Quality assessment of structure and language elements of written responses given by seven Scandinavian drug information centres

Assessing the quality of drug information provided by hospital pharmacies using a fictitious enquiry and simulated real-life conditions

OBJECTIVES

Guidelines for drug information (DI) provided by hospital pharmacists call for quality assurance procedures; however, no method of evaluation is internationally agreed on. The procedure should be feasible, reproducible and representative for real-life quality. We tested a new approach using a fictitious enquiry under simulated real-life conditions for quality assessment of DI by German hospital pharmacists.

METHODS

A fictitious enquiry was submitted under simulated real-life conditions (study part I; test week announced, but not exact day; response time given). An expert panel determined content-related (three essential, and up to seven additional items of useful information) and structural requirements for answers and performed blinded evaluations. To compare quality of routine DI answers (study part II), five recently answered routine enquiries could retrospectively be evaluated for plausibility (binary scale 0/1) and structural requirements.

RESULTS

Of 62 hospital pharmacies opting to participate, 45 (71%) entered study part I and 18 (40%) entered study part II. In study part I, 28 participants (62%) presented three essential contents, 11 (24%) two, five (11%) one, and one none. Additional useful information was given in 44-80%. Structural requirements achieved mixed results with low scores for logical conclusion deduction and reference presentation. In study part II, plausibility for the 90 recently answered routine enquiries was rated good (median 0.91, range 0.53-1). Concerning structural requirements, overall comparable results were achieved with minor variations compared with study part I. Thus, the quality of DI was judged to be comparable between study parts I and II.

CONCLUSIONS

An open quality assessment procedure with a fictitious enquiry under simulated real-life conditions can successfully be used for quality measurement of DI of hospital pharmacists and identifies areas for improvement.

Drug information centre queries and responses about drug interactions over 10 years-A descriptive analysis

Many people are treated with ≥1 drug, implying that risks of drug interactions need to be considered. The aim of this study was to describe drug interaction queries from healthcare professionals to a drug information centre in Sweden over 10 years focusing on drugs frequently asked about and the advice provided. Advice was recorded in mutually exclusive groups: Avoid, Adjust dose, Separate intake, Vigilance or No problem. For queries with Avoid, Adjust dose or Separate intake advice, alerts were extracted from an interaction database (Janusmed). Of 4335 queries to the centre in 2008-2017, 589 (14%) concerned interactions. Most were posed by physicians (91%) and concerned a specific patient (83%) before treatment initiation (76%). Sertraline, warfarin and methotrexate were the most frequently asked about, whereas queries about cyclophosphamide and rifampicine occurred most often in relation to the number of exposed patients. Advice provided in 557 (95%) replies comprised Avoid: n = 85 (15%), Adjust dose: n = 57 (10%), Separate intake: n = 17 (3%), Vigilance: n = 235 (42%) or No problem: n = 163 (29%). In all, 113 (71%) of 159 queries with Avoid/Adjust dose/Separate intake advice elicited an action alert on Janusmed, whereas 31 (20%) did not result in any alert at all. Summarized, seven in ten replies from the drug information centre recommended an explicit drug treatment action, regarding either specific prescribing aspects, for instance dose adjustments, or active follow-up including monitoring potential adverse reactions and/or laboratory results. Readily accessible decision support regarding drug interactions often provides relevant action alerts, but cannot be solely relied on.

Drug information center: challenges of the research process to answer enquiries in hospital pharmaceutical practices

Objective

To characterise information requests (IRs) from hospitals received by a drug information center (DIC-RS) according to the resolution of the inquiries.

Method

The sample consisted of all requestors and their respective IRs registered in the DIC-RS database from January 2012 to December 2016. Request without information in the consulted literature (RWI) were categorised according to the institution of origin. IRs from hospitals were classified by the information source, topic and subtopic of the questions, and the number of drugs and the pharmacological or therapeutic group.

Results

A total of 2,500 IRs were analysed. Of those, 25% did not exhibit conclusive information in the consulted sources. RWI from hospitals represented 51% of all RWI, followed by those from community pharmacies (13%) and health centres (9%). Tertiary literature was the most commonly used source (73%) for IRs from hospitals. The greatest difficulties in finding information were related to off-label drug administration and indication issues (52% of RWI). The most common type of off-label use was related to changes in the original pharmaceutical form of the drug. Furthermore, 61% of RWI were directed at a specific drug, mostly systemic anti-infectives.

Conclusion

We found that a quarter of the answers did not exhibit conclusive information in the consulted sources. Answers to IRs from the hospital environment exhibited the greatest extent of limited information, and off-label use was responsible for most cases.

Drug information centres and their provision of decision support: The Scandinavian experience

WHAT IS KNOWN AND OBJECTIVE

Appraisal of drug information centres (DICs) is mainly by word of mouth communication and surveys of overall user satisfaction. Efforts to study the impact of this type of informatics and decision support systematically are generally lacking within the healthcare system.

COMMENT

Scandinavian DICs question-answering databases are relevant sources for identifying recurring problems in pharmacotherapy, including drug safety questions, and for re-use of previous answers. Recent studies in this setting have shown that high-quality answers demand easily accessible literature sources, skills in literature search and critical assessment of the retrieved documentation. Furthermore, patient-specific advice in clinical cases presented within a requested time frame is appraised by clinicians.

WHAT IS NEW AND CONCLUSIONS

Effective decision support by Scandinavian DICs depends on skills among staff and technological resources. Our experience could motivate further studies investigating methods and evaluating the impact of DICs in the healthcare system.

Use of References in Responses from Scandinavian Drug Information Centres

Background: The aim of this study was to compare use of references in responses from Scandinavian drug information centres (DICs). Methods: Six different fictitious drug-related queries were sent to each of seven Scandinavian DICs. The six queries concerned adverse effects, pharmacokinetics, pregnancy, complementary medicine, polypharmacy, and breast feeding. References in the responses were categorised into five types of drug information sources: primary (original studies), secondary (reviews), tertiary (drug monographs, handbooks, etc.), DIC database, or personal communication. Results: Two hundred and forty-four references were used in the 42 responses. The mean number of references varied from 3.0 to 10.6 for the six queries. The largest difference between centres with regard to number of references used (range 1⁻17) was found for the query on complementary medicine. In total, 124 references (50.8%) were tertiary, and only 10 of the 42 responses (23.8%) did not have any tertiary references included. Complementary medicine, breast feeding, and pregnancy were query types associated with relatively frequent use of primary references. Use of DIC database was not uncommon, but personal communications were seldom used. Conclusions: Scandinavian DICs differ substantially in number and type of references to identical drug-related queries. Tertiary sources are mainly preferred irrespective of type of query.