Drug information needs of physicians treating diabetic nephropathy in a tertiary care hospital.

OBJECTIVE: Diabetic Nephropathy is a leading cause of end stage renal disease. Doctors often have questions during patient care when they are advised to seek the best available evidence. Rational drug use demands access to unbiased drug information. This study was conducted to delineate and analyse the patient-specific drug information needs of physicians treating diabetic nephropathy in Nephrology ward of a south Indian tertiary care hospital. METHODS: A prospective, observational study was conducted in the Department of Nephrology in St John's Medical College, Bangalore from 1st October 2003 to 31st March 2004. The relevant data regarding patient- specific queries of physicians on drug information were collected by joining physicians on clinical rounds and analysed. RESULTS: Out of 102 patients included in the study, physicians had queries on 66% of patients. The total number of queries was 80. The average number of queries per nephrologist was 9 and those per physician were 10. Queries on adverse drug reactions and drug interactions exceeded (31%) others. Queries on anti-hypertensive drugs were the maximum (33%) followed by antimicrobials (12.5%). About 93% of queries were answered. Tertiary sources (51%) were the most commonly used drug information sources. The mean time to find the answer to a query was about 30 minutes. CONCLUSION: Physicians treating DN are in need of drug information services, especially on adverse drug reactions and drug interactions during in-patient care. The majority of queries of physicians treating diabetic nephropathy can be answered by referring authentic drug information sources.

Information sources used by New South Wales cancer clinicians: a qualitative study.

BACKGROUND: This study identified (i) information sources used by cancer clinicians to guide pharmacological treatments, (ii) utilization of, and opinions about, online information sources and (iii) clinicians' ability to access a specific cancer treatment protocol (escalated bleomycin, etiposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone (BEACOPP) for Hodgkin's Lymphoma). The work was carried out before activation of the Cancer Institute New South Wales Standard Cancer Treatment (CI-SCaT) programme. METHODS: We conducted semistructured interviews with a purposeful sample of senior and junior doctors, nurses and pharmacists treating adult cancer patients (n = 32) in eight New South Wales public hospitals. RESULTS: Information seeking processes are context specific and vary from clinician to clinician and ward to ward. Clinicians use human, electronic and printed information sources at, or close to, the point of patient care; however, experienced colleagues are preferred where information is needed quickly or in unfamiliar clinical situations. Barriers to using online cancer information are environmental (hardware, connection speeds, time), personal (poor computer literacy and lack of awareness of appropriate sites) and economic (costs of journal subscriptions). Just over half of participants were able to locate a specific cancer protocol and none of these protocols was fully consistent with CI-SCaT recommendations. CONCLUSION: There is no standardized approach to the pharmacological treatment of cancer patients in this sample of New South Wales clinicians. CI-SCaT will fill a gap with respect to standardizing oncology treatment. However, to ensure maximal CI-SCaT uptake, implementation plans should harness positive behavioural influences and attempt to modify the negative forces that act on hospital clinicians in their day-to-day work.

Consumer involvement in Quality Use of Medicines (QUM) projects - lessons from Australia.

BACKGROUND: It is essential that knowledge gained through health services research is collated and made available for evaluation, for policy purposes and to enable collaboration between people working in similar areas (capacity building). The Australian Quality Use of Medicine (QUM) on-line, web-based project database, known as the QUMmap, was designed to meet these needs for a specific sub-section of health services research related to improving the use of medicines. Australia's National Strategy for Quality Use of Medicines identifies the primacy of consumers as a major principle for quality use of medicines, and aims to support consumer led research. The aim of this study was to determine how consumers as a group have been represented in QUM projects in Australia. A secondary aim was to investigate how the projects with consumer involvement fit into Australia's QUM policy framework. METHOD: Using the web-based QUMmap, all projects which claimed consumer involvement were identified and stratified into four categories, projects undertaken by; (a) consumers for consumers, (b) health professionals for consumers, (c) health professionals for health professionals, and (d) other. Projects in the first two categories were then classified according to the policy 'building blocks' considered necessary to achieve QUM. RESULTS: Of the 143 'consumer' projects identified, the majority stated to be 'for consumers' were either actually by health professionals for health professionals (c) or by health professionals for consumers (b) (47% and 40% respectively). Only 12 projects (9%) were directly undertaken by consumers or consumer groups for consumers (a). The majority of the health professionals for consumers (b) projects were directed at the provision of services and interventions, but were not focusing on the education, training or skill development of consumers. CONCLUSION: Health services research relating to QUM is active in Australia and the projects are collated and searchable on the web-based interactive QUMmap. Healthcare professionals appear to be dominating nominally 'consumer focussed' research, with less than half of these projects actively involving the consumers or directly benefiting consumers. The QUMmap provides a valuable tool for policy analysis and for provision of future directions through identification of QUM initiatives.

