E-drug: Drug information services
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Dear E-Druggers
I am doing a research on drug information services in hospitals. Can
anyone help me with information on "why is drug information
important to prescribers and dispensers in hospitals", and "does the
provision of drug information improve rational drug use". Has anyone
done a research on the impact of drug information services on rational
drug use.
I will be very grateful of any assistance.
M. Magagula
Quality Control Pharmacist
Swaziland
[This question is extremely important but unfortunately not often
asked, as it is generally assumed that providing drug information
automatically translates into improved prescribing. You could
take a look in the INRUD drug bibliography and find the
references I listed below. You could also look at the web site of
the International Conference on Improving Use of Medicines
(ICIUM) and see whether recent research has been done
(http://www.who.int/dap-icium/index.html) Hilbrand Haak]
1. Angunawela II, Tomson GB. Physicians perceptions of their own
prescribing. Proc Wandy Soc Med 1987; 3:92-94.
Notes : At institutions at different levels of health care in Sri Lanka,
26 physicians were interviewed about their prescribing. The
prescribers in the peripheral unit were totally dependent on and
positive to drug information from drug companies, whereas the others
mentioned colleagues and seminars as important sources of drug
information. A majority expressed a need for a Drug Information
Bulletin. Only 2/26 of the physicians had heard of the essential drug
list of WHO. Their own perception of number of drugs needed to treat
95% of their patients were on an average 35 different drugs. They
estimated that each patient was given a mean of 3-5 drugs. 24/26 of
them stated that they used placebos, most frequently vitamins. More
than 50% referred patients to Ayurvedic practitioners. MORE DRUG
INFORMATION SHOULD BE MADE AVAILABLE FOR PHYSICIANS. AS
A RESULT OF THE RESEARCH A `DRUG INFORMATION BULLETIN' IS
BEING DISTRIBUTED NATIONALLY 4 TIMES A YEAR TO ALL
PRESCRIBERS. (HAI-#-00005).
2. Christensen DB, Wertheimer AI. Sources of information and
influence on new drug prescribing among physicians in an HMO. Soc
Sci Med 1979; 13:313-322.
Notes : HMO physicians interviewed and their prescribing patterns
monitored to assess sources of drug information and patterns of
communication affecting prescribing decisions. Doctors used mostly
literature for general drug information, but the most influential source
in encouraging first prescribing of a new drug was colleagues.
3. Herxheimer A, Lionel NDW. Minimum information needed by
prescribers. BMJ 1978; 2:1129-1132.
Notes : This paper develops the proposals on the arrangement of drug
information made in the WHO report, "The selection of essential
drugs". (DAP #46).
4. Mitchell MF. Popular medical concepts in Jamaica and their
concepts on drug use. West J Med 1983; 139:841-847.
Notes : Popular medical concepts, developed in relation to traditional
herbal medicines, are now being applied to over-the-counter and
prescribed drugs in Jamaica. Consequently, consumers run the risk of
drug misuse and neglect of serious medical conditions especially in the
case of chronic diseases. Inadequate physician-patient communication
is seen as an important contributing factor to poor adherence to
prescribed drug regimens and misuse of prescribed drugs. Methods for
improving physician-patient communication and for providing needed
drug information to supplement the popular medical concepts are
suggested. (DAP/ANTHRO).
5. Rucker TD. Pursuing rational drug therapy: a macro view from the
United States. Journal of Social and Administrative Pharmacy 1988;
5:78-86.
Notes : Examines: definition and methods of measuring rational drug
therapy; prevalence and significance of irrational drug therapy; factors
contributing to inappropriate drug use; and macro strategies to
optimize drug benefits and minimize patient risk. Suggests a key role
for pharmacists, including the development of a National Drug
Education Foundation to disseminate drug information to practitioners,
evaluate formularies and coordinate information for patients. (DAP
#431).
6. Watkins WM, Maitai CK. A drug utilization survey of dosage forms
dispensed at Kenyatta Hospital Nairobi. East Afr Med J 1981;
58:284-287.
