Pharmaceutical Resonance 2021 Vol. 3 - Issue 2

REVIEW ARTICLE

DRUG INFORMATION CENTER: AN OVERVIEW

Vishal V. Laulkar, Mansi Mistry*, Karishma M. Rathi Dr. D. Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune, 411018, Maharashtra, India

Abstract : Drug Information Centers (DICs) are defined as operational units that provide up-to-date, scientific, evidence backed and critically evaluated information on all aspects of drugs in an objective and timely manner. The different types of DIC’s are Academics, Institutional, Hospital and Industry related DICs. The purpose of establishing a drug information center is to promote rational use of drugs by providing authentic, individualized, critically reviewed, accurate and unbiased drug related information to the inquirer. The DICs help evaluate major drug related problem areas that gets frequent inquiries. The requirements for the DICs and general process to be followed to answer questions, specifically varies for each type. Standard operating procedures and detailed process protocols may help the DICs to produce better health related outcomes. DICs may perform various activities according to their type that are ultimately linked to promote safe, rational and evidence backed use of drugs as well as to promote research and publication work culture. The questions to the DICs are mainly asked by different health-care professionals regarding general properties of active substances, contents of particular preparations, dosage, side effects and indications/contraindications. To answer such scientifically complicated queries, pharmacist plays an important role. Drug information specialist pharmacist may help preparing scientific communications and contribute in education and training of health care professionals on safe and effective medication-use policies and processes. It is needed that hospitals or hospital linked academic institutes and industries with the help of local and global government authorities, should promote establishment of DICs for better health related outcomes. Keywords : Drug Information Center (DIC), Drug information services (DIS), Drug information resources, DIC establishment: Challenges and strategies, Role of pharmacist in DIC . 1. Introduction : appropriate party without request.[1] Establishment of The drug information is up to date, scientific evidence DICs are needed to promote safe and rational use of backed, written, electronic or verbal piece of drugs. information or advice about any aspect of drug use DICs are vital part of healthcare services as they which is provided as responses to queries generated by provide valuable piece of information or advise on the drug information requester. The requester can be safety and risk management of drugs to the healthcare any healthcare professional, relevant organizations, professionals in hospitals. It establishes a culture of patients, consumers or members of public. [1] quality-use and safe-use of medicines in the affiliated The Drug Information Center (DIC) functions to hospitals. Further, DICs play important role in providing key information for therapeutic drug provide authentic, unbiased, critically evaluated and [3] validated drug information to the requester as well as it monitoring for individualization of drug therapy. monitors and document adverse drug reactions within DICs may reduce medication errors, prescription the hospital or performs other duties assigned to it.[2] errors, drug interactions, adverse drug reactions and DICs can also provide proactive information to the drug poisoning by proactively disseminating important drug information in public domain.[3] Dr. Mansi Mistry The DIC staff through specialized training, lectures Dr. D.Y. Patil Institute of and publications such as e-bulletins, posters and Pharmaceutical Sciences and Research, newslettersor by other activities related to drug safety Pimpri, Pune, 411018, Maharashtra, India such as drug use and drug use evaluation, quality eMail :[email protected] assurance, hospital formulary management can

Table 1: Types of DICs

DICs can be of different types based on their location:

Sr. No. DIC Types Location

1 Academic DICs Academic colleges or universities Societies, Associations, Independent Government Organizations, Chari- II Institutional DICs table trusts and Non-Government Non-profit organizations

