Pharmacy118

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Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore
Abdul Waheed, DEPARTMENT OF PHARMACY PRACTICE, VISVESWARAPURA INSTITUTE OF PHARMACEUTICAL SCIENCES, BANGALORE

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Pharmacy118

  1. 1. Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore By Abdul Waheed Dissertation Submitted to the Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore In partial fulfillment of the requirements for the degree of MASTER OF PHARMACY In PHARMACY PRACTICE Under the guidance of Mrs. Meera N.K DEPARTMENT OF PHARMACY PRACTICEVISVESWARAPURA INSTITUTE OF PHARMACEUTICAL SCIENCES BANGALORE 2007 I
  2. 2. Rajiv Gandhi University of Health Sciences DECLARATION BY THE CANDIDATE I hereby declare that this dissertation/thesis entitled Provision and Evaluation of Drug information Services in KIMS Hospital and Research Center, Bangalore is a bonafide and genuine research work carried out by me under the guidance of Mrs. Meera N.K Asst Professor &Guide VIPS, BangaloreDate: Signature of the candidatePlace: Abdul Waheed. II
  3. 3. CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled Provision and Evaluation of Drug information Services in KIMS Hospital and Research Center, Bangalore is a bonafide research work done by Abdul Waheed. in partial fulfillment of the requirement of Master of Pharmacy in Pharmacy PracticeDate: Mrs. Meera N.K.Place: Asst. Professor and Guide VIPS, Bangalore III
  4. 4. ENDORSEMENT BY THE HOD AND PRINCIPAL This is to certify that the dissertation entitled Provision and Evaluation of Drug Information Services in KIMS Hospital, Bangalore Is a bonafide research work done by ABDUL WAHEED under the guidance of Mrs. MEERA N.K. Assistant Professor VIPSSeal and Signature of the Head Seal and Signature of the PrincipalMrs. GITHA KISHORE Dr. KALYANI PRAKASAMHead of the department PrincipalDepartment of Pharmacy Practice VIPS, BangaloreVIPS, BangaloreDate: Date:Place: Place: IV
  5. 5. COPYRIGHT DECLARATION BY THE CANDIDATE I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka shall have the rights to preserve, use and disseminate this dissertation / thesis in print or electronic format for academic / research purpose.Date: Signature of the CandidatePlace: Abdul Waheed © Rajiv Gandhi University of Health Sciences, Karnataka V
  6. 6. VI
  7. 7. Dedicated to my Parents VII
  8. 8. ACKNOWLEDGEMENT Thanksgiving is a pleasant job but it is nonetheless difficult where one sincerelytries to put it in words. These humble words of expression and gratitude cannot whollyconvey my feelings. With a deep sense of gratitude, I owe my sincere thanks to my teacher and guideMrs. Meera N.K. M. Pharm, Assistant Professor, Department of Pharmacy Practice,Visveswarapura Institute of Pharmaceutical Sciences, Bangalore for her able guidance,critical evaluation and constant encouragement, which aided in the timely completion ofthis dissertation. I am extremely thankful for her guidance and support rendered. I would like to express my thanks to Mrs. Githa Kishore M . Pharm , AssociateProfessor and Head, Department of Pharmacy Practice Visveswarapura Institute ofPharmaceutical Sciences, Bangalore, , for her excellent advice and guidance throughoutmy academic career which would be difficult to forget. I extend my heartfelt gratitude to Dr. Kalyani Prakasam, Principal,Visveswarapura Institute of Pharmaceutical Sciences Bangalore, for her beneficentsupport. I would also like to thank all the staff of Department of Pharmacy Practice,Mr. Kiran, Mr. Kenneth, and Mr. Shekhar for their suggestions that helped me perfectmy work. VIII
  9. 9. I have great affection and my heartful thanks to Mr. Ponnu Shankar AsstProfessor JSS Colleage of Pharmacy, ooty, and my thanks extended to Rajan H, AnilTm, and Ravindra Reddy, I am forever indebted.  You guys have seen me throughout my postgraduate life in Bangalore and tolerated me .thanks guys for everything. “Good friendship is a gift of God”. Words are insufficient and inefficient toexpress my whole hearted thanks to Majid, Gaurang, Kiran, Jatin, Faisal, Anitha,Dharni. My Cool buddies Alim Pasha, and Zeeshan for their constant encouragementand support. I take great privilege to express my heartfelt thanks to all those who have directlyor indirectly helped me in getting through this project successfully Last, but by no means the least, I am eternally grateful to my family for theirabiding love and encouragement.Date: Signature of the CandidatePlace: Mr. ABDUL WAHEED IX
  10. 10. AbstractAbstractBackground and ObjectivesDrug information is defined as the knowledge of facts acquired through reading, study orpractical experience concerning any chemical substance intended for use in diagnosis,prevention or treatment of disease. Provision and Evaluation of Drug informationServices in KIMS Hospital, Bangalore was the objective of the study.MethodThis study was an open study to provide DI services to all the Health care professionalsand service users contacting the DI center at KIMS Hospital. And Research centre duringthe time period of September 06 to May 2007(Eight months). Awareness was created inthe Hospital by displaying the awareness posters and personally by giving the personalletters and the queries which were received were answered and documented. The datawere collected from the documents like, The DI Request Form, DI Documentation Form,DI Quality Assurance Form and Enquirer Outcomes Evaluation Form and analyzed. Theanswered queries were audited both internally and externally.ResultsA total of 51 queries were received and attended during the study period. It was observedthat maximum number of queries was received during the period of December 16 –January 15. An average of six queries were received and attended per month. Maximumnumber of queries were received from medicine department (45.10%) followed by otherdepartments. Post graduate students have used our services to the maximum, 35%;followed by interns, 23%; others 17%, physicians 13%, surgeons 6%, and residents 6%.Preferred mode of request for the Clinicians was either by direct access or during theward round participation. The Enquiry, was mostly to update knowledge which is 50.87%followed by better patient care 36.84%.About 22.2% of the query types belonged to miscellaneous followed by “drug profile”14.85% and indication 14.81%. About 11.11% of the queries were related to druginteraction.ConclusionThe practice of drug information is at the development stage in India and this study is onesuch in our Hospital setting, Successful drug information provision and evaluation is theresult of constant ward round participation and sustained interaction of the pharmacistwith the health care professionalsKey Words: DI, Awareness, Queries.Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore X
  11. 11. CONTENTSSl. No. Particulars Page No. 1 Introduction 1 2 Objectives 9 3 Review of literature 10 4 Methodology 22 5 Results 25 6 Discussion 38 7 Conclusion 42 8 Summary 43 9 Limitations 46 10 Future Directions 47 11 Bibliography 48 12 Annexures 50 XI
  12. 12. LIST OF TABLESTable No. Title Page No. 1 Drug Information Queries Received Per Month During The 25 Tenure of Study 2 Medical Speciality 27 3 Status of Enquirer 28 4 Mode of Request of Query 29 5 Purpose of The Query 30 6 Types of Query 31 7 Resources Consulted For Information 33 8 Time Specification Given By Enquirer 34 9 Mode of Information Provided 35 10 Drug Information Quality Audit 36 11 Evaluation of Query Outcomes 37 XII
  13. 13. LIST OF FIGURESFigure No. Figures Page No. 1 Drug Information Queries Received Per Month During The 26 Tenure of Study 2 Medical Speciality 27 3 Status of Enquirer 28 4 Mode of Request of Query 29 5 Purpose of The Query 30 6 Types of Query 32 7 Resources Consulted For Information 33 8 Time Specification Given By Enquirer 34 9 Mode of Information Provided 35 10 Drug Information Quality Audit 36 11 Evaluation of Query Outcomes 37 XIII
  14. 14. LIST OF ABBREVIATIONS USED (In alphabetical order)Sl No. Abbreviations Expansions 1 ADR Adverse Drug Reaction 2 AHFS American Hospital Formulary System 3 DI Drug Information 4 DIC Drug Information Centre 5 IDIS Iowa Drug Information System 6 KIMS Kempegowda Institute of Medical Sciences 7 KSPC Karnataka State Pharmacy Council 8 SHPA Society of Hospital Pharmacists of Australia 9 UK United Kingdom 10 US United States of America 11 USPDI United States Pharmacopoeia Dispensing Information XIV