Notes : In a previous study,the relationship between the different
pharmacological classes of drugs dispensed to out-patients at
Kenyattan Hospital Nairobi (KNH) has been investigated. The purpose
of the present study was to investigate the extent to which different
dosage forms are utilised at KNH, and in particular to examine the
feasibility of pre-packaging, which is only presently done to a very
limited extent. ADVANTAGES ASSOCIATED WITH PRE-PACKAGING:
OPPORTUNITY TO USE IMPROVED PACKAGING MATERIALS AND
LABELLING METHODS, AND THE OPPORTUNUTY TO USE THE
ADDITIONAL TIME GENERATED, FOR DRUG INFORMATION
COUNSELLING, ESPECIALLY WITH PATIENTS, WHICH HAS BEEN
SHOWN TO IMPROVE PATIENT COMPLIANCE WITH THE
PRESCRIBERS DIRECTIONS. (HAI-#-00107).
7. Zelnio RM, Gagnon JP. The effects of price information on
physician prescribing patterns - a literature review. Drug Intell Clin
Pharm 1979; 13(3):156-159.
Notes : Literature review was used in an attempt to predict the impact
that drug cost information might have on physicians' prescribing
decisions and reimbursement costs. Conclusion: physicians will not
incorporate price information in to the prescribing decision to the
extent necessary for the achievement of cost savings. Authors
propose alternative: use pharmacists to provide drug information.
8. Lilja J. Theoretical social pharmacy - the drug sector from a social
science perspective. Kuopio: University of Kuopio, 1988.
Notes : Aims to develop models which include cultural and
organizational factors to increase understanding of how drug systems
behave. The first chapters familiarize the reader with social science
methods and models. The succeeding ones describe different parts of
the drug system, including research, production, market structure,
distribution, consumption, prescribing and drug information.
9. Angunawela II, Diwan VK, Tomson GB. Experimental evaluation of
the effects of drug information on antibiotic prescribing: a study in
outpatient care in an area of Sri lanka. Int J Epidemiol 1991;
20:558-564.
Notes : The intervention level of epidemiology is useful for studying
effects in health systems research. Due to practical and ethical
reasons, it is often difficult to apply experimental methods such as
classical randomized clinical trials in the field. However with
alternative approaches such as 'randomization by group' some of
these problems can be overcome. Drug information has since long
been considered as an instrument to influence physicians, however
evaluation of its effects is a new field of research. In the present
study the impact of drug information on prescribing behaviour was
evaluated in an outpatient setting in Sri Lanka. The study included 15
state health institutions (45 prescribers) with a common drug
formulary. Groups of prescribers were randomized into two
interventions; newsletters and newsletters reinforced by a group
seminar, and one control group. The target topic was 'rational
prescribing of antibiotics'. Some 18,766 randomly selected outpatient
drug prescriptions were studied. Antibiotics (and sulphonamides) were
prescribed to 33.2% of the patients. An overall trend towards a
decrease in proportion of patients prescribed antibiotics in the two
intervention groups was seen, although the difference was not
significant (p greater than 0.05) compared to the control group. This is
similar to the effect of written information on prescribing in other
studies. A mean difference of -7.4% in written, -7.3% in written +
seminar and -0.4% in the control group was shown. The general
antibiotic prescribing pattern did not change in any of the three
groups. Penicillin was the most commonly prescribed antibiotic and
tetracycline was only rarely prescribed to children. This experiment
indicates the feasibility of drug information intervention studies in
developing countries.(ABSTRACT TRUNCATED AT 250 WORDS) 0
(Antibiotics). 0 (Penicillins).
10. Tomson GB. Drug utilization studies and people. A Swedish
perspective. [Review]. Ann Ist Super Sanita 1991; 27:239-245.
Notes : Innovative ways of collaboration between actors involved are
needed to increase the quality of drug therapy. Sweden is fortunate to
have access to reliable and detailed statistics on drug sales and
prescribing patterns. The various data bases are being described. A
common classification system (ATC) and a unit of measurement (DDD)
enable comparisons at various levels. Major differences between
countries, counties, and health centres are presented. Little is known
about the reasons for these differences. In order to leave its infancy,
drug utilization studies need that clinical pharmacology establishes
linkages with primary health care where a majority of the prescribing
takes place. Systems should also be developed activating the
prescribers involving them in a revolving cycle of self audit. To study
drug use in its context a multidisciplinary approach is needed. The
descriptive phase should be complemented by targeted intervention
and methods should be developed for drug information. Future drug
utilization studies need more of a patient-prescriber perspective (PPP).
[References: 29].
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