Research Article
Austin J Pharmacol Ther. 2014; 2 (6). 1033
“Drug Information Service as Pharmaceutical Care; Provided by Clinical Pharmacists’ in a South Indian Government Hospital”
Sushanta Kr Das1, Souvick Acharya2, Anand Vijayakumar PR3 and Saurabh Gupta4*
1Department of Pharmacy, CMR College of Pharmacy, Kandlakoya (V)-501 401, Hyderabad, India
2Department of Pharmacy, Fortis Escorts Hospital, Amritsar-643 001, Panjab, India
3Department of Pharmacy Practice, JSS College of Pharmacy (Off Campus JSS University), Ootacamund-643 001, Tamilnadu, India
4Department of Pharmacology, Indore Institute of Pharmacy, Rau pithumpur road-45331, Indore, Madhya Pradesh, India
*Corresponding author: : Dr. Saurabh Gupta, Department of Pharmacology, Indore Institute of Pharmacy, Opposite IIM institute, Rau pithumpur road, Indore-45331, Madhya Pradesh, India
Received: July 03, 2014; Accepted: Aug 04, 2014; Published: Aug 08, 2014
Abstract
Background: Clinical pharmacy services are aimed at better patient care to provide pharmaceutical care to patients by supporting other health care providers. Drug information service are one this, which leads to better patient care.
Aim: Aim of this study was ‘identification and response various drug information in a Government hospital as a part of pharmaceutical care. Objectives were to receive & respond various drug information queries and categorise & document them to obtain result.
Methods: In this prospective study drug information queries were received through various way viz; query box, direct access, e-mail and telephone from Government headquarters Hospital, Ooty, between April 2010 and January 2011. All the queries were responded by using standard and authentic reference within stipulate time period and documented & categorize after receiving feedback from questioners.
Result: A total of 210 drug information queries were received, responded, feedback obtained, documented and categorized. Out of 210 queries, 122 queries were received by direct access followed by query box. Nursing students and nurses were highest among the enquirer followed by pharmacist and doctors. Most of the queries were asked for up-gradation of knowledge (154) than better patient care (56). To respond, 25 were immediate, 13 within 2-4 hours, rest next day to within a week. Web based drug information data bank were maximum used (176) to respond queries followed by tertiary, secondary and primary reference resource. Feedbacks were obtained for entire response and shows the service was accepted by enquirers.
Conclusion: Drug information service in the hospital was found to be beneficial as queries were based on mainly to update the knowledge which ultimately helps in better patient care only.
Keywords: Drug information; Clinical pharmacist; Pharmaceutical care
Introduction
Concept of clinical pharmacy service was introduced in middle of the twentieth century by pioneers like Prof. Youngken Jr. and L. W. Rising at University of California. In India although clinical pharmacy is yet in infancy, challenges are to develop and provide clinical services to patient and other health care provider in all size of hospitals and pharmacy set up, so that health care role of pharmacist can be recognized both by health care community as well as patients. In contemporary clinical pharmacy service, professional responsibilities are to ensure that right drug dose and dosage form are administered to the patient at right time with right cost. Clinical pharmacy services provided by clinical pharmacist in the hospital include drug dispensing & distribution, drug information, pharmacy vigilance, medication reviews, academic detailing and sterile & non-sterile manufacturing [1]. Drug use is a complex process which leads to increase number of drug-related problems at various levels involving; prescribers, patients, pharmacist, pharmaceutical industry and government. In response to growing need for enhancing the effectiveness, safety, potency and preciseness of drug therapy, profession of pharmacy required to evolve new functions and responsibility for pharmacy practitioners in order to promote rational drug use [2]. The term “clinical pharmacy” was coined to describe the work of pharmacists whose primary job is to interact with the health care team, interview and assess patients, make specific therapeutic recommendations, monitor patient responses to drug therapy and provide drug information. Clinical pharmacists’ work primarily in hospitals and clinical care settings and provide patient-oriented rather than product-oriented services [3-5]. Clinical pharmacy has been defined as ‘those services provided by pharmacists in an attempt to promote rational drug therapy that are safe, appropriate and cost-effective’. The Society of Hospital Pharmacists of Australia (SHPA) says that, all patients should have access to appropriate clinical pharmacy services as part of hospital based care because these services reduce the incidence of adverse drug events [3,5]. In 1988 WHO consultative group recommended the role of pharmacist in the health care system, that clinical pharmacy should be promoted as a hospital discipline to ensure rational use of drug and reduction of costs and should play an active part in patient care by making their expertise available to other disciplines and departments [6]. In an increasingly complex health care environment, it has become difficult to compare the effectiveness of different treatment [7]. Clinical pharmacists should assume that all patients require pharmaceutical care until they have been assessed to exclude drug therapy problems. However, due to limited resources, this step is not always possible and a systematic approach may need to be adopted to facilitate the targeting of care [3].
