explained the time necessary to develop and test a vaccine and the duration of the pandemic. CONCLUSION: The interest expressed by the "likes" of educational materials about vaccines indicates that the DIC in question has a strategic role in disseminating scientifically backed information about the COVID-19 pandemic.

Long term impact of the WHI studies on information-seeking and decision-making in menopause symptoms management: a longitudinal analysis of questions to a medicines call centre.

BACKGROUND: While women are taking a greater role in decisions about menopause symptom management, the legacy of the Women's Health Initiative (WHI) studies persist. Despite hormone therapy (HT) being effective in reducing all-cause mortality, many women seeking relief of menopausal symptoms exaggerate HT harms and overstate the perceived benefits or ignore the risks of alternative therapies. We aimed to explore the longitudinal impact of the widely-publicised WHI 2002 study on women's information-seeking and describe determinants of decision-making about managing menopausal symptoms. METHODS: In a longitudinal analysis of both quantitative and qualitative data, we explored consumer questions about menopause-related medicines received by two Australian medicines call centres (1996-2010) before, during, and after WHI 2002. We analysed calls by age and gender of caller and patient, their relationship, postcode, enquiry type, and motivation to help-seek. We compared calls regarding HT and herbal medicines (HM) with the rest of calls, and thematically analysed question narratives across the three time-periods. RESULTS: There were 1,829 menopause-related calls received of over this time-period, with a call surge, primarily from women in their mid-fifties, in the two months after the WHI 2002 publication. Two in three calls were motivated by negative media reports as women sought support for decision-making, primarily reassurance to cease HT. While HT safety concerns persisted for eight years post-publication, the nature of information-seeking changed over time. Callers subsequently sought reassurance to use menopause treatments together with their other medicines; and pursued HT substitutes, including HM, in response to HT product discontinuation. CONCLUSIONS: Women sought information or reassurance to support a decision, based on dynamic changes in internal (symptom or risk intolerance, attitude towards menopause and treatment preferences) and external factors (perceived source trust and changes in treatment availability). In assessing HT benefit versus risk, women tend to overestimate risk with HT safety concerns persisting over time. Decision-making in managing menopause symptoms is complex and dynamic. Reassurance to reach or justify decisions from a perceived trusted source can support informed decision-making.

A bottom-up approach to creating an ontology for medication indications.

OBJECTIVES: The study sought to learn if it were possible to develop an ontology that would allow the Food and Drug Administration approved indications to be expressed in a manner computable and comparable to what is expressed in an electronic health record. MATERIALS AND METHODS: A random sample of 1177 of the 3000+ extant, distinct medical products (identified by unique new drug application numbers) was selected for investigation. Close manual examination of the indication portion of the labels for these drugs led to the development of a formal model of indications. RESULTS: The model represents each narrative indication as a disjunct of conjuncts of assertions about an individual. A desirable attribute is that each assertion about an individual should be testable without reference to other contextual information about the situation. The logical primitives are chosen from 2 categories (context and conditions) and are linked to an enumeration of uses, such as prevention. We found that more than 99% of approved label indications for treatment or prevention could be so represented. DISCUSSION: While some indications are straightforward to represent, difficulties stem from the need to represent temporal or sequential references. In addition, there is a mismatch of terminologies between what is present in an electronic health record and in the label narrative. CONCLUSIONS: A workable model for formalizing drug indications is possible. Remaining challenges include designing workflow to model narrative label indications for all approved drug products and incorporation of standard vocabularies.

Actual Use of Internet by Patients with Diabetes to Find Drug Information / 医薬品情報学

Objectives: It is important for patients to make correct use of drug information (DI) to promote the proper use of medicines. Many patients use the Internet to find DI, but awareness about the websites of public institutions that provide DI is low. This study aimed to identify the actual use of the Internet for DI and associated problems to inform development of a comprehensive DI website for patients.Method: Patients with diabetes were set as a model case for patients who take medicines and need DI. A questionnaire survey was conducted among patients with diabetes who visited community pharmacies in Kagoshima City from March 2019 to October 2019. The survey covered Internet use, DI needs, methods of sourcing DI, and problems obtaining DI via the Internet.Results: There were 349 valid respondents (median age 64 years), of which 52.1% used the Internet at least once a week. Around half of the Internet users searched for DI on the Internet. More than half of these respondents chose a DI acquisition site because it “appeared at the top of search results” and was “easy to understand.” However, around half of these respondents felt that “there is too much information on the internet and I don’t know what is correct.”Conclusion: This study suggests that older patients with a long history of diabetes use the Internet to obtain DI. However, patients face various problems accessing DI via the Internet. It may be necessary to construct a comprehensive website that is easy to use and enhance public health literacy to support the proper use of medicines by patients.