III Hospital Affiliated DICs Hospital or Community Center

IV Industry affiliated DICs Private/commercial companies, Commercial Service providers contribute significantly to improve overall hospital and  Primary sources may include original research patient outcomes and to promote research work.[3] . work, original case study reports and clinical 2. History: trials database reports, conference proceedings published in peer reviewed and authenticated The World War II gave rise to chemical and drug journals. abuse throughout the globe. In 1940s, few hospitals from European urban areas such as Budapest,  Primary sources provide up to date, critically Copenhagen, and the Netherlands started specialized evaluated original information. wards with bedside information as well as telephony b. Secondary : services for chemical and drug abuse cases. This  Secondary sources are based on primary formed the base for drug and poison information sources. center.[4]  Secondary sources may include review articles, In the United States of America (USA), the first drug hand books, text books, indexing and and poison information center known as Poison abstracting databases from authenticated and Control Center (PCC) was started in 1953 at Chicago. critically evaluated publisher [4] In 1957, the Bureau of Product Safety in the Food and Drug Administration (FDA)established the c. Tertiary : National Clearinghouse for Poison Control Centers  Tertiary sources may include information and State health departments were assigned with the based on primary and secondary database responsibility of PCCs within their states.[4] In 1958,The American Association for Poison Control  Reference books, drug monographs, pharmaco- Centers (AAPCC) was established to standardize the poeia, national formularies, encyclopedia, dicti PCCs in USA.[4] -onaries, national guidelines, drug information software, drug interaction checker software, The first formal DIC in the USA is reported to be such Asif acts, Micromedex, Lexi-Interact, established at University of Kentucky in August 1962. Pharmavista, and Epocrates etc. Micromedex [5] The name of the first DIC is reported to be Iowa drug databases such as DRUGDEX and DRUG Drug and Poison Information Centre, Buffalo’s School -REAX interaction system. of Pharmacy Drug Information Centre.[6] d. Other Sources : The first DIC in India is reported to be established in 1970s at Christian Medical College, Vellore.[7]In the Other sources may include hospital year 2007, The India Country Office of World Health formularies, regulatory notifications, local drug Organization (WHO) has collaborated with the list, websites and webpages. There are different Karnataka State Pharmacy Council(KSPC) for mobile phone-based applications such as the supporting the establishment of 5 drug information Drug Essentials application, Epocrates, centers; in Chhattisgarh (Raipur), Haryana Medscape, rxlist, drugs.com, CIMS and Indian (Sirsa),Rajasthan (Jaipur), Goa (Panaji) and Assam drug index application are also low-cost or free (Dibrugarh).[8] The first Independent DIC in India is sources of information. Lexicomp Online, and reported to be started by The KSPC in August 1997.[9]. FDA information. MedIndia.net is one of the Indian websites for finding Drug interaction 3. Basic requirements for DIC and drug related queries. 3.1 Information Sources: 3.2 Personnel: a. Primary : © Published by DYPIPSR, Pimpri, Pune - 411 018 ( MH ) INDIA 47 Pharmaceutical Resonance 2021 Vol. 3 - Issue 2

The drug information center may have different personnel requirements based on the day-to- 4.1 Requesters query: day tasks to be performed. It may include chief director, vice directors, residents, students/ interns, technical staff, administrative staff, human resource department and advisory board or monitoring board for quality assurance. 3.3 Place: based on the type and objectives, different kinds of DICs may have different locations. It is needed toensure that the place is well reachable for the variety of requesters and response can be given in timely manner. 3.4 Contact: Modern day DICs need to have reachable contact information such as toll-free phone Fig 2: Steps to document requesters query numbers, E-request form, official website and email address 4.2 DIC Documentation : 3.5 Hardware: This is highly specific requirement depending on DIC to DIC. Modern day DICs require high speed computers, printers, suitable furniture, phone (line-mobile), high speed Internet, access to drug information software and premium journals, fax machine and security surveillance 3.6 Regulatory requirements: depending on country specific guidelines, the DIC need to ensure fulfillment of regulatory requirements. Registration with local Fig 3: Steps for DIC documentation regulatory authority, local and international certifications, memorandum of understanding 4.3 Literature Search : with leading institutes or hospital may additionally benefit the DIC in various aspects. 3.7 Policy and Standard Operating Procedures: General framework and detailed outline of DIC Fig 4: Literature survey activities depending on the type and scope of DIC is needed to be prepared in advance. 4.4 Answer / response drafting and review 4. DIC general process :

Fig 1: Drug Information Center - Systematic Process to answer queries Fig 5: Steps to prepare answer / response © Published by DYPIPSR, Pimpri, Pune - 411 018 ( MH ) INDIA 48 Pharmaceutical Resonance 2021 Vol. 3 - Issue 2