  15. 15. LIST OF ANNEXURESAnnex No. Title I Drug Information Request Form II Drug Information Documentation Form III Awareness Letters IV Awareness Posters V Enquiry Outcome Evaluation Form VI Drug Information Quality Assurance Form XV
  16. 16. Introduction1. Introduction:Drug information is defined as the knowledge of facts acquired through reading, study orpractical experience concerning any chemical substance intended for use in diagnosis,prevention or treatment of disease. It covers all types of information provision includingsubjective and objective information, as well as information gathered by scientificobservation or practical experience.1A drug information centre (DIC) refers to a facility specifically set aside for, and 2specialising in, the provision of drug information .Three physical criteria, which define an information centre, are:1. Specific room set aside as location for DIC2. At least one dedicated and trained pharmacist must be available to answer queries.3. Sufficient information should be available to answer a broad scope of queries.A drug information service describes the activities undertaken by pharmacists inproviding information to optimise drug use. It is those services which encompass theactivities of specially trained individuals to provide accurate, unbiased, factualinformation which is primarily given in response to patient-oriented drug problemsreceived from pharmacists, nurses, physicians, and other healthcare professionals.1Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 1
  17. 17. IntroductionDrug information pharmacist refers to a pharmacist who has completed a course oftraining in drug information such as the advanced course established by the SHPAcommittee of speciality practice in drug information, or equivalent, and specialises inthe provision of drug information.2A generic aim of a drug information service is to optimise patient outcomes bysupporting the quality use of medicines. This is achieved by the provision of up-to-date,accurate, timely and objective information on the appropriate use of drugs and drugtherapy, a logical function for a pharmacist.AccessQueries may be received verbally (see requirements for documentation), or in writing bytelephone, facsimile, electronic means or via a third party. The method of responseshould be appropriate to the type of query, including the situation, complexity andurgency, and may be by any form of communication by which it was received i.e.verbally or in writing. The same form of communication for the reply by which thequery was received need not be used.Service provisionAll activities of the drug information service, which require medical judgement ortechnical knowledge, must be undertaken by a suitably qualified pharmacist. The servicewill require staff to perform clerical and/or library duties. All personnel involved in theprovision of drug information must receive adequate training.Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 2
  18. 18. IntroductionHours of ServiceThe service must make it known when it is available to take queries. At a minimum itshould operate during the normal working hours of the department.Data maintenanceThe key to provision of quality drug information in an information service is theavailability of current, objective information. Procedures should be in place to ensurethat data is continually reviewed and updated.1Sources of Drug Information1. Primary resourcesPrimary literature consists of research studies or clinical experience which has not beenpreviously published. This includes clinical trials, short reports, case reports and letters tothe editor which describe clinical events such as adverse drug reaction or unexpectedclinical outcomes. The term primary literature refers to the type of article rather than thesource of publication.2. Secondary resourcesSecondary resources provide an overview of previously published work, and includeindexing and abstracting services of the primary literature. Example of secondaryresources include the abstracting services DRUGDEX and internationalpharmaceutical abstracts , and the indexing services BIOSIS Previews , ClinAlert ,Embase , Iowa Drug Information System (IDIS ) and Medline .Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 3
  19. 19. Introduction3. Tertiary ResourcesThese consists of general literature including text books and full – text computerdatabases .Examples of tertiary resources include United states pharmacopeia. DrugInformation (USPDI), Meylers Side Effects Of Drugs , Remington PharmaceuticalSciences , Merck Index , Red Book , Martindale : The complete drug reference , AHFSDrug Information , Physicians Desk Reference , The Merk Manual , and AppliedTherapeutics . In addition, review articles in biomedical journals are some timesclassified as tertiary literature, as is much information found on the internet.3Classification of the requestEstablish the question and to which drug (if any) the request relatesi.e. why the enquiry was made and what is the type of question e.g. product availability,drug interaction or pharmacokinetics.Obtain the necessary background informationIf the request is patient specific, obtain the patient’s:i. Name, age, weight and sexii. Medical history (including allergies)iii. Major organ functions (cardiac, liver, kidney)iv. Drug history (name, dose, regimen, duration and indication)Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 4
  20. 20. IntroductionEstablish whether the caller has consulted any referencesThis helps to prevent duplication of the work and establishes the depth of informationrequired.Assign priority to the request according to the urgency of the problem or queryCases may be clinically urgent and the physician may have a patient waiting. To enhancethe credibility of the unit, it is essential that the caller be provided with some sort of timeframe within which they can expect an answer. It is important to maintain contact withthe caller and follow up if the agreed upon deadline cannot be metSystematic searchSearch the available reference texts for the appropriate response, using primaryreferences where necessary. It is helpful to develop a list of questions to ask related to aspecific type of query, which will assist in formulating the search e.g. dosing information,adverse drug reactionA systematic approach to searching should be developed; including keeping a record ofthe sources reviewed and utilised. Evaluate and interpret the information that has beensourced.Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 5
  21. 21. IntroductionFormulating the appropriate responseAll statements made should be traceable to the literature. Statements where you think theanswer is correct (but are not sure) are dangerous and must not be made. Always checkwith at least two reference sources. Only the information that is pertinent to the requestneed be used.Communicating the responseThis must be clearly and concisely given. It must be established that the caller fullyunderstands the answer.a. Oral response  Most suited in conveying response to a simple uncomplicated query. Can assess whether written response is required following the verbal replyb. Written response May be more appropriate for a more complex enquiry.Request and background informationResponse: In some cases a brief introductory paragraph is necessary for clarification ofthe terminology and issues at hand. Summarize what the literature says about theproblem, pointing out any inadequacies or deficiencies in the references. Be concise,unbiased, and above all, accurate.Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 6
  22. 22. IntroductionConclusionSummarize information together with the appropriate conclusion.ReferencesThe query should be appropriately referenced preferably in the Vancouver convention.DocumentationAll query information should be documented on a Query Form or on a computer for legalpurposes and for future enquiries.LoggingAppropriate records of all queries and answers are to be maintained preferably in somesort of database, which can be used for statistical purposes (quantifying workload),quality assurance and future research or query answering. Procedures for ensuring theintegrity of the data entry must be in place.Quality AssuranceThe aims of the drug information service need to be met and this can only be assessed bythe application of certain quality programmes. Principally all drug information centresshould aim to provide up-to-date, comprehensive, unbiased information, which assists inthe appropriate and rational use of drugs.Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 7
