|Year : 2012 | Volume
| Issue : 4 | Page : 302-306
Evaluation and appraisal of drug information services in a rural secondary level care hospital, Anantapur, AP
Rohit Bhavsar1, Seeba Zachariah2, Dixon Thomas2, Shanmugha M Kannan3
1 Department of Pharmacy Practice, RIPER, Anantapur, Andhra Pradesh, India
2 RDT/RIPER Drug Information Center, Andhra Pradesh, India
3 RDT Hospital, Bathalapalli, Andhra Pradesh, India
|Date of Submission||05-Feb-2012|
|Date of Decision||07-May-2012|
|Date of Acceptance||29-May-2012|
|Date of Web Publication||07-Nov-2012|
RDT/RIPER Drug Information Center, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Drug Information Center (DIC) is an information center which provides drug information (DI) to healthcare professionals. The aim was to evaluate the performance of DIC for improving the quality and quantity of information services provided to the healthcare professionals. The service was provided free of cost to the customers. Materials and Methods: This descriptive study was conducted for the period of 6 months from February to August 2011 excluding May due to vacation. Customers were asked: how did they find the service provided to them? Was it good, satisfactory, or need improvement? There were written feedback forms to be filled by the customers, including customer satisfaction questions. The official publication of the DIC, RIPER PDIC Bulletin was screened for its types of articles/number of drug news published. The bulletin is circulated for free to the healthcare professionals electronically. Results and Discussion: A total of 232 queries were obtained during the study period of 6 months. Average number of queried received to the DIC was 39 per month. Most preferred mode of queries was personal access (89%). Majority of queries were received from nurses, i.e., 162 (70%) queries and 81% of all queries were drug oriented for improving knowledge. There were only 19% of the queries for individual patients; doctors asked most of those queries. Only 3% queries answered were rated as need improvement by the healthcare professionals. Rest were considered as either Good (56%) or satisfactory (49%). Range of drug news published in each bulletin was 3-4 and most of the other articles include expert opinion to improve practice or training. Conclusion: The DI services were satisfactorily used for academic interests. Nurses used the service for the highest compared to other health care professionals. Future studies should plan to establish the usefulness of DI to improve healthcare practice.
Keywords: DIC, drug, pharmacist, query, service
|How to cite this article:|
Bhavsar R, Zachariah S, Thomas D, Kannan SM. Evaluation and appraisal of drug information services in a rural secondary level care hospital, Anantapur, AP. J Pharm Bioall Sci 2012;4:302-6
|How to cite this URL:|
Bhavsar R, Zachariah S, Thomas D, Kannan SM. Evaluation and appraisal of drug information services in a rural secondary level care hospital, Anantapur, AP. J Pharm Bioall Sci [serial online] 2012 [cited 2020 Aug 5];4:302-6. Available from: http://www.jpbsonline.org/text.asp?2012/4/4/302/103255
As a part of quality assurance of Drug Information Service, it is important to study the selected indicators of periodically. This study is one of the efforts to evaluate the quality and quantity of the service provided by the DIC.
Drug information (DI) is the provision of written and/or verbal information or advice about drugs and drug therapy in response to a request from other health care providers, organization, committees, patient, or members of public. Proactive information is provided to the appropriate party without request. 
The provision of medical information is one of the most fundamental responsibilities of pharmacist. The information may be either patient specific, as an integral part of pharmaceutical care, or relative to the group of patients, such as development of therapeutic guideline, publishing the electronic news letter, or updating the website. 
DI pharmacist refers to a pharmacist who has completed a course of training in DI such as the advanced course for Speciality Practice in Drug Information, or equivalent, and specialists in the provision of DI. 
The DI pharmacist contributes to the quality use of medicines by provision of current, recently, accurate, objective, and appropriate technical and scientific information on drug and drug therapy. 
Drug Information Centers (DIC) seek to provide authentic, unbiased DI to healthcare professionals, provide tailor-made counseling and DI to patients/consumers as well as monitor, and document adverse drug reactions within the hospital. 
DI is also defined as the knowledge of facts acquired through reading, study, or practical experience concerning any chemical substance intended for use in diagnosis, prevention, or treatment of disease. It covers all types of information provision including subjective and objective information, as well as information gathered by scientific observation or practical experience. 
DI services and centers are still in their infancy and we have only few such services that qualifies as specialist DI services. Most of them are working as part of some hospitals, state pharmacy councils, pharmacy, and medical institutions. There is also a DI center by the Indian Pharmaceutical Association, West Bengal branch, Kolkata. 
The active intervention of pharmacist can provide more information on the patient safety and to improve quality of life. 
