Learning GoalsLearning Goals

To understand the magnitude of drug To understand the magnitude of drug information available todayinformation available today

To understand the differences To understand the differences between primary, secondary, and between primary, secondary, and tertiary resourcestertiary resources

To be able to classify questions as To be able to classify questions as background or foregroundbackground or foreground

• There are three categories (types) of drug information resources based upon their proximity to the original source of information:

Resource Types:Resource Types:

Primary Primary

SecondarySecondary

TertiaryTertiary

Primary ResourcesPrimary Resources

Scientific journalsScientific journals

Provide original studies or reportsProvide original studies or reports

E.g. Clinical trial, case series, case reportE.g. Clinical trial, case series, case report

Good for foreground questionsGood for foreground questions

Scope is narrowScope is narrow

Good when topic is new or new data has Good when topic is new or new data has been publishedbeen published

• This type of resource is considered to be the most current source of information and forms the basis for the practice of evidence-based medicine

• evidence-based medicine, which is defined as the conscientious, explicit, and judicious use of current best evidence along with clinical expertise and patients’ values in making clinical decisions about the care of individual patients

Primary ResourcesPrimary ResourcesPros:Pros:

Most current evidenceMost current evidence

Provide data on new drugsProvide data on new drugs

Can personally assess validity of studiesCan personally assess validity of studies

Cons:Cons:May not lead one to best decision because of limited scopeMay not lead one to best decision because of limited scope

Data can be poor or controversialData can be poor or controversial

Every study has limitationsEvery study has limitations

Too complex for patientsToo complex for patients

Secondary ResourcesSecondary Resources

Bibliographic databases that provide abstracts or Bibliographic databases that provide abstracts or full-text of studies full-text of studies

Good for foreground questionsGood for foreground questions

• Secondary resources serve as gateways to primary drug information resources

• These include indexing services, which provide bibliographic citation information, and abstracting services, which—along with the bibliographic citation information—provide a brief synopsis of each article.

• Most of these services are available in an electronic format

Tertiary ResourcesTertiary Resources

Compilations of knowledge in the fieldCompilations of knowledge in the field

E.g. Textbooks, handbooks, online drug compendiaE.g. Textbooks, handbooks, online drug compendia

Good for background questionsGood for background questions

Scope is broadScope is broad

• summarize and interpret the primary literature• the most common types of references

pharmacist will utilize.• good starting point when researching a drug

information question• excellent sources for gaining an

understanding of a new topic.• include textbooks, review articles, and other

general data.

• time associated with publication, which may be as long as one to two years . or some of the information may be outdated, particularly if new guidelines or new material has been released since the time of publication of the reference

• the information provided may be incomplete due to space limitations or because of incomplete literature searches performed by the author(s) of the material.

• consider when utilizing these resources are the expertise of the author, purpose of the book, edition and year of publication, references cited, ease of use, and format in which the information is being obtained.

When trying to answer a clinical question, the best strategy is often to When trying to answer a clinical question, the best strategy is often to consult resources in the following order:consult resources in the following order:

Tertiary, Secondary, PrimaryTertiary, Secondary, Primary

Tertiary resources are good when:Tertiary resources are good when:

The answer to a question is basic factual knowledge in the fieldThe answer to a question is basic factual knowledge in the field

The question was studied extensively and a conclusion was madeThe question was studied extensively and a conclusion was made

Many experts have addressed the question and agree on answerMany experts have addressed the question and agree on answer

Secondary and primary resources are good when:Secondary and primary resources are good when:

A question is new and has never been studiedA question is new and has never been studied

There is no consensus among experts; various opinions aboundThere is no consensus among experts; various opinions abound

There is conflicting evidence and the question needs further studyThere is conflicting evidence and the question needs further study

Resource TableResource Table

Primary

Resources

JAPhA JAMA Pharmacotherapy

New England Journal of Medicine

Annals of Internal Medicine AJHP

Secondary

Resources

PubMed/Ovid MEDLINE

Cochrane Database of Systematic Reviews

Tertiary

Resources Drug Facts and Comparisons

Epocrates Lexi-Comp Micromedex

Clinical Pharmacology

Background v. Foreground QuestionsBackground v. Foreground Questions

Background QuestionsBackground Questions

Question is broad in scopeQuestion is broad in scope

Answer is general knowledge in fieldAnswer is general knowledge in field

Can best be addressed with tertiary resourcesCan best be addressed with tertiary resources

E.g. Is a drug available in the U.S.?E.g. Is a drug available in the U.S.?

What is a drug’s mechanism of What is a drug’s mechanism of action?action?

When is a drug contraindicated?When is a drug contraindicated?

Foreground QuestionsForeground Questions

Question is narrow in scopeQuestion is narrow in scope

Answer may require examining new or conflicting evidenceAnswer may require examining new or conflicting evidence

Can best be addressed with secondary and primary resourcesCan best be addressed with secondary and primary resources

E.g. How effective is a new drug when compared to E.g. How effective is a new drug when compared to

drugs that are already on the market?drugs that are already on the market?

Are there clinical trials supporting an off-label Are there clinical trials supporting an off-label use of a use of a

drug in a specific population?drug in a specific population?

Lab sessionLab session

• Use internet to locate – One primary reference– One secondary reference– One tertiary reference

• Write title and brief description of each one on your logbook.