Japanese Medical Academic Organizations Surveyed on the Current Situation of Medical Information Providedto the Public on the Internet / 医薬品情報学

Objective: The internet isflooded with drug information; however, some of it isinappropriate and thisinadequate information could expose the public to health hazards. Therefore, we conducted research on the idea of transmitting drug information to the public via the internet and the current state of the information currently provided by each academic society relevant to the field of Medical Informatics.Methods: A questionnaire was mailed to the website managers for the website of 129 specialist medical societies, all members of the Japanese Association of Medical Sciences. We conducted our research between October to November 2018. We investigated each website administrator’s opinion about offering drug information for consumers via the internet and what information each academic society is currently providing.Results: The effective response rate was 43.4% (56/129 groups). Most respondents thought that drug information overflowed in the current Internet society. Moreover, more than half of the respondents thought that the quality of drug information transmitted to the public wasinadequate. Currently, 30 of the academic groupssurveyed are providing information to the public. When providing information, they did not refer to the “Drug Guide for Patients” much. More than 80% of respondents said they would cooperate with linking to the information provided to the public. However, each academic society felt there would be many problems with doing so such as the need for a system to check the contents of the information provided and a system to perform maintenance.Conclusion: The results showed that the website administrators recognized that there is a need to improve the quality of and system for providing drug information to the public. We believe that an integrated information system can be constructed by aggregating the drug information held by each academic society. However, this cannot be realized without first solving many problems.

Withdrawal and Misuse Concerns of Consumers regarding Opioid Analgesic and Anxiolytic, Hypnotic and Sedative Medicines.

BACKGROUND: Opioid analgesic (OA) and anxiolytic, hypnotic and sedative (AHS) medicines use raise community concerns about risks of dependence: dose escalation, unintentional misuse. Objectives: We aimed to identify common consumer OA and AHS information gaps and concerns that led to information seeking from a hotline. Methods: We conducted a retrospective, mixed-method observational study of consumers' OA and AHS-related calls to an Australian national medicines call center (September 2002-30 June 2010). We analyzed these medicines' call characteristics compared to their respective rest of calls (ROC) and thematically explored narratives concerning withdrawal and misuse. Results: Of 123,217 calls, 7,395 (6.0%) involved OA and 7,789 (6.2%) AHS, with consistency between call characteristics. While female middle-aged callers predominated, more males called for these medicines than their complementary ROC. Uncertainty about unresolved OA and AHS concerns led to help-seeking that was consistent over eight years. Main motivations were inadequate information (OA 44.5%; AHS 41.2%), seeking a second opinion (OA 24.2%; AHS 24.2%), worrying symptoms (OA 21.6%; AHS 23.1%), and conflicting information (OA 4.9%; AHS 5.1%). Callers focused on withdrawal and issues related to inadvertent overuse or deliberate misuse (OA 9.2% vs. non-OA ROC 2.9%; AHS 12.6% vs. non-AHS ROC 2.7%). Primary themes were similar for both cohorts: concern about harm or aiming to minimize harm by information seeking, requesting a strategy, or reassurance. Conclusions: Consumers have under-recognized perceptions of harm from OA and AHS use, particularly withdrawal and misuse. Resources based on real world consumer concerns can encourage open dialogue between patients and their prescribers.

Service users' experiences of contacting NHS patient medicines helpline services: a qualitative study.