Drug information centre--analysis of activities of a regional centre.

Description and evaluation of a drug information centre's (DIC) professional activities one year after establishment are summarized. The aims of the centre are: to evaluate which problem areas are frequently requested, how frequently and by whom; which information sources are the most appropriate for the service and the approximate cost of such a service. We received 80 questions during the first 8 months. The questions were mainly asked by hospital physicians (32.5%) and pharmacists (32.5%), other health-care professionals were a minority; the scopes of most frequently asked questions include general properties of active substances (12.2%), contents of particular preparations (21%), dosage (11%), side effects (21%) and indications/contraindications (15%). Cost of the service included variable (mainly phone and mail charges, copy and print of the documents) and fixed costs (cost of software and salary of the staff).

A morbidity and therapeutic index in general practice.

The use of a morbidity and therapeutic index in general practice is described. The system can monitor practice activities, morbidity, prescribing and patient characteristics for individual practices or surgeys. A triplicate prescription form is used for data collection, with minimum inconvenience to the doctor. Complete patient confidentially is maintained. Some problems of classification and coding are discussed.

A framework for characterizing drug information sources.

Drug information is complex, voluminous, heterogeneous, and dynamic. Multiple sources are available, each providing some elements of information about drugs (usually for a given purpose), but there exists no integrated view or directory that could be used to locate sources appropriate to a given purpose. We examined 23 sources that provide drug information in the pharmacy, chemistry, biology, and clinical medicine domains. Their drug information content could be categorized with 39 dimensions. We propose this list of dimensions as a framework for characterizing drug information sources. As an evaluation, we show that this framework is useful for comparing drug information sources and selecting sources most relevant to a given use case.

European survey of independent drug information centers.

OBJECTIVE: The purpose of our survey was to ascertain the activities of the independent drug information centers (DICs) in Europe and to contact the person in charge of these services to establish a European network of DICs in the future. DATA SOURCES: The survey was conducted in 32 European countries. We contacted 2026 people in DICs and official healthcare organizations by mail. On request, we returned our questionnaire including 167 closed questions on the means and activities of a DIC. Data were collected and analyzed on a personal computer using dBASE III PLUS (Ashton-Tate). RESULTS: Of the 110 questionnaires received, 88 answered the question pertaining to the number of queries asked of the DIC per year and were analyzed (1 from West Germany, Denmark, Finland, Sweden, Portugal, Poland; 2 from Italy; 3 from Switzerland; 6 from Spain; 8 from The Netherlands; 16 from France; and 47 from the United Kingdom). We recorded data on their location, their means (e.g., staff, information), their users (e.g., health professionals), and activities. CONCLUSIONS: The DICs were located in healthcare structures, managed by pharmacists or physicians, and open to other health professionals. Only the United Kingdom maintains a national organized network. Most of the participants showed interest in cooperating with each other to establish a list of the centers, guidelines on good information practices, a database, and a European network.

Physician perceptions of prescription drug information.

This study reports the findings of an investigation designed to explore the importance of prescription drug information source characteristics among physicians. Differences were found to exist among the importance ratings both in aggregate, and between, categories of physician specialty and years in practice. Conclusions for pharmaceutical marketers and the implications for future research efforts are discussed.

Evaluation of drug interaction document citation in nine on-line bibliographic databases.

OBJECTIVE: To compare nine on-line bibliographic databases to obtain bibliographic references on specific drug interactions. DESIGN: Seven bibliographic databases were selected for their ability to provide information concerning drug interactions: EMBASE, MEDLINE, TOXLINE, BIOSIS, Chemical Abstracts (CAS), PHARMLINE, and International Pharmaceutical Abstracts (IPA). Two French on-line bibliographic databases (i.e., PASCAL, BIBLIOGRAPHIF) were also tested to compare them with the other international databases. Twenty drug interactions were selected randomly using the journal Reactions Weekly 1993. MAIN OUTCOMES MEASURES: The total number of references, the number of potentially relevant references, the number of case report references, the number of unique references in the total number of references, and the number of unique references between potentially relevant references were analyzed by using the Friedman two-way ANOVA by ranks. For each database, relevance and relative recall were calculated. RESULTS: For the total number of references, EMBASE was significantly more comprehensive then all other databases (p < 0.05). EMBASE had a significantly greater number of potentially relevant references than IPA, PHARMLINE, CAS, and BIBLIOGRAPHIF (p < 0.05). For the total number of case report references, only one significant difference, between EMBASE and BIBLIOGRAPHIF (p < 0.05), was observed. MEDLINE and TOXLINE had the lowest cost per potentially relevant reference. CONCLUSIONS: To obtain bibliographic references on drug interactions, the first step should be to search MEDLINE or TOXLINE; the second step, for completeness, should be to search EMBASE.