  23. 23. IntroductionThere are 3 major areas, which require assessment. They are:StructureOne needs to look at the facilities (is there enough space, appropriate equipment andaccess to a library), organizational aspects, such as policies and procedure manuals,appropriate hours of service and adequate staff, and resources (primary e.g. journals,secondary e.g. MEDLINE and tertiary e.g. textbooks).ProcessEvaluate the accuracy, appropriateness and completeness of the information response.See if the objectives have been met by review and measurement of productivity (e.g.number of queries) and quality in terms of timeliness, accuracy, consistency andcompleteness to name a few.OutcomeUsually these assessments reflect user satisfaction and impact.The above are a few assessment techniques, but this does not cover the whole scope ofthe topic. Each service must develop its own policy with respect to quality assurance.1Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 8
  24. 24. Objective2. ObjectivesGeneral Objective:  Provision and Evaluation of Drug information Services in KIMS Hospital, BangaloreSpecific Objectives:  To create awareness regarding Drug Information Centre among the health care professionals of KIMS  To provide drug information for the enquirer  Collection and assessment of feed backProvision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 9
  25. 25. Review of literature3. Review of LiteratureDrug Information is the provision of written and/or verbal information or advice aboutthe drugs and drug therapy in response to request from health care providers,organisation, committees, patients or the members of the public2.The first call centres were established in the 1950s and medicine information servicesin1960s in the United States. In 1970’s the medicine information centre was started inUnited Kingdom4.The first drug information centre was established at the university of Kentucky medicalcentre in North America in 1962. In the U.K the first centre was started in 1969 atLondon hospital and Leeds General Infirmary. Japan has also established a clinical druginformation centre to offer information on all package inserts of products in Japanesemarket. In India, the pharmacology departments of some teaching medical hospital likeSeth G.S. medical college and KEM hospital, Grant medical college and JJ hospital havealso established drug information centres in 1968 and 1974 respectively. A nationalinformation centre for drugs and pharmaceuticals (NICDAP) is operated by Central 5Drug Research Institute, Lucknow .Over the last 35 years there has been a tremendous increase in the number of organizeddrug information centres ( over 200) operating at the local , city or state level , all overthe world . Many drug information centres are large and sophisticated. however , it is notnecessary to have vast financial resources or affiliation to large institution or to possess 5expensive retrieval services in order to provide an effective drug information service .Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 10
  26. 26. Review of literatureAlthough the first drug information centres (DIC’s) were established decades ago bothin US and Europe , they have had different success , quality and impact in differentcountries , Also the developing countries have recognised the need for independent druginformation and DIC’s, The increase in number of centres in developed countriesplateaued in the beginning of the 1990s, most probably due to availability ofcomputerized drug information system , catering to the need of basic prescribing relatedinformation. Consecutively DIC’s have broaden their activities in to more sophisticatedareas of drug therapy consultation and Pharmacovigilance as well as prescribing researchand feed back provision and have also concentrated more on accuracy of the 6information provided and quality of their service .Drug information centers usually exist in hospitals, universities, managed careorganizations, and pharmaceutical companies. Hospital- and university-based druginformation centers have remained essentially unchanged since the first center wasestablished in Kentucky in 1962. The ultimate goal of the drug information center is tomaintain, improve, and promote the quality and delivery of drug information services andclinical pharmacy practice, and to elevate the level of patient care. Drug informationconsult, newsletter publication, monograph writing, drug policy development, education,and research are some of the professional services provided by drug informationcenters.However, continuous provision of a large volume of quality services requiresfinancial support7.Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 11
  27. 27. Review of literatureDrug information provides a challenging and stimulating career path for pharmacists,scientists, nurses, and other health care professionals. A specialised training in thepractice of drug information, such as specialised drug information residency brings finetuned skills and proficiency to the drug information settings8.DIC’s can be regarded as gateways to drug information. Almost every important hospitalor biomedical professional body has its own drug information centre. If they haveproperly trained staff, they can find whatever information on a drug is necessary; thefunction of DIC is often assessed by the number, of questions they have had in relation to 9their staff size .Drug information centers can be a great help in validating drug information. DI officersmust be well trained, specially in analysing the quality of specific publication andunderlined research; There currently is a need for general international quality criteria forDIC’s and specially for methods to measure their impact on health care9.A drug information center can be at the interface of these vast information and the userswho seek it. Moreover having up-to-date references alone doesn’t automatically ensureinformation of high quality. It is necessary for drug information provider to be able tocritically evaluate each source and to be able to determine its accuracy andappropriateness to a particular situation. The final challenge is to communicate theinformation effectively to the person who has requested it5.Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 12
  28. 28. Review of literatureIndia is a country with significant medication, and prescribing challenges, irrational andunnecessary prescribing are more common. When antibiotic resistance is widespread,these problems are the results of a wide variety of factors. The most important of theseinclude10,1. Lack of awareness about the importance of the Drug information centre.2. The availability of 80,000 plus formulations.3. Industry focussed, rather than health focussed National Drug Policy.4. Lack of awareness of the principles of rationale drug use among doctors and pharmacists.5. The widespread sale of illegal prescription drugs over the counter.6. High-level illiteracy and poverty among patients.7. There are more than 20000 biomedical journals available and more than 6000 articles published everyday. It is a Herculean task for healthcare professional to keep up-to- date with available information.The rapid expanding numbers of new drugs and treatment principles has created andincreased need for independently evaluated drug information and education11.In the past, the number of drugs available was less and thus, the need for druginformation was limited. But now, the scenario has come a long way with new modes oftherapy and vast number of drug products being available. It is not humanly possible toremember such vast information on drugs. There has also been a great explosion in thenumber of biomedical journals published each year. Hence, it is very important toProvision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 13