Methodology
This prospective study, conducted at Government headquarters hospital, Ooty, India, between April 2010 and January 2011, after obtaining the approval by Institute Ethics Committee, JSS College of Pharmacy, Ooty, India (JSSCP/DPP/IRB/006/2010-11). This service was available with direct access during ward rounds, telephone and e-mail. An innovative drug information query box were prepared and kept in outpatient and different inpatient wards along with query request form & detail contact number in hospital for receiving queries. For mailing query e-mail address was also written on query box. All the queries were received, responded, documented and categorized by using structured documentation forms. Drug information request were evaluated and answered according to modified systemic approach. Original research work publication was used as primary source of reference, full text articles was used as secondary source, standard text books was used as tertiary source and validated internet medicine data bank were used as other (web) source. Query response feedback was also obtained by using structured feedback questionnaire and the service was categorized as; good, satisfactory, need improvement and un-accepted. All the obtained data were categorized based on various parameters and final result was made.
Results
A total of 210 drug information queries were received, the entire query were responded missing any single & feedback were obtained and categorized within study period.
Table 1 represents the distribution of query received throughout the study period. It shows an almost equal distribution of query throughout the period except for the month of May which shows a double in the number of queries.
Month
Frequency
Percentage (%)
April 2010
21
10
May� 2010
44
21
June� 2010
15
07
July� 2010
13
06
August� 2010
15
07
September� 2010
21
10
October� 2010
23
12
November� 2010
17
08
December 2010
19
09
January 2011
22
10
Table 1: Month wise distributions of queries (n=210).
Table 2 represents the distribution of mode of request of query. It shows direct access as the highest mode of request with 122 times followed by query box. Least was seen with e-mail and telephone.
Mode of request
Frequency
Percentage (%)
Direct access
122
59
Query box
76
36
07
03
Telephone
05
02
Table 2: Distribution of queries based on mode of request (n=210).
Table 3 represents the professional status of enquirer, both nursing student and nursing staffs were high in number with 96 and 48 respectively followed by pharmacist. Drug information query asked by the doctors were least in this study.
Enquirer’s professional status
Frequency
Percentage (%)
Nursing student
96
46
Nurse
48
23
Pharmacist
42
20
Doctors
24
11
Table 3: EDistribution of queries based on mode of request (n=210).
Table 4 represents the purpose of query, in this study updating knowledge were more (154) than better patient care (56).
Updating knowledge (n=154)
Enquirer’s professional status
Number of Queries
Percentage (%)
Nursing Students
82
53
Nurses
17
11
Pharmacist
40
26
Doctors
15
10
Better patient care (n=56)
Nursing Students
14
25
Nurses
31
55
Pharmacist
02
04
Doctors
09
16
Table 4: Distribution of queries based on purpose of enquiry (n=210).
Table 5 represents the time taken for respond the query. 25 queries were asked with immediate response and 13 were within 2-4 hours. 69 queries were asked to respond on next day rest within a day and wit in a week.
