INTERNATIONALE PHARMACEUTICA SCIENCIA

| Jan-March 2011 | Vol. 1 | Issue 1 | Available online http://www.ipharmsciencia.com 2011 IPS

REVIEW ARTICLE

Drug Information Centers - Need of the Hour

ABSTRACT
With rapid advancement in medical and biological science, huge information about drugs and diseases has emerged out. Access and authenticity of this vast information is limited therefore rational selection and utilization of drugs has been more complex. The conventional method of obtaining drug information is through the medical representatives and product literature provided by the manufacturers, which may be incomplete or biased. An important alternative, DIC (Drug Information Centre) assists doctors and hospital pharmacists in updating on new drugs emerging at international level, in different therapeutic areas. DIC also serve to the poor people, to bring down the burden of health problem on our society through continuous education. As per WHO, DIC is defined as a service unit committed to providing drug information related to therapies, pharmacoeconomics, education and research programs. A DIC provides unbiased information to health care professionals, patients and/or consumers. Many centres also provide workshops or other forms of training to enhance the skills of healthcare professionals. DIC is an established concept in clinical practice abroad, in developed countries but concept is just taking its shape in India in recent years. There are many centers in south and there is need for centre in northern and other regions. DIC can be attached to a hospital which is more beneficial than other typeswhich are industry based and community based. A complete setup requirement along with good resources is very important. Running a DIC in developing countries is a very challenging job.

Kalra M.a*, Pakhale S.P.,b Khatak M. a, Khatak S.c Ramgopal College of Pharmacy, Sultanpur,Gurgaon-122001. b Dr. Reddys Laboratories Ltd. Qutubullapur, Andhra Pradesh500090. cDepartment Of Pharmaceutical Sciences, Raj Kumar Goel Institute of Technology, Gaziabad- 201003.
a

Date of Submission: 09-01-2011 Date of Acceptance: 12-03-2011 Conflict of interest: Nil Source of support: None

Introduction Information is key to preventing medication errors. Such information leads to enhanced quality of patient care and thus improved patient outcome. Poor drug regulation and lack of independent unbiased drug information are the main 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.[1] Drug information from commercial sources is very often biased and hence non-commercial, independent, unbiased source of drug information is important. The Drug Information Centres provides authenticate, unbiased drug information to healthcare professionals; provide tailorAddress for correspondence 147, Housing Board Colony, Sector- 7 Extension, Gurgaon-122001 Mobile Number- 09416369129 E mail- mohini_bajaj@yahoo.com 69

made counselling and drug information to patients / consumers as well as monitor and document adverse drug reactions. Drug Information is the provision of written and / or verbal information or advice about drugs and drug therapy in response to a request from other healthcare providers, organizations, committees, patients or members of the public. Drug Information Service describes activities undertaken by pharmacists in providing information to optimize drug use. History [2] In 1962, the first drug information centre was opened at the University of Kentucky Medical Centre and was intended to be utilized as a source of selected, comprehensive drug information for staff physicians and dentists to allow them to evaluate and compare drugs besides catering to the information needs of nursing staff. The staffs of the drug information centre were expected to take an active role in the education of
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Kalra M, et al: Drug Information Centres - Need of the Hour

health professionals within the institution. USA. [4]

[3]

In 1973,

The list of various drug information centres is given in Table 1. The registering authority for drug information centres is the International Register of Drug Information Services (IRDIS). [10]

the number rose to 54 drug information centres in the According to a report published in 1995, there were about120 full-fledged pharmacist-operated drug information centres in the United States, which accept a broad scope of requests from health care professionals. [5] In India, the concept started at JSS Ooty, Trivandrum Medical College, Karnataka State Pharmacy Council. Maharashtra State Pharmacy Council (MSPC) centre was 3rd Drug Information Centre in India and probably the first one in West Zone of our country. The provision of accurate and timely drug information to health care professionals is an important mechanism to promote safe and effective drug therapy. Such service is lacking in India. [6] The purpose of the centre is to provide accurate, current, and unbiased information for the promotion of rational drug therapy.
[7]

Table 1: List of drug information centres in India.