Selected topics in drug information access and practice: an update.

The area of drug information is broad and of increasing importance to all pharmacy practitioners. The efficient and effective use of the literature should not be limited to those individuals with specialized drug information education and training. Pharmacists must be familiar with the many sources of information available to them, including the expanding line of CD-ROM products and on-line databases. Drug information specialists should serve as consultants and facilitators in the appropriate use of these products. All pharmacists should have a baseline level of critical literature evaluation skills. Part of the responsibilities of drug information specialists should be to help educate practitioners in the acquisition and development of these skills and to assist with the actual analysis of clinical studies. Finally, pharmacists in all settings, in conjunction with drug information specialists, need to work to develop DUE and adverse event monitoring programs that will maximize positive patient outcomes.

Changes in physicians' sources of pharmaceutical information: a review and analysis.

Since 1952, 20 datasets have been generated through 17 studies in an attempt to describe the sources and importance and/or use of information about pharmaceuticals by physicians. The authors review the findings of the studies and subject them to three sequentially relevant, but different, meta-analytic procedures. The results of these analyses indicate significant changes in the sources and importance of various commercial/noncommercial and personal/nonpersonal information as they relate to physicians' prescribing behavior. Those changes over time have specific implications for marketers of pharmaceuticals.

Needs and use of drug information sources in community pharmacies: a questionnaire based survey in German-speaking Switzerland.

OBJECTIVES: To explore the types of drug information used by pharmacists in daily practice, their needs and wishes concerning drug information and their opinions about future changes of pharmacy practice. METHODS: Postal survey to a random sample of 223 (26% out of 859) community pharmacies from the German-speaking part of Switzerland. The 48-item questionnaires were processed automatically with the Cardiff TELEform-Software. In addition, a telephone-survey to a random sample of 20 non-responders was performed in order to test for non-response bias. RESULTS: A total of 108 pharmacists (response rate 48%) reported that the official Swiss drug reference book is still the most popular source of drug information used to solve all kinds of drug related problems. The Internet as a source of drug information is of minor importance, even though 88% of the pharmacies have Internet access. Deficits in drug information were reported for paediatrics, phytotherapy, drugs during pregnancy/lactation and for therapy guidelines. According to 35% of the pharmacists, the importance of offering drug information to customers will increase in the future. Most of the pharmacists are not afraid that Internet pharmacies would replace them. CONCLUSIONS: The results show that the majority of the community pharmacists are only partially satisfied with the sources of drug information currently available. The Internet still plays a minor role for solving drug-related problems in daily practice, even though the available infrastructure makes the community pharmacies able to use the Internet more frequently. The pharmacists need more websites tailored to their needs. The pharmacists have clear visions about possible future developments. They do, however, have to adopt quickly to the changes ahead in order to remain competitive.

[Drug interaction computer programs: which choice?]. / Bases de données informatiques d'interactions médicamenteuses: quel choix?

Adverse drug reactions represent a partly preventable cause of morbidity. Computer-based tools may be useful for the prevention of those events resulting from drug interactions. While several such tools are currently available to practitioners, they have rarely been compared regarding their performances and limits. This article presents a benchmark evaluation of seven drug interaction databases which may be elected by physicians or pharmacists as an aid to prescription on a regular basis. None of the databases tested appears to be perfect, and the systems vary in their overall completeness and ease of use.

Drug information sources and antidepressant adherence.

The purpose of the study was to examine how patient sources of antidepressant information were related to antidepressant adherence. Eight community pharmacies in central North Carolina participated in the study. A research assistant interviewed eighty-one English-speaking patients who were picking up antidepressant refill prescriptions. Patients most frequently reported receiving antidepressant information from: pharmacists (58%), primary care physicians (50.6%), mental health specialists (40.7%), friends or family members (32.1%), and the Internet (18.5%). Patients experiencing more side effects were significantly less adherent to their antidepressants. Patients who received antidepressant information from more sources were significantly more adherent to their regimen than patients who received information from fewer sources.