Response time
Frequency
Percentage (%)
Immediately
25
12
Within 2 - 4 hours
13
06
Within a day
69
33
Within 1- 2 days
71
34
Within a week
32
15
Table 5: Distribution of queries based on time taken for response (n=210).
Table 6 represents the reference source used to respond the queries. Primary and secondary resource were 04 and 08 respectively, 21 tertiary resource and 176 web based drug information data bank were used.
Reference
Frequency
Percentage (%)
Primary sources
04
02
Secondary sources
08
04
Tertiary sources
21
10
Others (web)
176
84
Table 6: Distribution of reference sources used for response (n= 210).
Table 7 represents the feedback status of the responded queries, the entire query requests were responded and feedback obtained. All most all the response shows use fullness as 146 were good and 55 satisfactory. Only 7 were recommended to improve and 02 were not accepted by the enquirer.
Feedback of response
Number
Percentage (%)
Unacceptable
02
01
Need improvement
07
03
Satisfactory
55
26
Good
146
70
Table 7: Distribution of feedback for response (n=210).
Discussion
From this study we found that, steady inflows of drug information query were there throughout the period. This is mainly because of drug information service provided by clinical pharmacists’ in the hospital were found to be accurate & unbiased which has helped the health care provider for improve their knowledge regarding vast range of drugs which are available which is similar to previous work by Das SK, 2011 [8]. Direct access was the main mode of receiving the queries as because clinical pharmacists were present in the hospital throughout the day, same was reported previously by Raal A, 2006 [9]. An innovative method to receive queries was ‘query box’ which has shown a well come approach from the enquirer as they were able to put queries whenever they need irrespective of presence of clinical pharmacist. Query through e-mail was less as its time consuming and such facility may not be available at all the time. In terms of enquirer’s professional status, nursing student and nurses of the hospital used it maximum than pharmacist and doctors. This may a reason that nurses are at the forefront of patient care and accurate & unbiased drug information will ultimately help them with proper discussion making for better patient care which is our main target as pharmaceutical care same was reported earlier by Thompson C, 2004 [10]. Though the number of queries from doctors were less but their participation in this study proves that, pharmaceutical care plan in the form of drug information plays a vital role. Though the main purpose of drug information service is to improve patient care by optimizing the drug therapy but there was a steep hike in update the knowledge than that of better patient care same was reported previous by Vijayakumar TM, 2011 [11]. However, updating knowledge will also ultimately lead to better patient care. In this study we found that, a great number of queries were asked to respond immediately or within 4 hours of time. This clearly indicates the importance of drug information service for better patient care. Present study shows that, tertiary sources and validated internet medical data bank were most useful to respond the queries which are similar to the early findings of Devi P, 2008 [12]. Feedback response from this study clearly demonstrate that, quality of drug information was at per as almost all the response were good or satisfactory, only a few were directed to improve and not accepted which is similar to the previous report of George B, 2005 [13].
Conclusion
From this study it was concluded that, drug information service in the hospital was found to be beneficial for all health care providers as queries were based on mainly to update the knowledge which ultimately helps in better patient care only. This study also demonstrates that drug information service provided by clinical pharmacists’ was proved to be as a part of pharmaceutical care also.
Acknowledgement
Authors whole heartedly convey their regards to the JSS College of Pharmacy (off Campus, JSS University), doctors, nurses, pharmacists and nursing students of Government head quarter hospital, Ooty, Tamilnadu for their kind support and participation in this study. The authors are also thankful to Dr. Vineet Gupta, Postdoctoral fellow, Md Anderson cancer center, Clinical cancer prevention department, Houston, Texas, USA for his valuable inputs in writing this manuscript.
NB: 1st author was a faculty of Department of Pharmacy Practice, JSS College of Pharmacy, Ooty and supervisor of this study.
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