Independent Drug Information Centres Hospital Attached Drug Information Centre with Clinical Services Christian Medical College Hospital, Vellore, Tamilnadu CDMU Drug Information Centre, Victoria Documentation Hospital, Bangalore, Centre, Calcutta Karnataka Drug Information Maharashtra State Centre, (KSPC) Pharmacy Council, Bowring & Lady Curzon Maharashtra Hospital, Bangalore, Karnataka Andhra Pradesh State Department of Pharmacy Pharmacy Council, Practice, Chidambaram, Andhra Pradesh Tamilnadu Karnataka State Department of Pharmacy Pharmacy Council Practice, National Institute of (KSPC),Bangalore, Pharmaceutical Education and JSS, Ooty Research (NIPER), Chandigarh Tamilnadu Pharma Jawaharlal Nehru Medical Information Centre, College Hospital (JNMC), Chennai Belgaum, Karnataka JSS, Mysore, Karnataka JSS, Ooty, Tamilnadu N.R.S. Medical College & Hospital, Calcutta

The centre also provides

relevant information to physicians and faculty of the medical academy on evidence-based medicine at their request. Recognizing the need to provide organized drug information to health care professionals as well as consumers, the WHO India Country Office in collaboration with the Karnataka State Pharmacy Council (KSPC) has supporting the establishment of 5 drug information centres. These centres have been established in Haryana (Sirsa), Chhattisgarh (Raipur), Rajasthan (Jaipur), Assam (Dibrugarh), and Goa (Panaji). They started functioning in 2007.Thus, in India the concept is in a state of infancy. Types of DICs [8] 1. Hospital based DIC[9] The hospital-based DIC perform various activities which include answering the in-house call, assist in formulary decision, participate in drug use evaluation, coordinate adverse drug reaction reporting, publishing newsletter, provide in service education, assist in Pharmacy 2. 3. and Therapeutic committee (P&T) committee, oversee investigational drug activity. Industry based DIC Community based DIC

Need of the concept [11] 1. The availability of more than 80,000 formulations makes it very difficult for a person to remember all the formulations and daily new formulations are being added. 2. The national drug policy is industry focused rather than health focused thus large number of new drugs is added frequently. 3. Lack of awareness of the principles of rational drug use among doctors, pharmacists and other health care professionals. 4. Widespread sale of prescription and over the counter drugs. 5. A high level illiteracy and poverty among patients. 6. There are more than 20,000 biomedical journals available and more than 6,000 articles are published every day. It is not possible for a person to have access to all the information. [12] 7. Lack of adequate drug information due to limited availability or lack of current literature and also poor documentation, poor funding available.

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Kalra M, et al: Drug Information Centres - Need of the Hour

8. Lack of unbiased drug information from the sources available. Main Objectives: The objectives of DIC are: 1. To provide an organized database of specialized information on medicines and therapeutics to meet the drug information needs of practitioners. 2. To educate pharmacy students to serve as effective providers of medicines information service to information. [13] pharmacists, 3. To provide accurate and unbiased medicines the physicians and other health care professionals in the hospital and community. 4. To promote patient care through rational use of medicines. Types of drug information healthcare providers and queries[14] recipients. Medical

- Adverse Drug Reaction Reporting (ADR Program) - Investigational Drug Program - Education and Training - Publications (Newsletter, Bulletins, Journal, Column) - Community Services Answering patients questions related to-[17] - One of the 5 Rs: Right drug, Right dose, Right dosage form, Right route, Right patient. - Drug Interaction - Availability / Substitute - Drug Identification - Formulary Decision - Drug Identification Requirements for establishing
[19]

Drug

Information Centre [18] 1. Organization and Space - The various parameters are considered while determining the requirements of space and organisation. These factors include- Type of activities offered, Space available, Budget, Staff, Resources 2. Resource
[20]