 Therapeutic policy management 4.5 Response to requester  Regulate investigational drug activity  Coordinate in therapeutic drug monitoring  Promote Drug statistics, publication and research work 4.5 Industry :  Promote rational use of drugs and setup awareness campaigns  Quality assurance  Ensure medical communication Fig 5: Steps to submit answer/response to requester  Disseminate accurate information about 5. General Activities Performed by DIC : product materials and programs Modern day DICs need to perform variety of activities  Industry collaboration ranging from answering drug related queries as well as  Proactively provide critically examined actively participating in hospital administration information to the subscribers activities.  Coordinate in medical writing work 5.1 Academic :  Regulate research publishing work  Promote rational use of drugs  Perform drug use survey or cross-sectional  Postgraduate training programs ( pharmacy studies on targeted population practice residency and drug information skills training, Medical writing training )  Perform drug informatics and analytics activities  Research and publications 6. Challenges :  Drug use awareness campaigns Drug information services are reported to be well  Free-for-service activities established in most of the developed countries. As far 5.2 Institutional : as India is concerned, there are comparatively less  Promote rational use of drugs numbers of DICs available.  Perform drug use surveys on large scale Many surveys reported challenges in establishing drug information center such as lack of knowledge in  Industry collaboration healthcare professionals as well as community, lack of  Adverse event monitoring, providing e-alerts funds, lack of trained professionals, lack of awareness related to drugs about national drug policy, industry focused health policy, irrational prescribing, poor economics,  Medication use evaluation restricted access to quality literature, the widespread  Medical writing, research and publications sale of Over The Counter drug formulations, lack of 5.3 Hospital : social awareness, inconsistent and high level illiteracy, poverty among patients population, lack of quality  Promote rational use of drugs and setup assurance or monitoring in already established DICs. awareness campaigns [10,11]  Answering in-house queries 7. Strategies to overcome challenges :  Assisting in formulary decision and maintain Drug information centers, local government medicine database authorities, pharmaceutical industries and healthcare  Performing drug use evaluation professionals needed to collaborate to find better solutions to overcome modern day challenges and to  Reporting adverse drug reaction and promote medication safety promote safe and rational use of drugs.  Conducting drug information services related  Newsletter publishing, providing electronic alerts, education and training awareness programs among healthcare professionals as well as community  Coordinate in Pharmacy and Therapeutic committee (P and T) activities  Policy and standard operating procedure development and timely updating © Published by DYPIPSR, Pimpri, Pune - 411 018 ( MH ) INDIA 49 Pharmaceutical Resonance 2021 Vol. 3 - Issue 2

 Establishing DICs in hospital settings for  Drug information specialist pharmacist may maximum utility so as to improve hospital help manage drug shortages by identify in outcome in terms of health and economics. alternative treatments, protocol development Allocating specific budget for proper for restrictive use and by updating formulary. functioning of DIC. Collaboration with  Clinical Pharmacist in collaboration with DIC Industry, commercialization of high value may contribute in development of clinical services for pharmaceutical and other decision support tools such as dosing protocols, healthcare industries may help in increasing order sets and order-entry alerts funds. . 9. List of DIC in INDIA :  Applying for research grants from government or government owned ventures and programs. Table 2: List of Drug Information Centers in India  Providing Certified professional courses and (as accessible in public domain, as of December training in drug information services. 2020)  Disseminating drug related information to the members of public with minimum/no cost by Name of DIC City / State using modern technology. Andaman & Nicobar Islands Andaman & Institute of Medical Sciences Nicobar 8. Role of Pharmacist : Riper Poison and Drug Information In developed countries, pharmacist play vital role in Centre Anantapur Andhra disseminating critically evaluated and scientifically Andhra Pradesh State Pharmacy Pradesh validated drug information. Pharmacist after relevant Council advanced training, education and experience as well as skills may become drug information specialist having Assam Medical Collage, Dibrugarh additional expertise. [12] Girijananda Chowdhury Institute of Assam Pharmaceutical Science (GIPS),  Apart from providing drug information, drug Guwahati information specialist pharmacist may help Pharma Information Center preparing scientific communications and Chennai contribute in education and training of health Sri Ramachandra Hospital care professionals on safe and effective Chhattisgarh State Pharmacy Council medication-use policies and processes. Chhattisgarh All India Institute of Medical  Drug information specialist pharmacist may Sciences promote quality improvement research projects and drug cost analyses and biomedical Poison Information Centre, AIIMS Delhi research. Hindu Pharmacy Goa Poisons Information Centre,  Clinical Pharmacist working in collaboration with DIC may help establish and maintain a National / Institute of Occupational formulary based on critically evaluated Health, Ahmedabad scientific evidences of efficacy and safety, Gujarat State Pharmacy Council Gujarat pharmaco economics and other institution- KB Institute of Pharmaceutical specific factors.[13] Education and Research  Drug information specialist pharmacist may Sumandeep Vidyapeeth College of contribute to coordinate national programs for Pharmacy population-based medication practices to Lord Shiva College of Pharmacy Haryana maximize patient outcomes. Himachal Laureate Institute of Pharmacy  Drug information specialist pharmacist may Pradesh contribute in developing institutional Central Drugs Standard Control Jammu & compliance to Risk Evaluation and Mitigation Organization Kashmir Strategies (REMS) as well as leading reporting Karnataka State Pharmacy Council and analysis programs such as Med Watch. (KSPC), Bangalore  Drug information specialist pharmacist may DIC Victoria College contribute in coordinating investigational drug JSS College of Pharmacy Karnataka services by participating on institutional review J.N. Medical College boards (IRBs) and protocol evaluation. Kasturba Medical College (KMC), Manipal © Published by DYPIPSR, Pimpri, Pune - 411 018 ( MH ) INDIA 50 Pharmaceutical Resonance 2021 Vol. 3 - Issue 2