OBJECTIVES: Patient medicines helpline services (PMHS) are available from some National Health Service (NHS) Trusts in the UK to provide medicines information to hospital patients and carers. To date, studies of PMHS have examined the views of service users via satisfaction surveys. This study used qualitative methods to explore service users' experiences of using a PMHS, including perceived benefits and areas for improvement. DESIGN: Qualitative, using semi-structured interviews. SETTING: This study was conducted across seven NHS Trusts in England. PARTICIPANTS: Forty users of PMHS were individually interviewed over the telephone. Interviews were audio-recorded, transcribed verbatim and analysed using Braun and Clarke's inductive reflexive thematic analysis. Ethical approval was obtained before study commencement. RESULTS: Participants predominantly called a PMHS for themselves (82%; carers: 18%). Two main themes were generated. Theme 1: timeliness-PMHS provide support during the uncertain transition of care period from hospital to home, when patients and carers often feel vulnerable because support is less available. PMHS met service users' needs for timely and easily accessible support, and quick resolution of their issues. PMHS could be improved with staffing beyond typical work week hours, and by having staff available to answer calls instead of using an answerphone. Theme 2: PMHS are best-placed to help-PMHS were perceived as best-placed to answer enquiries that arose from hospital care. Service users felt reassured from speaking to pharmacy professionals, and PMHS were perceived as the optimal service in terms of knowledge and expertise regarding medicines-related questions. However, several participants were initially unaware that their PMHS existed. CONCLUSIONS: PMHS are perceived to be a valuable means of accessing timely medicines-related support when patients and carers may be feeling particularly vulnerable. However, their availability and promotion could be improved. We recommend that providers of PMHS consider whether this is achievable, in order to better meet the needs of service users.

Real-world questions and concerns about disease-modifying antirheumatic drugs (DMARDs): a retrospective analysis of questions to a medicine call center.

BACKGROUND: Disease-modifying antirheumatic drugs (DMARDs) have transformed the treatment of numerous autoimmune and inflammatory diseases but their perceived risk of harm may be a barrier to use. METHODS: In a retrospective mixed-methods study, we analysed conventional (c) and biologic (b) DMARDs-related calls and compared them with rest of calls (ROC) from consumers to an Australian national medicine call center operated by clinical pharmacists from September 2002 to June 2010. This includes the period where bDMARDs became available on the Pharmaceutical Benefits Scheme, the government-subsidized prescription medicines formulary. We compared caller and patient demographics, enquiry types and motivation to information-seek for both cDMARDs and bDMARDs with ROC, using a t-test for continuous data and a chi-square test for categorical data. We explored call narratives to identify common themes. RESULTS: There were 1547 calls involving at least one DMARD. The top three cDMARD enquiry types were side effects (27.2%), interactions (21.9%), and risk versus benefit (11.7%). For bDMARDs, the most common queries involved availability and subsidized access (18%), mechanism and profile (15.8%), and side effects (15.1%). The main consumer motivations to information-seek were largely independent of medicines type and included: inadequate information (44%), wanting a second opinion (23.6%), concern about a worrying symptom (18.8%), conflicting information (6.9%), or information overload (2.3%). Question themes common to conventional and biological DMARDs were caller overemphasis on medication risk and the need for reassurance. Callers seeking information about bDMARDs generally overestimated effectiveness and focused their attention on availability, cost, storage, and medicine handling. CONCLUSION: Consumers have considerable uncertainty regarding DMARDs and may overemphasise risk. Patients cautiously assess the benefits and risks of their DMARDs but when new treatments emerge, they tend to overestimate their effectiveness.

Incorporation of a mock drug information telephone call exercise in a health-systems pharmacy laboratory.

BACKGROUND AND PURPOSE: Hospital pharmacists routinely receive and answer drug information questions via telephone while performing order verification. This report describes the development, implementation, and evaluation of a mock learning experience for student performance of these tasks in a health-systems pharmacy laboratory course. EDUCATIONAL ACTIVITY AND SETTING: An active learning skills-based exercise involving students receiving and answering a standardized drug information question via telephone during an order verification activity, referred to as a cold-call exercise, was developed and implemented. Data collected included student grades on a baseline assessment, the cold call exercise, order verification exercises, and student perceptions from a voluntary post-exercise survey. Student performance on the cold-call exercise was further evaluated via individual sections of the cold-call rubric. Data were summarized using descriptive statistics. Thematic analysis of student opinion and an estimate of faculty time were also executed. FINDINGS: Student grades on the cold call and order verification exercises were 86.14% and 88.8%, respectively. Students often failed to ask category-specific questions because they did not categorize the ultimate question appropriately. Students found the activity organized and applicable. Time dedicated to creation was extensive, but execution and grading were reasonable. SUMMARY: Students performed well on the drug information exercise as well as the order verification component. Students and faculty enjoyed the experience, and students found the exercise relevant and challenging. This exercise could be implemented into any pharmacy curriculum in order to prepare students using authentic learning experiences.