Different levels of drug information are required by practitioners and pharmacists need access to the information required by regulatory authorities for new drugs. Healthcare workers require who a have subset limited of this prescribing authority

- The can be classified based on the

era in which they emerged: [21] DIC Resources: Pre-Computer Era References can be categorized into: [22] - Primary (journals) [23] - Secondary (indexing & abstracting) - Tertiary (general reference books) [24] Primary sources:
[25]

information together with protocols for diagnosis and treatment. All health providers require information resources for therapeutic decision support, implementation and monitoring of outcomes. People receiving medication need instructions for use of prescribed and over-the-counter medicines. Additional information may be necessary for high-risk groups (e.g. paediatrics, geriatrics, pregnancy
[15]

They are the foundation on

which all other drug information is based. These include journal publications on drug-related subjects, such as reports of clinical drug trials, case reports, and pharmacological research.
[26]

and

breastfeeding) and in some diseases (e.g. diabetes, kidney and liver dysfunction). Strategies to promote adherence include once-daily dosing, and drug selection and dosing to minimise adverse effects. Other information that would be useful to consumers is whether a particular drug is a banned or hazardous drug, or its combination useless and irrational, and advice regarding traditional remedies. Answering health care professionals questions related to-[16] - Pharmacy and Therapeutic committee (P&T) - Drug Use Review (DUE) / Evaluation
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Evaluating

primary

literature is difficult.

The most reliable evidence

comes from reports on randomized controlled trials. Proper evaluation of these trials requires considerable experience, and systematic reviews of combined trials (meta-analyses) may be necessary. This work is being undertaken by the Cochrane Collaboration.
[27]

In

judging primary literature, one cannot assume that the results of a study or a research paper are valid simply because it has been accepted for publication. However, it is useful to consider the source of a study or paper when one seeks to determine its quality. There are a
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number of respected medical and pharmacy journals whose high standards for acceptance and publication make it unlikely that a research article containing erroneous data or misrepresented information would survive the editorial and review process.
[28]

they are looking for. Examples of such services include Medline, Current Contents, International Pharmaceutical Abstracts, Index Medicus, Excerpta Medica, and the Iowa Drug Information Service (which also includes full-text reprints of articles). Tertiary or general sources present documented information in a condensed format. Examples include formulary manuals, standard treatment manuals, textbooks, general reference books, drug bulletins, and drug compendia. It is advisable to obtain the most current edition available when using secondary or tertiary sources. Tertiary references, written by individuals or groups, are often developed with the input of consultant reviewers and may be widely peer reviewed. In general, the more thorough the peer review process is, the sounder the information is likely to be. In many countries, the most widely available tertiary resources are formulary manuals and standard treatment manuals produced by the health system. List of most respected tertiary resources is in Table 3. Table 3: List of most respected tertiary resources.
Essential Drugs Lists and Therapeutic Formularies British National Formulary, updated every six months National list of essential medicines (2003), Issued by Directorate General of Health Services Ministry of Health & Family Welfare, Government of India The WHO Model Lists of Essential Drugs: The Use and Selection of Drugs. Technical Report Series 615, 641, 722, 770, 850 (1977, 1979, 1983, 1985, 1988, 1992, 1995), World Health Organization, Geneva WHO Model Prescribing Information: Drugs Used in Anesthesia, Parasitic Diseases, Mycobacterial Diseases, Sexually Transmitted Diseases, Skin Diseases