Amrita Institute of Medical G, Foran S, Whyte R, et al. SHPA Standard for Sciences & Research Centre practice of drug information services. Aust J Alshifa DIC Kerala Hosp Pharm. 1999;29:171–176. Trivandrum Medical College, [2] Thomas D, Zachariah S. Drug informatics to Trivandrum promote pharmacy profession in India. Indian J Med Inform. 2010;5:3. CDMU Documentation Center Kolkata [3] Ahmed Ibrahim Fathelrahman, Yaser Al- Maharashtra State Pharmacy Worafi.Chapter 15 - Medications safety Maharashtra Council's Drug Information Centre resources and tool. In: Drug Safety in Developing Countries, Academic Press., 2020:179-186 All India Institute of Medical Odisha Sciences (AIIMS), Bhubaneshwar [4] SL Hon, Drug and Poison Information Centers. In:Encyclopedia of Toxicology (Third edition – volume 2), Academic Press., 2014:236-239 Department of Pharmacy Practice, Punjab NIPER [5] Parker PF., The University of Kentucky drug information center. Am J Hosp Pharm. All India Institute of Medical 1965;22:42-47. Raipur Sciences [6] Hana Müllerová, J. Vlček.,Drug information centre-analysis of activities of a regional Rajasthan Pharmacy Council Rajasthan centre,International Journal of Medical Informatics,Volume 45, Issues 1 (2),1997:53-58 Sri Ramachandra Institute [7] Kumar M.M.,NagarA.K., Evaluation of Shri Ramkrishna Hospital performance of drug Information center Tamil Nadu providing quality of information services to Christian Medical College healthcare professionals in a tertiary care JSS College of Pharmacy teaching hospital of south India. Innovations in Pharmaceuticals and Pharmacotherapy, Vol 1 NRS Medical Collage and Hospital West Bengal (2), 2013:81-90 Conclusion: [8] Chauhan N, Moin S, Pandey A, Mittal A, Bajaj U. Indian aspects of drug information resources The DICs not only provide high value drug and impact of drug information center on information to the requester but also performs other community. J Adv Pharm Technol Res important activities to establish a culture of quality-use 2013;4:84-93 and safe-use of drugs and to promote rational use of drugs. Hospital DICs has significant potential to [9] Karnataka state pharmacy council Drug improve health related outcomes. DICs, with the use information and research center. Available at: of various resources, standard operating procedures http://karnatakadruginfo.com. Last accessed on and process protocols, relevant education, training, December 16, 2020. skill development and board certifications may quickly [10] Patil An, Padhy Bm, Prasanthi Sk, Rohilla R. provide vital information to the healthcare “Drug Information Center in India: Overview, professionals. Specifically, drug information specialist Challenges, And Future Prospects” Int J Pharma pharmacist plays an important role in delivering Investig 2018;8:1-6. quality information in timely manner. There is smaller [11] Dr. P.J.Narain ,Mukesh K. Malik, Babita number of DICs in India as compared to developed R.Malik “Drug Information Services – An countries. Many DICs face critical challenges that can Emerging Practice in India” Pharmacology be strategically reduced by proper funding and online 2: 334-338 (2010). increased support from local government authorities. It is highly needed for all the healthcare professionals to [12] Ghaibi Shadi, Ipema Heather, Gabay Michael. collaborate and establish new DICs in India as well as ASHP Guidelines on the Pharmacist's Role in other developing countries to promote rational use of Providing Drug Information. American journal drugs, ultimately benefitting the patient population and of health-system pharmacy: AJHP: official members of the public. journal of the American Society of Health- System Pharmacists, Vol 72 (7). 2015:573-577. References: [13] Md Awaise Baig, Jyothi M R, Rajeev J [1] Bingham JM, Matthews H, Saunders A, Vernon © Published by DYPIPSR, Pimpri, Pune - 411 018 ( MH ) INDIA 51 Pharmaceutical Resonance 2021 Vol. 3 - Issue 2

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