  29. 29. Review of literatureretrieve specific unbiased information. A clinical pharmacist is professionally trained andlegally competent to provide drug information, which is also a key component of his/her 12daily activities .In India, the concept of rational drug use is yet a long way to go. Lack of unbiased druginformation and lack of time are some of the factors that makes the physicians unable toupdate their knowledge about drugs which have resulted in an increasing demand forindependent and unbiased information about drugs for better patient care. It is important,to periodically evaluate the mode of functioning and quality of the services provided by 12the centre, so that necessary modifications can be made for better functioning .The pharmacist’s role is to provide other members of the healthcare team the relevantdrug related health care information at the right moment together with the informationfeedback from patients. This means pharmacy information becomes health careinformation13.In the past three decades, along with the “therapeutic explosion” there has also been an 3information explosion, as literature related to drugs, has expanded at colossal rate .Druginformation to health professionals is multifaceted and challenging .Professionalsactively, seek DI information. Once they have become acquainted with the service thereis a potential for increasing activities, and increased cooperation between DI centers,hopefully methods will be developed to evaluate the impact on health care of theseactivities9.Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 14
  30. 30. Review of literatureA large proportion of drug information is generated with the needs of healthy and adultconsumers in mind. The need for information among specific groups , for example theelderly , children, or the disabled , may actually be greater than that of healthyconsumers , they should also be offered drug information appropriate to them and withtheir special needs in mind 14.Written drug information should also be transparent. Patients and consumers should atleast be able to recognize the origin, author, the possible sponsor and date of preparationof the information available. For obtaining information, the internet is a natural andfamiliar tool especially for adolescents, obtaining information on internet is for manyeasier than, for example, using books, health care professionals or package inserts as theresource. However, the internet based information and interactive discussion do notnecessarily affect patients disease management. The overwhelming amount ofinformation available on the internet may also make decision making more difficult14.The whole spectrum of information available on the internet varies a lot. As the contentsof the web pages are hardly at all supervised, the information available may be incorrector even harmful. Consumers using the internet may have difficulties in finding completeand accurate information on health problems. The volume of and ease of access to druginformation for patients and consumers should be increased including the means bywhich they may evaluate the quality of drug information. The information about the toolsfor evaluating should be published in the media, for example, in news papers and 14magazines .Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 15
  31. 31. Review of literaturePatients and consumers should be instructed and encouraged to use interactive internettools, the purpose of which is to train consumers to check the quality of information.Drug information available to patients with special needs should be increased , individualwith low literacy skills , the blind and those with poor eye sight , as well as the elderlyand children , need drug information appropriate for their needs14 .There are many kinds of consumers and patients, not every one has an opportunity tomake use of information technology, and this may increase inequality. Drug informationshould still in the future be available in many different forms, both written and verbal,and it should be mediated by several different means. In order to improve the druginformation more research in to the needs, opportunities and attitudes of the individualconsumers and patient concerning the drug information needs to be carried out14.Pharmacist are indispensable in their role as providers of drug information to patientsthrough the use of package inserts and other forms of documentation , however , thedifficulty of providing more comprehensive information to patients due to timeconstraints , among other factors , prevents pharmacist from addressing the specificconcerns of individual patients 15.The term drug information is used to mark a variety of data, both general and patientproblem related, depending on the context of its use. Also the availability of thatinformation depends on the meaning in which the term is being used while generalProvision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 16
  32. 32. Review of literatureprescribing data from data sheet ( summaries of the product characteristics , approvedupon authorization of the product ) should be readily available for professionalsprescribing and dispensing the drug , problem specific information and pharmacotherapyrelated consultation may often be hard to find6 .Drug information centre in its today’s variety of functions as source of both basic andproblem-related data, collection point of frequent questions, and possibly also aparticipant in pharmacovigilance and prescribing feedback may relieve some of theburning information needs of professionals. This can be achieved with moderateresources and can be developed in to professionally and technically more sophisticateorganization when staff and financing are available6.Health care decision making and consumers , who play a key role in this field , arerarely involved in the promotion of rational use in developing countries , and, in thosecountries there is an imbalance between promotional information and independentinformation on medicines for consumers and health professional’s . They both receive alot of advertisements for drugs, directly and indirectly. in addition , most healthprofessionals aren’t , trained to evaluate critically the information received , whichmakes the situation worse , in brief , this lack of independent information easily leadsto irrational selection , prescribing dispensing and consumption of medicines , whichcould harm patients and negatively impacts on health economics16 .Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 17
  33. 33. Review of literatureDrug information centres have been instrumental in improving the rational use of drugs.One of the reason for setting up DIC’s is that health professionals and common people ingeneral will receive drug information mainly from pharmaceutical industry, and theinformation can be biased. Additionally, especially the new powerful and specificallyacting drugs need precise update ed, unbiased, and digested drug information that mustbe used properly16.Drug information to professionals is not a clearly defined concept , but consists ofvarious activities which motivates the participants and stake holders . The over all aim isto promote safe, effective and economic use of medicines. A broad definition of drug-induced activities would be any activity that provides information about medicines to ahealth professional. Good quality information has been described as a rationedcommodity for health professional, as health care makes limited investments to provideindependent information. It is generally acknowledged that professionals need more highquality drug information but few have specified whether an increase should be inavailability, quality and range of activities. Information must be reliable and theprofessional should feel confident about using it, and services should be easily accessible.Pharmacist’s communications with doctor often contain drug information to some extent.DI activities towards health professionals often consists of items such as question /answers (Q/A) services , news letters, adverse drug reaction ( ADR) reporting , drugsand therapeutics committees , formularies and educational activities17.Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 18
  34. 34. Review of literaturePharmacist, by tradition has been prime source of information on drugs and theirformulation for practicing, nurses, paramedical staff and patients. In the past when drugswere few in number and of relatively low potency, the number of drug related enquirieswas also small and they could be generally answered quickly by reference topharmacopoeias and formularies. A quick reference to such standard books alone is nolonger sufficient in most cases to provide an adequate answer today.In recent years two factors have created a need to alter the traditional pattern ofinformation generation and dissemination.1) The number of drugs and medicines available in the market have increased enormously, the newer drugs are generally more potent and selective and the dosage forms in to which they are formulated have become more complex. This makes it difficult for rational choice of drugs in the therapy2) Secondly, the literature relating to drugs has also expanded at a staggering rate. It covers a wealth of information on newer drugs, comparative efficacy and so on. The source of this literature is also very diverse, including a variety of topics dealing with pharmacy, medicine, pharmacology and related topics In the view of this current therapeutic and drug information explosion , there exists a great need for the dissemination of drug related information to physicians, hospitals , health care professionals , and the consumers . Consequent to the development of clinical pharmacy practice, drug information services have also evolved as a specialization in the context of pharmaceutical and medical sciences 5.Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 19
