IMPORTANCE OF INFORMATION AND STATISTICS IN THE FIELD OF PHARMACY

MICHELLE CHAI YET LING

BP119

00000031332

Dissertation Submitted to the International Medical University, in Fulfilment of the

Requirements for the Bachelor of Pharmacy (Hons)

Research Project Supervisor:

Dr. Cheong Kok Whye

Co-supervisors:

Dr. Wong Lai Chun

Dr. Chee Chin Fei

NOVEMBER 2019

1
 ABSTRACT

Pharmacy information system (PIS) is taking part in a very important role in helping pharmacists to
take their responsibilities. To maximize the benefits of PIS, it is important to assess its impact on
pharmacists' workflow and medication management processes. This current PIS design pays less
attention to clinical features based on the results collected. Moreover, this current system failed to
offer clinical info for pharmacists and outside organization relationship. Many pharmacies’ software
has deficiencies such as unable to assess drugs interaction and drugs information. Hence, emphasis
ought to be applied on the implementation of corrective actions so that this current system's
deficiencies were removed. Besides, statistics can be from issues of design of experiments, to
analysis of drug trials, to issues of commercialisation of a medicine. This is of particular importance
when attempting to determine whether the pharmacological effect of one drug is superior to
another which clearly has implications for drug development. Therefore, it is essential for
pharmacologists to have an understanding of the uses and abuses of statistics.

KEYWORDS: pharmacy information systems, pharmacy practice, statistics, drug

2
 INTRODUCTION

Health information technology is gradually turning into an important tool for pharmacists. In
addition, it is also integrated with the pharmacy operation and management that ends up in lower
possible harms to patients over the medical treatment procedures.[1] Pharmacists have not
obtained the knowledge associated with monitoring drug usage and its management even though
they are aware of the pharmaceutical care management.[2] There were several core uses of the
pharmacy information system (PIS) like outpatient and inpatient order entry, dispensing and
purchasing management, and pharmacy stock.[3] Other different activities included reporting,
clinical monitoring, intervention management, administrating drugs, connection with other systems,
transferring info, and financial statement management ought to be also supported by PIS.[4] It is
noticeable that PIS makes healthcare providers alert to potential drug interactions and overdose
through the smart alert and quick clinical info access.[5] Most pharmacies' software has a lot of
deficiencies like lack of ability to assess drug interaction, connection to the web, and access to drugs
information banks.[8] Besides that, Kazemi et al. focused on a multidimensional analysis of the PIS.
They noticed that PIS is designed to support financial activities, whereas clinical features and patient
safety were unfortunately not given enough attention yet.[9] From Isfahani et al.'s study, it showed
that almost all of the PIS in Isfahan hospitals was semi-computerized and had the smallest amount of
conformity to the system (input, process, output) standards.[10] Thomsen et al. also conducted an
investigation on the PIS in eighteen European and non-European countries. They discovered that the
major application of PIS was bothered with the features such as distributing drugs and then it is
followed by providing practice in drug consumption and dose determination.[11] Lack of
functionality practices in information systems will result in not understanding of their potential and
actual advantages. Designing and setting up information systems are expensive, which is even more,
highlighting the importance of these systems assessment. Therefore, to gain the most out of
information systems, we should compare them with standard criteria. In this vein, the principle aim
of this study is to clarify the PIS practice features and notice its strengths and weaknesses.
Moreover, pharmaceutical statistics is the application of statistics to matters concerning the
pharmaceutical industry. Statistics contributes in evaluating the activity of a drug, to explore
whether the changes produced by the drug are due to the action of drug or by chance, to compare
the action of 2 or more different drugs or different dosages of the same drug and find an association
between diseases and risk factors. Also, statistics is used in improving public health and design,
monitor, analyse, interpret and report results of clinical trials. [7]

3
 METHODS

I searched all of the information online. First and foremost, I typed ‘Implications of information in
pharmacy’ by using Google search engine. After that, I clicked on this link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680619/ and looked into an article about ‘The
performance implications of pharmacy information system at the university teaching hospitals of
Shiraz, Iran: Cluster approach’ published by S Bayati. Then, I referred to this journal and rephrase the
datas to complete my work. Secondly, I typed ‘Importance of statistics in pharmacy’ and browsed
this link: https://www.slideshare.net/mobile/shufol99/lecture-1statistics-in-pha. It was presented in
slides named ‘Statistics in pharmaceutical sciences’ provided by Department of Pharmacy NSU and I
extracted out some key points required for my work.

4
 FINDINGS

Our major findings in assessing systems in the reporting section indicated that the majority of
practice feature existed in all systems. Additionally, system’s deficiencies in this feature mostly
included providing report based on each physician, drug functions, patient drug history based every
year. Also, PIS should track patients' drug history and store demographic information of physicians
who prescribe medication and drug information such as dosage and drug effectiveness.[12] In this
matter, it is shown that only 1/4 of systems possessed the possibility to supply the frequency report
regarding the ward's emergency requirement of drugs, drug manufacturers, and expired date and
defined consumption period of drugs. It is also remarkable that Asadi et al.'s study revealed that only
7.6% of pharmacies' systems had the chances to produce a frequency report concerning emergency
drugs requirement of various wards and 15.3% of them can provide the drug manufactures
frequency report.[6]

Drug interaction results in cost imposition, the greater length of stay in the hospital, and even death.
[4] In this issue, PIS should also provide a drug interaction report to reduce the medication error.[6]
Malone et al. study showed that the most of pharmacies' software in the United States has not had a
capability to acknowledge and report drug interaction.[13]

