Systematic approach in answering DI queries request

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

25. Thanks for your Patience