  35. 35. Review of literature Healthcare practitioners, patients, and the general public now demand more information and services from pharmacists regarding the rational use of drug therapy than ever before. The significant impact of drug therapy on clinical practice has prompted drug information centers in various institutions to assist healthcare practitioners in providing rational drug therapy. The first formalized drug information center was established at the University of Kentucky in 1962. Since that time, many formal drug information centers have been developed throughout the United States with the purpose of delivering accurate and timely clinical information 7.Location of Some of the Drug Information Centres in India 1. All India Institute of Medical Sciences Poison Information Centre, Delhi 2. Andhra Pradesh State Pharmacy Council, Andhra Pradesh 3. Christian Medical College Hospital, Vellore, Tamilnadu 4. CDMU Documentation Centre, Kolkata, West Bengal 5. Victoria Hospital, Bangalore, Karnataka 6. JSS Hospital, Mysore Karnataka 7. Karnataka State Pharmacy Council, Bangalore, Karnataka 8. JSS of College Of Pharmacy, Ooty, Tamilnadu 9. Kasturba Medical College Hospital, Manipal, Karnataka 10. Kempegowda Institute of Medical Sciences, Bangalore Karnataka 11. Maharastra State Pharmacy Council, Mumbai, MaharastraProvision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 20
  36. 36. Review of literature 12. Pharma Information Centre, Chennai, Tamilnadu 13. Sri Ramachandra Medical College Hospital and Research Institute, Chennai, Tamilnadu 14. Sri Ramakrishna Hospital, Coimbatore, Tamilnadu 15. Trivandrum Medical College Hospital, Trivananthaapuram, Kerala 3Pharmaceutical products that promise a so-called "blockbuster potential" require anincreasingly coordinated medical information function at the local, continental, andglobal levels. A strong emphasis must be placed upon the provision and evaluation ofmedical information. To assist in the management of this information, a number of toolsand databases are employed 18.Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 21
  37. 37. Methodology4. Methodology1. Study site: Drug Information Centre at the Department of Pharmacy Practice, KIMS Hospital and Research centre, Bangalore2. Study period: This study was conducted for a period of eight months from September 2006 to May 20073. Study design: The Research Design is an Open Study to provide DI services to all the Health care professionals and service users contacting the DI center at KIMS Hospital. and Research centre4. Source of data: DI Request Form, DI Documentation Form, DI Quality Assurance Form and Enquirer Outcomes Evaluation Form.4. Study Procedure: a) Preparation of the Drug Information Request Form: DI request form were prepared which included the following details such as, details of the enquirer, mode of request, purpose of enquiry, question category, answer needed, patient details if any, etc., (Annexure I)Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 22
  38. 38. Methodology b) Preparation of Drug Information Documentation Form: The Drug Information Documentation Form was also prepared where the Clinical Pharmacist entered the details of the enquirer’s professional status, type of enquiry, query category, and other details. (Annexure II). c) Awareness activities: were conducted (in all the Departments of the hospital) in person and through personal letters such as Pediatrics, Medicine, ENT, Psychiatry, Orthopedics, Surgery, Nursing Department, etc; regarding the DI services. (Annexure III) Awareness posters were prepared and were displayed in prominent areas of hospital [Out-patient Department, Pharmacy Services, lifts etc] for the awareness of the general patient population, doctors and health care professionals regarding the services. (Annexure IV). During the ward round participation the forms were shown to the Doctors and services extended were explained. The Health Care Professionals were intimated that they could send in their Drug Information Requests by any mode such as direct access, telephone, and. Email d) Query Handling: Any DI query from Doctors, Nurses, Pharmacists, Patients, Researchers were received pertaining to the Allopathic System of Medicine. This study did not include the queries related to poison information and the alternate systems of medicine. e) Query Information: Answers for the queries were formulated by referring to different sources such as primary secondary and tertiary resources. SometimesProvision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 23
  39. 39. Methodology other DIC’s were also contacted such as Karnataka state pharmacy council (KSPC) or the local pharmacies for formulation of the information. The information collected was tailored to suit the individual requirements of the enquirer. f) Reply: Reply was communicated to the enquirers in the requested mode which was either verbal, printed material was handed over personally, telephone, or email as per the request of the enquirer. g) Documentation: The reports sent were documented both as soft copy as well as hard copy. h) Quality Assessment: To assess the quality of the reply Enquiry Outcomes Evaluation (Annexure V) was prepared and given to the users of the DI Services and the filled-up form was collected back. i) The quality of the DI services was assessed by audits using the DI Quality Assurance Form (Annexure VI) internally, by random selection of the queries by the team which comprised of the HOD, Department of Pharmacy Practice and a Clinical Pharmacist. j) The queries were also assessed by external auditing by eminent personalities in the field.Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 24
  40. 40. Results5. ResultsA total of 51 queries were received and attended during the study period in theDepartment of Pharmacy Practice, KIMS Hospital, Bangalore.Drug Information Queries Received Per Month During The Tenure of StudyIt was observed that maximum number of queries was received during the period ofDecember 16 –January 15.An average of six queries were received and attended per month. The Drug InformationQueries Received per Month during the Tenure of Study is presented in Table I andFigure 1. Table 1: Drug Information Queries Received Per Month During The Tenure of Study Sl. No. Month Range No. of queries Percentage 1 Sep 16 – 0ct 15, 06 7 13.72 2 0ct. 16, - Nov 15, 06 5 9.8 3 Nov 16, -.Dec. 15, 06 7 13.72 4 Dec 16 -Jan. 15, 07 11 21.56 5 Jan 16 - Feb.15, 07 6 11.76 6 Feb.16 – Mar.15, 07 4 7.84 7 Mar 16- Apr.15, 07 5 9.8 8 Apr16 –May.15, 07 6 11.76Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 25
  41. 41. Results Figure 1: Drug Information Queries Received Per Month During The Tenure of Study Drug Information Queries Recieved Per Month During The Tenure Of Study APR 16 - MAY 15 07 6 11.76 MAR 16 - APR 15 07 5 9.8 FEB 16 - MAR 15 07 4 7.84 JAN 16 - FEB 15 07 6 11.76 period DEC 16 - JAN 15 07 11 21.56 NOV 16 - DEC 15 06 7 13.72 OCT 16- NOV 15 06 5 9.8 SEPT 16 - OCT 15 06 7 13.72 0 5 10 15 20 25 30 35 40 45 50 55 value NO OF QUERIES % OF QUERIESProvision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 26
  42. 42. ResultsMedical SpecialityMaximum number of queries were received from medicine department (45.10%)followed by other departments. The queries received and attended from different medicalspecialties is presented in Table 2 and Figure 2. Table 2: Medical Speciality Sl. No. Enquirer No. of Queries Percentage 1 Medicine 23 45.09 2 ENT 2 3.92 3 Dermatology 3 5.88 4 Surgery 7 13.72 5 Psychiatrists 2 3.92 6 Dentists 4 7.84 7 OBG 2 3.92 8 Others 8 15.68Note: Others, include patients, pharmacist, general public, medical representative etc. Figure 2: Medical Speciality Medical speciality OBG Other 3.92% 15.69% Dentists Medicine 7.84% 45.10% Psychiatrists 3.92% Surgery 13.73% Dermatology ENT 5.88% 3.92% Medicine ENT Dermatology Surgery Psychiatrists Dentists Other OBGProvision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 27