Findings associated to medications stock checking indicated that half of the systems possess below
than 50% of that capability. Regarding to this situation, PIS should support four main features,
including entry inpatient and outpatient orders, dispensing, supply management, and purchasing.[3]
Examples of most common systems' deficiencies in medication stock checking included warning
before the medication expiry date, documentation regarding how and where to ensure drugs in the
warehouse are maintained, distinguishing the thresholds stock level, purchasing alert order
whenever the inventory level drops below the threshold stock level, medication inventory sharing in
between alternative pharmacies, and providing purchasing proposal automatically whenever it
reaches order point or based on the pharmacy's need. In a study done by Sadoughi et al., vital
elements of PIS in the majority of users perspective contained features such as warning before the
medication expiry date, record information concerning how and where to keep medication in the
warehouse, and awareness ability whenever a shortage seen in the inventory and sharing
information in between pharmacies.[14] Kazemi et al. assessed 5 PISs and realised that all of them
have had to identify the threshold level of inventory feature.[9] Such variations in the study's
findings could be attributed to the fact that features existed in a symbolic way, yet they haven't
done the related functions.

In the measurement and process features, we found out that the probability of calculating drug
dose, patient drug usage based on diagnosis, volume of injected medication, nutrient receiving
through injection, average number of medicine prescribed, and its percentage with the generic
name had the lowest conformity to standards. In Asadi et al.'s study, we figured out that only 30.7%
of hospitals possessed dose calculation feature.[6] By giving consideration that drug dose calculation
is one of the core parts of medication care and the occurrence of any medication error can harm
patient safety.[15] Moreover, we observed that all hospitals' PIS under investigation failed in
calculating the percentage of the prescription with a minimum of one antibiotic, calculating the
percentage of the prescription with at least one injected medication, and calculating the percentage
of prescription based on the drug manual. We noticed that these findings parallel with Asadi et al.'s
study.

5
PIS may have 3 databases that involved patients, drugs, and prescriber and these databases cause
facilitate prescription management affairs and drug dispensing.[16] By investigating systems in terms
of recording the information and output, we surprisingly found that over half of the systems were
without features such as recording and retrieval of address and telephone number of prescriber in
prescribers' database plus recording and retrieval of address and telephone number of patients in
the patient's database. Another characteristic of PIS is recording the patient drug history, recording
allergies, and other physiological characteristics of patients.[17] Accordingly, in the majority of
hospitals' PIS under examination, features such as the conditions in which patients take their
medications, drug allergies, drug interaction, patients' nutrition status, and their physical functions
were not recorded. Besides, other features such as recording and retrieval of chronic conditions,
patients' prescription profiles, and their compounded drugs were also not recorded in most of the
hospitals' PIS. In this regard, Saghaeiannejad-Isfahani et al. found that medication error status, drug
interaction, adverse drugs reaction, and problems associated with drug usage were off from its
optimum level.[18] Secondly, El Mahalli et al., by assessing PIS in three hospitals, found that
receiving the clinical decision support and drug allergies alerts was at the minimum level.[5]
Furthermore, in Asadi et al.'s study, recording of patients' clinical information was also not existed.
[6]

The correlation between hospital information system and different departments in pharmaceutical
companies such as marketing, pharmaceutical analysis, and development, product introduction,
monitoring product after sales, and drugs quality has an powerful impact on the drug care
development and drug usage management.[19] In this vein, our findings again showed that the
majority of systems with reference to this feature failed in recording the drug order through
systems. In line with our findings, Asadi et al. found that none of the PIS allowed order drugs
electronically.[9] Thus, the electronic relationship between pharmacies and pharmaceutical
companies should be provided for the sake of providing the efficient drugs services.[20]

With respect to the optimisation of drug therapy, it is obvious that only a quarter of systems enabled
to revise drug plan, select for different medications, and document reasons of revising the drugs'
plan. Goldberg et al. concluded that if pharmacists revised the drug orders through the system, it
would decrease the potential errors, time, and cost.[21]

Regarding to smart clinical features, none of the systems enabled to outline adverse drug reactions
in the basic table notify if prohibited drug usage for patients were requested, drug–drug
intersection, drug–disease interaction, and drug–food interaction; furthermore, it was shown that
they have not had a supporting system in diagnostic decision-making. On top of that, the results of
Kazemi et al.'s study showed that designing the PIS reflected the least attention which was given to
the both patient safety and prescription management.[9] Apart from that, similar results were found
in El Mahalli et al.'s study too which indicates that application of decision support system was the
lowest possible quantity.[5] In contrast with our finding, Hines et al.'s study suggested that PIS
equipped with the drug interaction alert and prohibiting drug usage alert.[22]

Affect of investigating other features showed that the rate of barcode technology usage in hospitals'
pharmacy was more than radio-frequency identification (RFID) technology; the reason is it may be
derived from the higher price of RFID compared to barcode technology. RFID results in cost saving,
rising patient safety and promoting effectiveness in supply chain management.[23] Based on
Sadoughi et al.'s study, 67% of managers and users fail to agree with the implementation of RFID
technology in pharmacy.[14] It is noteworthy to mention that barcode technology results in a less
errors in drug usage.[24] Pedersen et al. by assessing the pharmacy practices contained dispensing

6
and administration in the hospital settings found that 9.4% of hospitals took benefit of barcode
technology and the trend of using this technology is increasing.[25]

7
 CONCLUSION

In conclusion, finding the system deficiencies was a key point on the implementation of corrective
actions and providing crucial future implications. Other than that, findings showed that the present
emphasis on designing PIS was placed more on the pharmacy's management instead of providing
clinical information for pharmacists and outside organization relationship. Moreover, statistics plays
a major role for better gaining and accurate results. Hence, pharmacy education should focus on
providing current and future pharmacists with a thorough understanding of the common statistical
terms and methods identified to facilitate the appropriate appraisal and consequential utilisation of
the information available in research articles.

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