Information is the key to practice evidence-based medicine. Such information leads to enhanced quality of patient care and thus improved patient outcome. Poor drug regulation and lack of independent, unbiased DI are some of the contributing reasons for irrational drug use in India. About 40% of the health care services budget is consumed by medicines and with a limited resource available, it is essential to promote rational drug use. 
The major aim of the study was to evaluate the performance of DIC in a rural secondary level care hospital. As the pharmaceutical companies had a limited access to the health care professionals in the hospital, because of the hospital policies there was a greater scope of DI center as an established service provider of unbiased quality DI.
| Materials and Methods|| |
This is a descriptive study done as part of Pharm. D project work. Evaluation and appraisal of DI services was carried out for 6 months in 2011. The questions collected from requesters were recorded and answered mostly in a standardized form for answering. While answering the queries recommended recourses were used and standard operating procedures of the Department of Pharmacy Practice were followed. DI was provided only for the health care professionals.
While documenting and answering of DI query, confidentiality of the requester was maintained. Records were maintained of all requests, including date, coded or un-coded identity of the requester, answer prepared, timings, and resources used. Those who prepared the answers and the supervising teachers signed on the DI report. Records were maintained for periodic review of the services as part of quality assurance. Feedback forms were attached to the answers. The feedbacks were used during the review process for quality improvement.
The policy for answering the query includes single-page answering in 30 min as 5 min for selection of resources, 10 min for searching appropriate answer, and 10 min for preparing the answer. Single-page answering reduces the number of words to be read to understand the answer. Also it saves paper. It was also highly encouraged to as electronic a request which is more environment friendly. Some of the regular DI resources used were Elsevier Gold Standard Clinical Pharmacology Database, AHFS Drug Information 2009, World Health Organization (WHO) Model Formulary 2008, British National Formulary (BNF), and drugs.com. The Department of Pharmacy Practice is also publishing monthly RIPER PDIC Bulletin from August 2010. The bulletin was also screened for its consistency on drug news in the study period.
| Results|| |
A total of 232 queries were obtained during the study period of 6 months. Healthcare professionals using the services of the DIC in the hospital include doctors, nurses, pharmacists, and other health care professionals.
In February, we received highest number of queries (56, i.e., 24%). It reduced in the month of March (9, i.e., 8%), followed by a slight increases in number of queries on later months. May was not considered for the evaluation as the majority of May was summer vacation and the services were not comparable to the other fully functioning months. Average number of queried received to the DIC was 39 per month [Table 1].
We received highest numbers of queries by directly approaching (191, i.e., 82%) the health care professionals at their workplace then by email (29, i.e., 13%). Through ward rounds and phone received fewer queries (3 and 9, i.e., 1% and 4%, respectively) [Table 2].
In total, 232 queries highest queries came from medical followed by gynecology and infectious diseases. The least enquiring department was pharmacy. One of the reasons was the availability of DI from other sources. Pharmacy also had connection to internet and also had some of the reference books. All those reasons could contribute to a less number of queries asked from the pharmacy [Table 3].
Majorities of queries were about indication (68, i.e., 27%) and adverse effects (59, i.e., 24%). Fewer queries came from interaction (4, i.e., 2%) and contraindication and precaution (25, i.e., 10%) [Table 4].
Majority of queries were received from nurses (162, i.e., 70%) queries. In this, junior nurse ask most queries (147, i.e., 63%). From doctor, we got 38, i.e., 16% queries. Nurses had less time to refer and access to DI resources was limited. Therefore, the DI services were of great use to the nurses for easy and dependable information [Table 5].
Majorities of questions asked were drug oriented (187, i.e., 81%) and less of patient oriented (45, i.e., 19%) [Table 6].
DI service was widely satisfactory, there were fewer complaints about answering time, quality of information, or the specificity of answering the question [Table 7].
All questions were answered in a practical level with a suggestion to refer to other relevant resources also. Majority of the questions were answered on the same day or the next. In some cases, it took 2 days by more than 2 days were rare [Table 8].
Proactive drug information
Proactive DI is given without a query. There are no requesters of information. Some information needs to be disseminated in advance for the benefit of healthcare professionals and patients in the settings.
Proactive DI was provided in time of drug ban/withdrawal in India or change of important clinical guidelines. Those emails of drug or clinical news were sent to all the departmental heads through email. Some of the examples of drug bans circulated were Rosiglitazone, Sibutramine, Gatifloxacin, and Nimesulide for children, placenta extracts, Phenylpropanolamine, and Cisapride.
Guidelines and policy-making documents circulated include WHO essential medicines list 2010, National list of essential drugs 2011, and WHO Priority medicines for mothers and children.