Table 2

lists some English-language journals that have strong editorial policies and peer review processes that include conf1ict-of-interest disclosure requirements to minimize the possibility of biased or unsupportable conclusions being reported. Table 2: Primary Information Sources
Medical and Therapeutic Journals Annals of Internal Medicine British Medical Journal Journal of the American Medical Association Lancet New England Journal of Medicine Drug and Toxicology Information and Pharmacology Journals British Journal of Clinical Pharmacology Clinical Pharmacology and Therapeutics European Journal of Clinical Pharmacology Human and Experimental Toxicology Journal of Toxicology and Clinical Toxicology Medical Toxicology and Adverse Drug Experience Journals in Specific Areas American Journal of Emergency Medicine Annals of Emergency Medicine British Journal of Obstetrics and Gynaecology Critical Care Medicine Journal of Antimicrobials and Chemotherapy Journal of Infectious Diseases Journal of Paediatrics and Child Health

Pharmacy Journals American Journal of Hospital Pharmacy Annals of Pharmacotherapy Clinical Pharmacy DICP-Annals of Pharmacotherapy Journal of Clinical and Hospital Pharmacy Journal of Clinical Pharmacy and Therapeutics Pharmaceutical Journal UK

Secondary sources function as a guide to or review of the primary literature. Secondary sources include review articles, meta-analyses, indexes (Index Medicus), abstracts (International Pharmaceutical Abstracts), and combinations of abstracts and full-text reprints. Secondary information resources are essentially derivations of the primary literature. Some review articles summarize the results and conclusions of a number of reports from the primary literature. Bibliographic, abstracting, or indexing services provide listings or compilations of published articles. Some list the addresses of the principal authors; others contain abstracts of articles, along with key words or subject headings to help users find the articles or references
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Drug information provided by manufacturers is secondary or tertiary information. The type and quality of information provided by drug manufacturers vary considerably from country to country, depending on governments' regulations and ability to enforce them. DIC - Resources: Computer Era Computer assisted search and retrieval - Online service - Compact Disk-Read Only Memory (CD-ROM) DIC Resources: Internet Era

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Sometimes called National Information Infrastructure, the information superhighway, Infobahn. Using of Electronic Mail by health care professionals Access to pharmacy-related World Wide Web (www).

established centres and developing centres can facilitate the exchange of staff for education, training and sharing of experience. 4. Policy and Procedures (P&P)

3. Personnel

[29]

Policy means general outlines (framework) and Procedures means detailed outlines (how to). Both helps in smoothing the operation of the DIC. P&P development depends on type of the DIC and scope of service. It is subdivided into Administrative and professional guides. It is important to have well defined P&P as it serve as a guide for training new employee, give insurances the task has been carried properly. It is means of evaluating job performance and is an important elements in case of conflict. It also answers the various questions like What, when, where it should be done and who should do it and how. 5. Equipment [31] Furniture - desks, chairs, shelving; Communications internet access; Computers - including external data backup, printer; Software - for word processing, spreadsheets, appropriate databases and presentations; Photocopier; Textbooks and electronic information resources. Approach to answering DI queries:
[32]

The number of personnel required depend on the range of activities offered and the hours of service. A centre aim to provide a direct service during periods of major demand by its clients. For patient-related enquiries this is likely to be when clinic consultations occur and during peak periods for hospital functions. The professional staff should include a full-time clinical pharmacist or a clinical pharmacologist. Clinical training and experience is essential for effective communication with clinicians. Other important attributes are computer skills, literature analysis, editing and library management. The manager of a drug information centre should have experience with service delivery as well as managerial skills. [30] The managers responsibilities include: establishing and maintaining a viable financial base; staff recruitment and coordination; training; promoting the service; identifying resources; data management and reporting; quality assurance and improvement; liaison with colleagues, professional organisations (e.g. FIP Pharmacy Information Section), networks, university departments of pharmacy practice, and government agencies; strategic development. Medical and non-medical specialists may be required as additional resource personnel. As the centre expands, it may be necessary to include some of these specialists as advisers on a part-time basis. It is also necessary to have secretarial assistance and support staff for maintaining equipment and cleaning. There should be a career structure for all professional staff with the possibility of additional training and advancement.
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Basic equipment required for a centre include: telephones, facsimile,

and

maintaining

The

manner in which information is communicated is as important as the substance of the information. For information to be effective it must be accurate, reliable, accessible, user-friendly and provided at a basic and comprehensive level, depending on the consumers requirements. The purpose of the service is to provide accurate, current and unbiased drug information in the promotion of rational drug therapy. The steps involved are: [33] 1. Analyse the type of drug information[34] 2. Understand the background of the question 3. Understand the real need of the physician 4. Follow systematic approach