  43. 43. ResultsStatus of EnquirerThe status of enquirer is shown in Table 3 and Figure 3, wherein post graduate studentshave used our services to the maximum, 35%; followed by interns, 23%; and others 17%.The physicians were 13%, surgeons 6%, and residents 6%. Table 3: Status of Enquirer Sl. No. Status of enquirer Number Percentage 1 Post Graduates 17 35 2 Physicians 6 13 3 Surgeons 3 6 4 Interns 11 23 5 residents 3 6 6 Nurses 0 0.0 7 Others 8 17 Figure 3: Status of Enquirer Status of Enquirer Other 8, 17% Nurses 0, 0% Post Graduates 17, Residents 3, 35% 6% Interns 11, 23% Physicians 6, Surgeons 3, 13% 6% Post Graduates Physicians Surgeons Interns Residents Nurses OtherProvision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 28
  44. 44. ResultsMode of Request of QueryTable 4 and Figure 4 shows the Mode of Request of Query. It can be observed that thepreferred mode of request for the Clinicians was either by direct access or during theward round participation. Table 4: Mode of Request of Query Sl. No. Mode of Request Number Percentage 1 Direct Access 27 52.94 2 During Ward Rounds 17 33.33 3 Telephone 5 9.80 4 Email 2 3.92 Figure 4: Mode of Request of Query Mode Of Request Of Query 2, 5, 3.92% 9.80% 27, 52.94% 17, 33.33% Direct Access 52.94% During Ward Round 33.33% Telephone 9.80% Email 3.92%Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 29
  45. 45. ResultsPurpose of The QueryTable 5 and Figure 5 indicates the Purpose of the Enquiry, was mostly to updateknowledge which is 50.87% followed by better patient care 36.84%. Table 5: Purpose of The Query Sl. No. Purpose of query Number Percentage 1 Update Knowledge 29 50.87 2 Better Patient Care 21 36.84 3 other 7 12.28 Figure 5: Purpose of The Query Pupose Of the query Other, 12.28% Update Knowledge, 50.88% Better Patient Care, 36.84% Update Knowledge Better Patient Care OtherProvision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 30
  46. 46. ResultsTypes of QueryThe type of Query is represented in Table 6 and Figure. 6 About 22.2% of the querytypes belonged to miscellaneous followed by “drug profile” 14.85% and indication14.81%. About 11.11% of the queries were related to drug interaction. Table 6: Types of Query Sl. No. Types of query Number Percentage 1 Indication 8 14.81 2 Dosage recommendation 2 3.70 3 Availability 3 5.55 4 Drug Interactions 6 11.11 5 Pharmacokinetics 2 3.70 6 Drug Profile 8 14.81 7 Adverse Drug Reaction 5 9.25 8 Dosage/Administration 2 3.70 9 Pregnancy/ teratogenicity 2 3.70 10 Drug of choice/ therapeutics 4 7.4 11 Miscellaneous* 12 22.22Note:  Miscellaneous* includes pharmacology, newer drugs, calculation of dosage based on BSA, advancement, precautions, contraindication etc  One query can belong to more than one typeProvision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 31
  47. 47. Results Figure 6: Types of Query Types of Query 25.00% 22.22% 20.00% 14.81% 14.81% 15.00% Value 11.11% 9.25% 10.00% 7.40% 5.55% 5.00% 3.70% 3.70% 3.70% 3.70% 0.00% 1 Type Indication n = 8 Dosage recommendation n = 2 Availability n = 3 Drugs Interactions n = 6 Pharmacokinetics n = 2 Drugs Profile n = 8 Adverse Drug Reaction n = 5 Dosage/Administration n = 2 Pregnancy/teratogenicity n = 2 Drug of choice/therapeutics n = 4 Miscellaneous n = 12Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 32
  48. 48. ResultsResources Consulted For InformationAll the three sources namely Primary, Secondary and Tertiary Sources were consulted toanswer the queries. The nature of the queries and the time of response given by theclinicians demanded maximum use of the text books to about 51%. The resourcesconsulted for information are presented in the Table 7 and Figure 7. Table7: Resources Consulted For Information Sl. No. Resources Consulted Number Percentage 1 Drugdex 3 5.35 2 Micromedex 5 8.92 3 Internet 14 25 4 Textbooks 29 51.78 5 Local Sources* 5 8.92 * Local Pharmacies/Other DICs Note: More than one resource used at a time Figure 7: Resources Consulted For Information Resources Consulted For Information , Local Sources 8.92% Drugdex , 5.35% Micromedex, 8.92% Internet, 25.00% Textbooks, 51.78% Drugdex Micromedex Internet Textbooks Local SourcesProvision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 33
  49. 49. ResultsTime Specification Given By EnquirerAbout 35.29% of the queries were answered later than 24 hours as shown in Table 8 andFigure8. Table 8: Time Specification Given By Enquirer Sl. No. Time Taken Number Percentage 1 Immediately 9 17.64 2 Within 30 min 8 15.68 3 Within 2hour 16 31.37 4 More than 24 hours 18 35.29 Figure 8: Time Specification Given By Enquirer Time specification given by enquirer , Immediately 17.64% More than 24 hours, 35.29% , Within 30 min 15.68% , Within 2 hours 31.37%Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 34
  50. 50. ResultsMode of Information ProvidedMost of the information was provided as printed material (68..6%) as requested inaddition to verbal (21.56%) as shown in Table 9 and Figure 9. The information was alsoprovided by other modes such as email 5.88%, written and verbal 3.92% Table9: Mode of Information Provided Sl. No. Mode of Information Number Percentage (%) 1 Printed Material 35 68.6% 2 Verbal 11 21.56% 3 Email 3 5.88% 4 Written and verbal 2 3.92% Figure 9: Mode of Information Provided Mode Of Information Provided 5.88% 3.92% 21.56% 68.62% Printed Material Verbal Email Written and verbalProvision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 35
  51. 51. ResultsDrug Information Quality AuditFrom the results of the internal and external auditing, it can be seen that 83.125 % of theresponses to the queries audited were satisfactory and 16.875 % not satisfactory. Thedrug information quality audit is presented in Table 10 and Figure 10. Table 10: Drug Information Quality Audit Sl. No. Auditor No Satisfactory (%) Not satisfactory (%) 1 Internal 10 83.75 16.25 2 External 5 82.5 17.5 3 Overall 15 83.125 16.875 Figure10: Drug Information Quality Audit Drug Information Quality Audit Overall Results 100 90 83.75 82.5 83.125 80 70 Percentage (%) 60 50 40 30 15 16.25 17.5 16.875 20 10 5 10 0 n Satisfactory (%) Not satisfactory (%) Internal External OverallProvision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 36
  52. 52. ResultsEvaluation of Query OutcomesEvaluation of quality audit outcomes results are shown in Table 11 and Figure 11.Indicating overall services as 81.25% and courtesy of personnel as 87.5 % Table 11: Evaluation of Query OutcomesSl. No. Parameters Satisfactory (%) Not satisfactory (%) Accuracy 75 25 1 Response Time 62.5 37.5 2 68.75 31.25 3 Relevance 75 25 4 Completeness 62.5 37.5 5 Clarity 62.5 37.5 6 Applicability to Patient Care 68.75 31.25 7 Presentation of Data 87.5 12.5 8 Courtesy of Personnel 75 25 9 References 81.25 18.75 10 Overall Services Figure 11: Evaluation of Query Outcomes Evaluation OF Query outcomes 18.75 Overall Services 81.25 References 25 75 12.5 Courtesy of Personnel 87.5 31.25 Presentation of Data 68.75 37.5 Applicability to Patient Care 62.5 37.5 Clarity 62.5 25 Completeness 75 31.25 Relevance 68.75 37.5 Response Time 62.5 25 Accuracy 75 Satisfactory (%) Not satisfactory (%)Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 37
  53. 53. Discussion6. DiscussionIn a period of 8 months (September 2006 to May2007) 51 queries were received.Table 1 and Figure 1 gives the Number of queries received per month during the tenureof the study. It was observed that the number of queries received per month rangedfrom4-11. There was an increase in the number of queries received when the regularpersonal meetings or ward round participation was done. The average queries per monthwere 6.Figure 2 analyzes the queries received from each department during the study period. Theanalysis shows that maximum number of queries were from the medicine department at45.10%. This was followed by ‘others,’ which included patients, pharmacists, generalpublic, etc., at 15.68%; and department of surgery at 13.72%.Majority of the queries were from the department of medicine which shows the impact ofward round participation and regular follow up. As the general physicians were dealingwith the patients with multiple diseases, they had many queries with regard to drug, druginteractions, new drug profiles, etc., for which they had to constantly update theirknowledge. The percentage queries from other departments are given in the descendingorder; dermatology 5.88%, OBG 3.92%, psychiatry 3.92%, and ENT 3.92%. Dental department also had queries, which was only through personal contacts, whichmade up for 7.84% of the total queries.Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 38