From February 2011, more than 20 email communications of proactive DI were sent to the health care professionals in the hospital.
In RIPER PDIC Bulletin from January 2011 to September 2011 total 49 articles are published in these majorities of expert opinion (23, i.e., 47%) then review articles (13, i.e., 26%). From January 2011, the bulletin was indexed in Open J-Gate and registered with ISSN. Considering the academic interest of the healthcare professionals, research, review, and expert opinion article were published in the bulletin to improve knowledge and clinical practice [Table 9]. 
|Table 9: Articles published in RIPER PDIC bulletin from Jan 2011 to Sep 2011|
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Total 20 drug news were published in RIPER PDIC bulletin. Four drugs news were published in months February and April and three drugs news are published in March, May, June, and July [Table 10].
| Discussion|| |
The project student and the other Pharm.D students used to go for regular ward rounds and request of queries if any from the health care professionals. There was remarkable response from the healthcare professionals while approaching them for queries. It saved their time in practice. In March, we tried not to go and request for queries to observe the initiatives from the healthcare professionals in the hospital to forward queries to the DIC. But we got less number of queries by this strategy. When there is a query developed while practice, it needs to be addressed immediately. If a personal help was not available in recording and forwarding the query to the DIC, utilization of the services of DIC decreases. As the Pharm.D students had more freedom and easy access to the nurses in the wards, they were able to collect and answer more number of queries with nurses than doctors. But even though there was higher access to pharmacists, the numbers of queries were less. More number of drug queries generate in the clinical side, especially in the ward rounds. And doctors do communicate that to the nurses and they do communicate it to the DIC through Pharm.D students in the ward. Many of the queries generated in the pharmacy could be easily answerable by the pharmacists using the DI resources present in the pharmacy. After all doctors and pharmacists have access to the internet and other DI resources in their workplace which decrease the use of DIC by them.
The Maharashtra state council is having updated list of DICs in India. The RIPER Poison and Drug Information Center is recognized DIC by Maharashtra State Pharmacy Council. 
During the study period, a great percentage of the queries were from the nurses of three departments, i.e., gynecology, infectious disease, and pediatric. This could reflect the academic interest of the nurses working in the area. The service was utilized by nurses to a greater extent compared to pharmacists, physician, and other healthcare professionals. There was consistency in the queries asked by the nurses throughout the study period.
Majority of the queries were asked were drug oriented for update the knowledge. The DI queries most commonly asked were related to adverse drug reactions or side effects and indication.
Most of the queries were received by direct access, which could be accounted by the easy accessibility of the center and its service. In future, we are planning to encourage all the healthcare professionals to ask more queries through email or SMS and practice less paper policy.
There is need of improvement in time required as doctors need information mostly within few minutes or hours for using it in their practice. Time of delivery of service is one of the important factors in clinical practice. Many healthcare professionals including pharmacists were not using the DI services for their practice because they needed the information within few minutes to use it in their practice. Therefore, majority of the DI requests were for academic improvement and not for individual patient care.
The study was done in the beginning stages of the DIC. After the study period, the DIC was registered with International Register of Drug Information Services by the Society of Hospital Pharmacists of Australia.  There was also changes made the protocols for functioning of the DIC. Evaluation and critical appraisal of the DIC services need to be done on a regular basis as quality is not a destination, it is a journey. DIC is a great step as it is helping to prevent all the errors, which could have took place, in absence of proper information provided by DIC. This shall establish the significance of DIC as an organization and shall also open markets for DIC for other healthcare professionals.
Our DI services could be made available for the healthcare professionals of other healthcare institutions. The DIC is also planning to start a full time poison information center and health information center for public. The awareness of DI center can be improved by advertising DIC from newspaper, social media, and website. The CME/CNE programme or seminars can be conducted for better DIC performance. As a future study it could be planned to analyze the type and rate of preventable errors in healthcare practice not consulting DIC compared to those who are consulting DIC. This shall further establish the importance of consulting DIC.
| Conclusion|| |
In this study, we concluded that the service provided by DIC service is helpful for all health care professionals to increase their knowledge and then practice. There were less number of queries came to use directly in individualized patients as the services of the center was not popularized in the hospital. Using appropriate evidence-based DIC with shortest time with shortest modes of communication (phone) could establish a system of DI to improve practice of prescribers. An effective DIC service saves the time of practitioners. At present the DIC services were mostly used for academic interests. Nurses used the service for the highest compared to other health care professionals. Once the DIC start giving quicker and dependable answers consistently, it shall become one of the integral parts of healthcare practice. It is advisable to study in future about the impact of DIC services in the hospital for reducing errors and improving healthcare practices.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]