Twinning

arrangements

between
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Steps of Modified Systematic Approach: [35] The first step is to secure demographics of requestor then to obtain the background information then to categorise question. The next step is the conduct of search for the topic and then to perform evaluation[36] and finally provide the response. A very important step is to conduct follow-up and documentation of the information so that retrieval is easy. Challenges for Running A DIC in Developing Countries: The various factors affect the efficient running of a DIC in developing countries like lack of recognition, because most people misunderstand their role, improper permanent financial support, only few DI Officers are employed and exclusively dedicated to the service. The most important is under staffing, illdefined quality assurance programs, outdated drug information sources and inappropriate facilities for working. The lack of clinical and managerial skills adds to list. Promotional Activities: The promotional activity important for the working of a DIC are Q/A services, Patient counselling, SDI, ADR reporting, Drafting guidelines, supporting working of Drugs & Therapeutic Committee (DTC), contributing to Rational Use of Drugs (RUD) Projects, release of Bulletins or news resources. The best source which is on the top now a days is Media. Conclusion Pharmacists role is expanding by the advert of DIC and clinical training has also played a major contribution. In addition, new technologies and resources, increasing ease of access of information has played a leading role in pharmaceutical care. The DIC has provided itself to be an impressive resource, which is used regularly as an information source by all levels of people involved in the health system from patient to provider and also contribution through providing access to up-to-date information. There has been a steady increase in the number of enquiries indicating an increase in awareness of the center, as a source of unbiased drug information among the doctors. This
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experience lead to development of more number of DIC's and encouraging networking of DIC's in India. Drug information centres can be regarded as the gateways to drug information and can be of great help in validating drug information, but drug information practitioners must be well trained especially in analyzing the quality of scientific publications and underlying research. Highly successful programs in Southern India had demonstrated that future of clinical pharmacy and drug information in India is very bright. Government and private hospitals should come forward to establish DIC and to provide patient focussed services through efficient drug information centres. References1. Promoting rational use of medicines: core components. WHO Policy Perspectives on Medicines, September 2002. 2. Hansen KN, Nahata MC, Parthasarathi G. Clinical Pharmacy in India, In: BG Nagavi. A textbook of clinical pharmacy practice, essential concepts and skills. 1st ed. Orient Longman, 2004, pp-1-8. 3. Parker 7. 4. Beaird SL, Coley RM, Crea KA. Current status of drug information 5. centers. Am J Hosp Pharm 1992;49(8):103-6. Malone PM, Kier KL. Pharmacy and therapeutic committee. In: Malone PM, Mosdell KW, Kier KL, Stanovich JE, eds. Drug Information: A Guide for Pharmacists. Stamford, CT: Appleton & Lange; 1996. p. 227-81, 448-57. 6. Lakshmi PK, Gundu Rao DA, Gore SB, Shyamala Bhaskaran. Drug information services to doctors of Karnataka, India. Ind J Pharmacol 2003; 35: 245247. 7. Merritt GJ, Garnett WR, Eckel FM. Analysis of a hospital-based information center. Am J Hosp Pharm 1977; 34(1):4246. 8. Gong SD, Millares M, VanRiper KB. Drug information pharmacists at health-care facilities, universities and pharmaceutical companies. Am J Hosp Pharm 1992;49(3):1121-30. 9. Health Systems Development (HSD) Essential Drugs and Medicines, Vol 1 Issue 1 Drug Information Centes, 74 PF. The University of Kentucky drug information center. Am J Hosp Pharm 1965;22(6):42-

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