Professional Documents
Culture Documents
3: Systematic and Modified
Systematic Approach to Answering
Question.
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• An essential component within pharmacy practice
is the ability to effectively answer questions posed
by health care professionals and the lay public.
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Where to apply drug information
principles?
Job Opportunities?
• drug information center.
• community pharmacy
• pharmaceutical industry
• institutional pharmacy management
• general application in any type of professional
consultation
31
Systematic Approach to Answering Question.
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Modified Systematic Approach to Answering
Question.
33
1‐ Requestor Demographics
• It is important to more directly determine the
requestor's
– Position
– training
– anticipated knowledge.
• For example, an elderly patient and cardiovascular
specialist may each inquire about the availability of
an investigational medication; however, each brings a
different frame of reference to the request, and the
approach and final response to the request will differ
for each requestor.
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2‐ Background Questions
• This step is the most difficult for both students
and practicing pharmacists.
• If you can truly answer the question "Why is
the requestor asking for this information?"
then adequate background information has
been obtained.
• To answer this question, the background
information must be sufficient.
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General Questions for Obtaining
Background Information
The requestor's name
The requestor's location and/or pager number
The requestor's affiliation (institution or practice) if a health care professional
The requestor's frame of reference (i.e., title, profession or occupation, 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 medical information
The urgency of the request (i.e., negotiate the time response)
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3‐ Ultimate Question/Categorization of Question
• In 85% of the questions, the original question— the one provided
by the requestor — is not usually what the person is asking for.
• For example, if a male asks about the effectiveness of beta
blockers in diabetes, and if there are better alternatives; he might
actually want to know about their adverse effects (like sexual
dysfunction).
• In this case the ultimate/real question would be: do beta‐blockers
cause sexual dysfunction?
• Thus, the final response will not agree with the initial question.
However, the requestor will be satisfied with response provided.
• This demonstrates that refocusing the requestor's question was
useful for the drug information requests.
37
3‐ Ultimate Question/Categorization of Question
• The determination of the ultimate question is important for
effective use of the modified systematic approach.
• If background information is obtained correctly, the ultimate
question is easily known.
• If adequate background information is not obtained, the
determination of the ultimate question may not be possible.
• It is critically important that the requestor confirms the ultimate
question prior to categorization and the development of a search
strategy.
• Once the ultimate question has been decided and acknowledged
by the requestor, the question is categorized.
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3‐ Ultimate Question/Categorization of Question
• The beta‐blocker case, again:
• When a male asks about the effectiveness of beta blockers in
diabetes, and if there are better alternatives; he might actually
want to know about their adverse effects (like sexual
dysfunction).
• In this case the ultimate/real question would be: do beta‐
blockers cause sexual dysfunction?
• Thus, the final response will not agree with the initial question.
However, the requestor will be satisfied with response
provided.
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4‐ Search Strategy
• The categorization of the ultimate question prompts
the resource selection process.
• For example, the categorization of a question as
"adverse effect" suggests the use of adverse effect
oriented resources.
• Once resources have been selected, they are arranged
(by priority) based on the probability of their
containing the information or data desired.
• Without this arrangement, resources may be utilized
based on ease of access or degree of comfort instead
of probable efficiency.
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5‐ DATA EVALUATION, ANALYSIS, AND SYNTHESIS
• The information retrieved must be objectively critiqued.
• The techniques and skills for literature evaluation and
clinical application of statistical analysis.
• Application of these skills at this step is one of the
opportunities to differentiate the professional from the
technician through using the modified systematic
approach.
• The analysis and synthesis must be performed with
consideration of the background information, obtained
previously, for the response to be pertinent and useful
to the requestor.
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6‐ FORMULATION AND PROVISION OF RESPONSE
• Consider the background information obtained.
• Consider the evidence collected from resources
• Consider the analysis and synthesis you performed.
• If the literature includes conflicting data that
must be presented to the requestor (see next
slide).
• You must provide a response. Verbal or Written?
– Most of the cases verbal
– Some cases require a written response, e.g. formal requests.
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Format for Logical Argument in Response
Formulation
Step I. Present the competing viewpoints or considerations
• Follow‐up: is the process of verifying the
appropriateness, correctness, and completeness
of a response following the communication.
• More professional gives you higher credibility
• Certain situations necessitate follow‐up, e.g. a
patient was asking about the dosing regimen of
a drug; and the decision was based on
assumptions or “soft” data (weak evidence). So
you do follow‐up to see if the response was
adequate.
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Follow-through
• Definition: To readdress the request if new
data become available, or the circumstances
have changed:
– A new publication
– Patient developed renal/hepatic failure etc.
– A good practice (professional)
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Documentation
• Decreases liabilities
• Improves service
• promotes the development of a continual service
• Can be very simple or comprehensive (detailed)
• In all cases, it must include:
– Includes the ultimate question, searched materials,
the response, follow‐up and follow‐through
procedures.