Systematic approach in answering DI queries request
1. Systematic approach in answering
DI Queries/Request
Khadga Raj Aran
M. Pharm, Ph.D. Research
scholar (Pharmacology)
2. Systematic Approach to Answer Drug
Questions
• 1. Secure demographics of requestor.
• 2. Obtain background information.
• 3. Determine and categorize ultimate question.
• 4. Develop strategy and conduct search.
• 5. Perform evaluation, analysis, and synthesis.
• 6. Formulate and provide response
• 7. Conduct follow-up and documentation
3. 1. Request Demographics
• Obtain requestor’s knowledge base and
position, training and knowledge of
medicine.
• Obtain telephone, address, fax, etc for
follow-up later.
• Determine approximate age (elderly,
adolescent, etc.) (usually no need to directly
ask)
4. • Secure requestor demographics
-Name, profession, location or practice
-Contact information: Mobile
• Determine a method for delivery of the
response
-Verbal, written, email
5. 2. Background Information
• Think, “Why is requestor asking for this
information?”
• Weigh time involved to get background info.
• Use tact, politeness and assertiveness
• Background questions should be specific for the
nature of the request.
• Ask, “What sources have already been used?”
• Useful info: age, gender, weight, allergies, other
disease states, other meds, lab values, etc
6. • Request background information
• Name And File Number
• Age
• Ht/Wt
• Diagnosis
• Allergies - If Yes, Description And Outcome
• Organ Function
• Other Medical Problems
• Other Medications
7. • Pregnant, which trimester?
• If it is ADR question
- If the drug was already administered
- How much and since when
• When the drug started and how much given
(dose?) Patient related
8. 3. Determine and Categorize Ultimate
Question
• The requestor's purpose for the information
must be understood
• Restate the request to confirm the question
with the caller
• Develop a time line for response
• Categorize the question
9. Categories of Questions
• Strength, manufacture, availability of product,
approval
• Tablet identification, general product information
• Laws/policies/procedures, Cost, Foreign products
• Compatibility, stability, administration rate
• Drug interactions (drug, lab, disease, food)
• Pharmaceutics (compounding, formulations)
• Pharmacokinetics (ADME/levels)
• Nutrition support
10. Categories of Questions...
• Therapy evaluation-- picking drug of choice
• Dosage, regimen, recommendations
• Adverse effects
• Poisoning, toxicology
• Pregnancy, Teratogenicity
• Lactation/ infant risks
11. 4. Strategy and Conduct Research Resources
Available: Primary Literature Resources
• Research studies published in biomedical
journals.
• Provide details of research methodology
and scientific results that lead to therapeutic
conclusions.
• Advantages: Most current resource for
information. Least biased, so most accurate
12. Primary Literature Examples:
• New England Journal of Medicine
• Archives of Internal Medicine
• JAMA (Journal of the American Medical
Association)
• CHEST (from the American College of Chest
Physicians)
• Clinical Pharmacy and Therapeutics
• Annals of Pharmacotherapy
• British Medical Journal
13. What do we find in Primary Resources
(journals)?
• Primary journal articles: clinical drug trials
– *** These articles are the primary resources we
are talking about ****
• Clinical trial types:
– Intervention types (highly rated)
• Randomized controlled trial
–Parallel
–Crossover
–Before and After (time series)
14. Primary journal article resources
• Observational (weaker than interventional studies)
– Cohort (strongest in class)
– Case control
– Cross sectional
– Case series, Case report, descriptive
15. Secondary Literature Resources
• Indexing and Abstracting Services
• Indexing service: provides only bibliographic
information that is indexed by topic.
• Abstracting service: also provides a brief
description or “abstract” of information contained
in a specific citation.
• Both provide access to primary literature
• Each can cover different journals, texts, publicat.
• Cost will vary from $150 to $60,000 / year
16. Secondary Literature Resources:
• Medline- largest 380,000 ref, 4000 journals
• BIOSIS
• Embase
• Index Medicus
• IDIS (Iowa Drug Information System)
• PUBMED (access to Medline)
17. Tertiary Literature Resources
• Textbooks (Goodman and Gilman, Handbook of
Non-Prescription Drugs, etc)
• Drug Encyclopedias (Martindales, Merck Index,
etc)
• Review articles in primary journals, Meta
Analysis articles in primary journals
• Drug Compendia (Facts and Comparisons, AHFS,
PDR
• Full Text Computer Database(Micromedex)
18. Tertiary Literature Resources
• Advantages:
– provide rapid access to information
– detailed sufficiently for quick reference
– good general information condensed into easy
to read format
• Disadvantages:
– Outdated quickly, may not reflect current
standards of practice, incomplete, human bias,
incorrect interpretation of research or lack of
expertise by author
19. Alternate Sources for Drug
Information
• Internet Sites
• Electronic Bulletin Boards (EBB’s): FIX,
FDA, Helix, Pharmnet, Pharmline
• Local and National Professional
Organizations
• Pharmaceutical Manufacturers
• Drug Information Centers, Poison Control
Centers
20. 5. Data Evaluation, Analysis, Synthesis
• Objectively and thoroughly evaluate located
information
• Confirm information with other references to
assure consistency between various resources
• Performing a comprehensive search is an
important part of this process to ensure
recommendations are based on all of the current
evidence available
• Derive an answer by professional judgment after
critically analyzing the available information when
resources do not provide a direct answer
21. 6. Formulate and Provide Response
• Provide the information and recommendation
• Written responses should always be concise and
fully referenced.
22. 7. Follow Up and Documentation
Document the question and response, and conduct
follow-up
• Methods of follow-up
– Mail survey
– Phone call
– Written communication
• Reasons for follow-up
– Provide the requestor with additional information
that supports or changes a prior recommendation
– Obtain feedback concerning the quality of the
service
