BI: Systematic Approach to Answering Questions

The University of Kentucky in 1962. This Drug Information Center was used by all the health care professionals (doctors, pharmacists, nurses, etc.). They had a pharmacist "specialist" to sort out all the information because it quickly became over-whelming.

The MEDLARS System developed by the National Library of Medicine (NLM) in the 1960's. Requests were submitted by snail mail. The information was looked up on computers, which no one else had at the time. This system was not very efficient, but it was a step in the right direction.

The MEDLINE System developed in 1971 was the first online drug information system. This provided the ability to transmit information over telephone lines.

• A seven-step approach to answering drug information requests that includes:
• 1) secure demographics of requestor
• 2) obtain background information
• 3) determine and categorize ultimate question
• 4) develop strategy and conduct search
• 5) perform evaluation, analysis and synthesis
• 6) formulate and provide response
• 7) conduct follow-up and documentation

• 1) Location
• 2) Profession
• 3) Age
• 4) Gender
• 5) Weight
• 6) Disease states
• 7) Medications
• 8) Lab values
• 9) Allergies

Consider different questions that could be asked depending on the focus of the request (e.g., general information, dosage, method of administration, drug interactions, drug of choice, adverse effects, and teratogenicity).

• 1) The requestor's name.
• 2) The requestor's location and/or page number.
• 3) The requestor's affiliation (institution or practice), if a health care professional.
• 4) The requestor's frame of reference (i.e., title, profession/occupation, and rank).
• 5) The resources the requestor has already consulted.
• 6) If the request is patient specific or academic.
• 7) The patient's diagnosis and other medications.
• 8) The urgency of the request (negotiate time of response).

• Patient Factors
• Disease Factors
• Medication Factors
• Pertinent Background Information

• • Availability/Cost
• • Compounding/Stability/ Formulation
• • Dosing and Administration
• • Drug-drug, Drug-food, Drug-lab Interactions
• • Drug Identification
• • IV Compatibility/Stability
• • Method of Administration
• • Natural Products
• • Patient Education
• • Pediatrics
• • Pharmacoeconomics
• • Pharmacokinetics
• • Pharmacology
• • Pregnancy/Lactation
• • Special Populations
• • Therapeutic Consult
• • Toxicology

• General to Specific, or in other words:
• Tertiary to Secondary to Primary

Tertiary Literature: a broad, all encompassing source that gives general information. Tertiary references provide information that is collected and evaluated from multiple types of references and are organized in a useful way.

Examples include: Lexicomp, Micromedex, Facts and Comparisons.

Secondary Literature: Allow for efficient access to primary literature. Indexing or abstract services that direct you to primary literature. However, secondary literature does not interpret the primary literature.

Examples include: PubMed, Medline, EMBASE, International Pharmaceutical Abstracts.

Primary Literature: Introduces new knowledge or enhances existing knowledge on a subject. Data is original.

Examples include: clinical trials, case reports, conference proceedings.