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Systematic Approach forAnswering a Drug
InformationRequest:
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An essential component within pharmacypractice is the ability to effectively answerquestions posed by health care professionals and
the lay public.
In 1975, Watanabe et al. presented a systematicapproach for responding to drug informationrequests
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Systematic Approach (1975)
Step I. Classification of the request
Step II.Obtaining background information
Step III.Systematic search Step IV.Response
Step V.Reclassification
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Modified Systematic Approach (1987)
Step 1: Secure Demographics of Requestor
Step 2: Obtain Background Information
Step 3: Determine and Categorize the Ultimate Question
Step 4: Develop Strategy and Conduct Search Step 5: Perform Evaluation, Analysis, and Synthesis
Step 6: Formulate and Provide Response
Step 7: Conduct Follow-Up and Documentation
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Demographics of Requestor
The requestor's "profession, or educational background (e.g.,
physician, pharmacist, nurse, patient)
The presentation of the initial question provides insight to therequestor's sophistication and knowledge regarding the subjectmatter. However, it is important to more directly determine therequestor's position, training, and anticipated knowledge.
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Background Questions
(clarifying the question)
The ability to obtain background information to develop a morecomplete picture of the question is essential for effectively using
the modified systematic approach.
To make you able to answer the question "Why is therequestor asking for this information?
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General Questions for Obtaining Background
Information
The requestor's name
The requestor's location and/or contact information
The requestor's affiliation (institution or practice) if a health careprofessional
The requestor's frame of reference (i.e., title, profession oroccupation, and rank)
The resources that the requestor already consulted
Whether the request is patient specific or academic
The patient's diagnosis, other medications, and pertinent medicalinformation
The urgency of the request (i.e., negotiate the time response)
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Background Questions
Example: If you were asked What is the dose of amoxicillin? It is inaccurate to answer quickly that the normal dosage is 500 mg every eight
hours.
gathering background information is crucial
The dose of this antibiotic depends upon a number of factors
Determine if the question is in regard to a specific patient or general research for
the treatment of a disease state.
If the question is patient specific, important information to acquire would include
the patient's age, weight, allergies, type of infection, concurrent disease states,
other medications, and preferred dosage form (e.g., oral suspension, capsules,
chewable tablets).
the dose of amoxicillin can be 500 mg every eight hours for adults withpharyngitis or 2 grams as a single dose one hour prior to dental procedures forbacterial endocarditis prophylaxis.
Other issues to consider are dose adjustment for renal impairment and
interactions with concomitant medications.
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Determine and Categorize the Ultimate
Question Categorization of the question (request)
A vital step in the systematic approach
Allows for efficient use of the resources by providing the foundation of alogical progression process
An all-inclusive resource with data to answer every drug informationquestion does not exist
References contain specific types of information
Numerous topic specific resources are available (e.g, drug interactions,infectious disease, internal medicine)
Classification of a request aids in developing a more effective searchstrategy
Selecting the resource with the highest probability of containing thedesired information can decrease the time requirement and increase theaccuracy of the response
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Examples of question classifications
Adverse Drug Reaction Contraindication
Availability
Dose
Drug compatibility/stability
Drug interaction
Drug therapy
Pharmacy practice
Pharmacology
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In the previous example above, the amoxicillinrequest pertains to a dose
examples of references that provide this information:
American Hospital Formulary Service (AHFS)
Facts and Comparisons
USP Drug Information (USPDI) for the Health CareProfessional
Drug Interaction Facts
Hansten and Horn's Drug Interactions Analysis andManagement
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Develop Strategy and Conduct Search
Select and prioritize resources based on: probability of locating the desired information.
Availability of resources.
Conduct a systematic search Be familiar with the three types of information sources in theliterature hierarchy
Begin with the established knowledge located within the tertiaryliterature (e.g., textbooks) due to the condensed, easy-to-use format
of the information presented Progress through the secondary literature (e.g., MEDLINE,
International Pharmaceutical Abstracts [IPA]) to the primaryliterature (e.g., controlled clinical trails, letters to the editor)
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Perform Evaluation, Analysis, and
Synthesis
Confirm information with other references toassure consistency between various resources
The analysis and synthesis must be performed
with consideration of the backgroundinformation, obtained previously, for theresponse to be pertinent and useful to therequestor.
authors, editors, and publishers attempt to assure the reliability of the
information published, most resources include a disclaimer statementsince errors do occur occasionally
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Formulate and Provide Response
Restate the question and any pertinentbackground information
This allows the requestor to be informed of the question and
focused on the impending response
Provide the information and recommendation(if applicable)
In addition, a brief review of the search strategy and references
reviewed may be included in the response as a confirmation tothe comprehensive search conducted
Compose the response at the requestor's comprehension level
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Conduct Follow-Up and
Documentation
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
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Methods of documentation (examples) Paper form
Logbook
Computer database
Reasons for documentations (examples) Justification of pharmacist's professional value to the
institution
Future reference for repetitive drug information requests Protective measure against legal liability
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