  54. 54. DiscussionThe category ‘others,’ includes patients, pharmacist, general public, etc., made up for15.68% of the total queries. This was primarily due to the awareness created by theposters which were displayed in prominent areas of hospital.Despite the awareness program, there were no queries from the department oforthopedics and the department of pediatrics. This may be due to less usage of drugs inthe department of orthopedics. The department of pediatrics deals with a special group ofpopulation, and hence more queries were expected. However, this was not the case; itmay be an indication that further motivation is required for this department.The status of enquirer is shown in table 3 and figure 3, wherein post graduate studentshave used our services to the maximum, 35%; followed by interns, 23%; and others 17%.The physicians were 13%, surgeons 6%, and residents 6%.respectively. Post graduatestudents are usually motivated to ask the query by the specialists or doctors in the wards.There were no queries from the nurses which indicate that further motivation is required.Table 4 and Figure 4 shows the Mode of Request of Query. It can be observed that thepreferred mode of request for the clinicians was either by direct access or during the wardround participation. Telephonic and electronic mode of requests were very few.Table 5 and Figure 5 indicates the Purpose of the Enquiry, was mostly to updateknowledge which is 50.87% followed by better patient care 36.84%, some of queryincluded both, update knowledge as well as better patient care.Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 39
  55. 55. DiscussionThe type of Query is represented in Table 6 and Figure. 6 About 22.2% of the querytypes belonged to miscellaneous followed by “drug profile” 14.85% and indication14.81% wherein the purpose was to gain more knowledge about the newer class of drugsand indication. About 11.11% of the queries were related to drug interaction which isvery promising as it can further help the clinicians in reducing the ADRs in their clinicalpractice.The next type of the queries belonged to adverse drug reaction amounting to 9.25%,which are important contributing factors for better patient care. Drug of choice andtherapeutics constituted 7.4%. Pregnancy/teratogenicity 3.70%, Dosage/Administration3.70% and Dosage recommendation queries amounted only to 3.70%.Very few queries5.55% were regarding the availability probably due to the more availability of new drugswithin the hospital.From Table7 and Figure 7, it was observed that all the three sources namely Primary,Secondary and Tertiary Sources were consulted to answer the queries. The nature of thequeries and the time of response given by the clinicians demanded maximum use of thetext books to about 51%. Information regarding the recent advances and research findingscommanded the need for internet search.Consultation with the other DICs provided the information for some queries through theuse of Drugdex and Micromedex sources .Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 40
  56. 56. DiscussionAbout 35.29% of the queries were answered later than 24 hours as shown in Table 8 andFigure8. Depending on the urgency of the queries they were answered immediately17.64%, within 30 minutes15.68% and within 2 hours 31.37%.Most of the information was provided as printed material (68..6%) as requested inaddition to verbal (21.56%) as shown in Table 9 and Figure 9. The Information was alsoprovided by other modes such as email 5.88%, written and verbal 3.92%Table 10 and Figure 10 which gives the results of the internal and external auditing, it canbe seen that 83.125 % of the responses to the queries audited were satisfactory and16.875 % not satisfactory.Evaluation of quality audit outcomes results are shown in Table 11 and Figure 11. Fromthe available results, it was found that the overall services 81.25% and courtesy ofpersonnel 87.5 % was most satisfactory followed by accuracy, clarity, and presentation ofdata.Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 41
  57. 57. Conclusion7. ConclusionThe practice of drug information is at the development stage in India and this study is onesuch towards providing the information at KIMS Hospital, Bangalore. Successful druginformation provision and evaluation is the result of constant ward round participationand sustained interaction of the pharmacist with the health care professionalsThe drug information must be disseminated to the health care professionals by consultingdifferent resources such as primary, secondary and tertiary resources.The DI Centre at the KIMS hospital though at nascent state has been of help toclinicians in getting necessary and vital information on drugs, for the maximumtherapeutic outcome which ultimately results in better patient care.Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 42
  58. 58. Summary8. SummaryAccording to the SHPA Standards, Drug information is the provision of written and/orverbal information or advice about drugs and drug therapy in response to a request fromother healthcare providers, organizations, committees, patients or members of the public.This may relate to a specific patient or consist of general information promoting the safeand effective use of medications. The rapid expanding numbers of new drugs andtreatment principles has created and increased need for independently evaluated druginformation and education.In the past, the number of drugs available was less and thus, the need for druginformation was limited. But now, the scenario has come a long way with new modes oftherapy and vast number of drug products being available and it is important to retrievespecific unbiased information. There has also been a great explosion in the number ofbiomedical journals published each year.The aim of drug information services is to optimize patient outcomes by supporting thequality use of medicines. The drug information pharmacist contributes to the quality useof medicines by the provision of current, timely, accurate, objective and appropriateinformation on drug and drug therapy.Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 43
  59. 59. SummaryThe drug information services of the Department of Pharmacy Practice, VisveswarapuraInstitute of Pharmaceutical Sciences, at KIMS Hospital and research centre was initiatedin 2003 to provide unbiased drug information to the health care professionals. Theawareness in the hospital regarding the availability of this facility was minimal.The aims and objectives were successfully led to their goals in the following way. The DIRequest Form, DI Documentation Form, DI Quality Assurance Form and EnquirerOutcomes Evaluation Form were prepared. Awareness activities were carried out invarious departments of the hospital. Personal letters were handed to all the health careprofessionals and posters were exhibited in the different departments of the hospital. andin the prominent places in the hospitals such as OPD lifts etc. The queries were receivedby the Clinical Pharmacists during ward round participation, or by direct access, or bytelephone or email. The information was formulated by referring different resources suchas primary secondary and tertiary resources as per the need of the enquirers, and weredocumented and provided to the enquirer in their requested mode. This amounted to 51queries at the end of the study from September 2006, until May 2007, i.e. the period ofthis study. The quality assurances was carried out by both internal, and external auditsand the enquiry outcomes evaluation forms were distributed to the service users and feedback collected.The Drug Information Services were utilized by Clinicians from various departmentssuch as Medicine, Others, Surgery, Dental, Dermatology, ENT, Psychiatrists, OBG,given in the descending order of their usage. Others which included Pharmacists,Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 44
  60. 60. SummaryGeneral Public, Patients etc. The enquirer status included all levels such as Post Graduatestudents, Surgeons, Physicians, Interns and Residents. The purpose of most of the querieswas to update knowledge followed by better patient care.Most of the queries were graded as satisfactory and few were graded as not satisfactory.Response time, update knowledge, presentation of data, courtesy of personnel andOverall services were graded as satisfactory.Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 45
  61. 61. Limitations9. Limitations  Short duration of study and this being a new concept in the health care set up at KIMS Hospital, it is restricted to less number of queries  Availability of limited number of resourcesProvision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 46
  62. 62. Future Directions10. Future Directions  Regular awareness and Orientation Programs to be carried out in all the departments of the hospital  Addition of more resources (online services) in the Drug information centre  Creating Public awareness through the different modes of communication conventional tools such as leaflets and booklets on drug information will be of great value  Auditing should be carried out on a periodical basis for the constant improvement of the DI services  Networking with the other DICs in IndiaProvision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 47
  63. 63. Bibliography11. Bibliography 1. Carolyn Rochat.Practice standard for provision of drug informaton sevices.www.saahip.org.za/ 2. Jhonstone JM, Vienet MD. The society of hospital pharmacist of Australia case mix working party, definition for hospital pharmacy services. The society of hospital pharmacists of Australia. Melbourne SHPA 1996. 3. Rajendran S D. Drug Information. A textbook of Clinical Pharmacy Practice by Parthasarathi G, Karin Nyfort-Hansen, & Nahata MC.Orient Longman 2004; 17: 269 4. Marika Pohjanoksa- Mantyla , Marja Airaksinen.Drug information via telepharmacy- whom to serve?.international pharmacy journal 2004;18(1) 5. Tiphis HP,Amrita Bajaj.Clinical pharmacy:Career publications; 2003.p.543-561. 6. Ain Raal, Krista Fischer, Alar Irs: “Determination of drug information needs of health care professionals in Estonia”. Medicina (Kaunas) 2006; 42(12).p: 1030- 34. 7. Ansong ,Miriam A: Free for service drug information centres. Drug Information Journal 2003. 8. Susan E Malccha Amy J Cha, Robet J Holt.Establishing combined drug information residency in industry and academia. American journal of pharmaceutical education 2000; 64:177-80. 9. J.W.F.van Mil: “Drug Information”, International Pharmacy Journal: Pharmacy Information, Vol 18, No. 1, 2004.Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 48
  64. 64. Bibliography 10. Lakshmi PK, Bhaskaran S, Gayathri Devi S. Drug information services-an emerging practices in India. International pharmacy journal 2005;19(1) 11. WHO drug information2002; volume 16(3):p:209. 12. Beena George, Padma G.M.Rao, Assessment and evaluation of drug information services provided in a South Indian teaching hospital.Indian J Pharmacol, October 2005, Vol 37, Issue 5, p :315-318. 13. Han de Gier. “Trend watching for pharmacy information”.International pharmacy journal 2004;18(1). 14. Ulla Narhi. Drug Information for consumers and patients- a review of the research. Publications of National Agency for Medicines 1/2006. 15. Sei-ichiro HAYASHI, Teiichi MUKAI, Keiko OHNO, Masayuki HASHIGUCHI. “Patient prospective on provision of drug information services in Japan”. YAKUGAKU ZASSHI 123(8); p: 697-706. 16. Carols Cezar Flores Vidotti. “Drug information centres in developing countries and the Promotion of rational use of drugs”. A view point about challenges and Perspectives Pharmacy information volume 18, No 1, 2004. 17. Tone Westergren, Jan Schjott. “Delivering balanced and quality drug information to professionals”. International pharmacy journal, Vol 18, No.1, 2004. 18. Cowlrick, Ivor, Dumon,Jeroen, Bauleser, Manfred. Managing medical information effectively facilitates the quality and time to delivering the final product. Drug Information Journal, Oct-Dec 2002.Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore 49
  65. 65. Annexure Annexure-I Department of Pharmacy Practice Drug Information Centre – V.I.P.S. KIMS Hospital and Research Centre 4th Floor, New Building, K.R. Road, Bangalore 560 004DRUG INFORMATION SERVICES Drug Information Request Form Date: -__________ Time:-_________ Received by: - ___________________ Name of the Enquirer: -____________ Contact no________ Unit:-_______ Enquirer’s Professional Status: Physician  Surgeon  Resident  PG  Intern  Nurse  Others  Details of Enquiry: Query:________________________________________________________________ ______________________________________________________________________ Purpose of Enquiry: Update knowledge  Better patient care  Others  Answer Needed: Immediately  within 30 min  within 2h  more than 24h  Patient Details: Age: ______ years Weight: _______ kg Sex: M  F Liver/renal function Allergies Current medical Relevant drug problem therapy Other details If pregnant: - first trimester  second trimester  third trimester  If breast feeding age of infant:-_____________________________________________ Pharmacist’s notes:- Signature of Attending Pharmacist Signature of EnquirerProvision and Evaluation of Drug information Services in KIMS Hospital, Bangalore I
  66. 66. Annexure Annexure-II Department of Pharmacy Practice Drug Information Centre – V.I.P.S. KIMS Hospital and Research CentreDRUG INFORMATION SERVICES 4th Floor, New Building, K.R. Road, Bangalore 560 004 Drug Information Documentation Form Date:-________ Time:-___________ Received by:-_________________ Name of the enquirer:-________________Department: _______________________ Unit:_______________ Contact no.:_________________ The Enquirer’s Professional Status:- Physician  Surgeon  Resident  PG Intern  Nurse Any Other (Specify) Details of enquiry: - Query:- ___________________________________________________________________ ______________________________________________________________________ Patient details:- Age__________ weight __________kg Sex: - M F Liver/renal function Allergies Current medical Relevant drug problem therapy Others details: If pregnant: -  first trimester  second trimester  third trimester If breast feeding, age of infant:- _____________________________________________ Mode of Request : Direct access During ward rounds Telephone E-Mail OthersProvision and Evaluation of Drug information Services in KIMS Hospital, Bangalore II
  67. 67. Annexure Purpose of Enquiry: Update Knowledge Better Patient Care Other Category : Indication Availability / Identification Administration / Dosage Drug Profile Dosage Recommendation Drug of Choice / Therapeutics Pharmacokinetics Adverse Drug Reactions (ADR) Pharmacoeconomics Drug Interactions(Drug–Drug, Drug–Lab, Drug– Disease, Drug – Food) Pregnancy / Teratogenicity Poisoning / Toxicology Lactation / Infant risk Compatibility / Stability (Chemical, Pharmaceutical, Sorption, Solubility, etc.) Efficacy OtherDate of reply : ___________ Time of Reply: _________________Answer needed Immediately  with in 30 mins within 2 hours more than 24 hours Delay in Answer : Yes NoIf Yes, Reason for Delayed Answer__________________________________________Follow-up if any;-________________________________________________________Form of Reply : Written Verbal Both Printed Material Telephone E. MailInformation provided_____________________________________________________Reference consulted______________________________________________________Name of the clinical pharmacist Signature of H.O.DProvision and Evaluation of Drug information Services in KIMS Hospital, Bangalore III
  68. 68. Annexure Annexure-III Awareness Letters Date: 29/09/06To:KIMS Hospital and Research CentreBangaloreDear Sir/Madam,I wish to bring to your kind notice that Vokaligara Sanghas Visveswarapura Institute of PharmaceuticalSciences has established a Department of Pharmacy Practice in KIMS Hospital and Research Centre.Our major activities are providing unbiased Drug Information to health care and practicing professionals,paramedical staff and patients, monitoring and reporting of Adverse Drug Reactions (ADRs) and PatientCounseling.In view of this, I would request you to make use of our services for the benefit of Staff & patients for anyinformation with respect to drugs like dosage, precautions, and drug dilutions with respect to injections.You could also report any ADRs noticed to our Department in your day to day practice.I take this opportunity to invite you to visit our Department for any drug information.Thanking you,With regards,Provision and Evaluation of Drug information Services in KIMS Hospital, Bangalore IV
  69. 69. Annexure Annexure-IV Awareness PostersProvision and Evaluation of Drug information Services in KIMS Hospital, Bangalore V

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