Abdu-Aguye et al., Nig. Journ. Pharm. Sci., October, 2018, Vol. 17 No.2 01-09

Nigerian Journal of Pharmaceutical Sciences Vol. 17, No2 , 20 18 , ISSN: 0189 - 823X 2 All Rights Reserved

UTILIZATION OF INTERNET AND NON-INTERNET BASED DRUG INFORMATION RESOURCES BY PHARMACISTS PRACTICING IN HOSPITAL AND COMMUNITY SETTINGS IN KADUNA, NIGERIA

1*Abdu-Aguye, S.N, 2Yusuf, H, 1Thomas, N, and 1Ma’aji, H.U

1 Department of Clinical Pharmacy & Pharmacy Practice, Ahmadu Bello University, Zaria, Nigeria 2 Department of Clinical Pharmacy & Pharmacy Administration, University of Maiduguri, Nigeria

*Author for correspondence: +234 803 201 9135 [email protected]

ABSTRACT

Provision of reliable information on the appropriate use of medicines is an essential component of pharmacy practice and patient care. The aim of this study was to describe the drug information (DI) needs and sources used by pharmacists practicing in Kaduna state, Nigeria and their practices when retrieving and utilizing internet based sources of DI. A survey was carried out between August and October 2017, on pharmacists working in hospitals and registered community pharmacies. The study instrument was self-administered and contained 33 items distributed in three sections. The first section collected data on the demographic characteristics of participants, while the second and third sections focused on their utilization of general and electronic drug information resources respectively. While 128 questionnaires distributed, 110 were finally retrieved. Majority of the participants were males (55.5%) and practiced in the hospital (81.8%). Drug specific and disease information were their most common drug information needs, and official drug monographs (92.7%), medicines leaflets (74.4%) and asking other pharmacists (65.5%) were their most used sources of non-internet based drug information. In addition, up to 80% had medical/drug applications installed on their mobile devices. Majority of respondents (90.5%) reported needing to search for drug information on the internet at least few times a week. Websites were the most utilized source of information accessed by them on the internet, and popular websites visited by them included Google, Medscape, Medlineplus and Wikipedia. About 73% of study participants reported ensuring that the information they obtained off the internet was authentic and they did this mainly by fact crosschecking with other websites (77.9%). The pharmacists used a wide range of drug information resources both on and off the internet, although some sub-optimal practices when utilizing these resources were observed.

Keywords: Drug information, Internet, Nigeria, Pharmacists

INTRODUCTION to describe information or advice provided in response to requests from health Pharmacists are drug information specialists professionals, organizations, or consumers. because they provide some level of drug This information may relate to specific information, either to healthcare patients, or consist of general information practitioners, patients or other members of promoting the safe and effective use of the public (Brand and Kraus, 2006). Drug medicines (SHPA, 2017). information (DI) also called medication/medicines information, is used

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Abdu-Aguye et al., Nig. Journ. Pharm. Sci., October, 2018, Vol. 17 No.2 01-09

The constantly expanding list of available needs and sources of drug information used pharmaceuticals, new technologies and by Pharmacists practicing in Kaduna state, medical information, in addition to the and their practices when retrieving and widened scope of pharmacy practice has utilizing internet based sources of drug greatly increased the information needs of information. the modern day pharmacist (Shields and Blythe, 2012). Pharmacists will often METHODS require information covering a wide range of Study Setting, Design and Sampling areas including drug specific information like dosing, costs, and pharmacokinetics. The study areas (Kaduna Metropolis and They also often need additional information Zaria) represent urban and semi-urban about the body, diseases or even non-drug settlements respectively in Kaduna State, treatments in order to better answer drug North-Western Nigeria, and were chosen information requests and/ effectively because around 90% of all public hospitals, counsel patients or other relevant parties. and 100% of registered community pharmacies in the state are located within To obtain all of this information, those areas (PCN, 2016). pharmacists will usually need to utilize a wide range of resources including traditional The study was a descriptive survey using a print references like drug compendia, self-administered questionnaire carried out formularies and text books. In addition, between August and October 2017. Study several online or internet based resources participants were Pharmacists (either fully have also come to be recognized as registered or interns) working in public and alternative sources of drug information private hospitals or registered community (Higgins et al., 2011; Shields and Blythe, pharmacies located within Kaduna 2012). metropolis and Zaria who agreed to participate. These pharmacists were chosen Pharmacists have a professional because it was believed that they would be responsibility to provide relevant, current directly involved in patient care and be most and unbiased drug information to patients likely to search for and use drug information and other health professionals. Therefore, that could affect patient outcomes. finding out by what means they obtain and establish the authenticity of this information Hospitals and community pharmacies were is important. A few studies have looked at chosen based on the likelihood of there the information needs and sources of drug being pharmacists present within the information used by Nigerian healthcare facilities. Therefore, all seven public professionals (Udezi et al., 2007; Adibe, hospitals-secondary and tertiary-within the 2010: Oshikoya et al., 2011). All of these study areas and three private hospitals (two studies have reported heavy reliance on print in Kaduna metropolis and one in Zaria) were material like textbooks and materials from visited. All of the pharmacists working in pharmaceutical companies. However, to the the visited hospitals or community best of our knowledge, no study has pharmacies were eligible to participate if specifically looked into the use of the they were willing. internet as a drug information resource by Nigerian pharmacists. Therefore, the aim of this study was to describe the information

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Abdu-Aguye et al., Nig. Journ. Pharm. Sci., October, 2018, Vol. 17 No.2 01-09

Study Instrument after which the researchers went back to retrieve them. Data from the questionnaires The instrument used in this study was was coded and entered into a Microsoft partially adapted from one used in a similar Excel 2013 spreadsheet and analyzed. study (Oshikoya et al., 2011). The Results obtained were reported using questionnaire was reviewed by five descriptive statistics. pharmacists (three in academia and two working within the hospital setting) to assess Ethical Considerations its content validity. It was then pretested on 15 pharmacists, after which minor Ethical approval was sought for and modifications were effected. obtained from the Committee on the Use of Human Subjects for Research of Ahmadu The final questionnaire was structured and Bello University, Zaria, Nigeria before the contained three sections. Section one commencement of the study contained nine items that collected data on (ABUCUHSR/2017/UG/007). Written demographic characteristics including informed consent was also obtained from gender, age, highest educational each participant before administering the qualification and years of experience. questionnaire. No potentially identifying Section two contained ten items covering information was collected, and all completed various aspects of non-internet based DI questionnaires were securely kept and utilization. Areas covered in this section handled only by those directly affiliated with included: types of information commonly the study. required, resources frequently used to search for them as well as the identity of requestors RESULTS and frequency of their requests. Section Of the 128 questionnaires distributed, 110 three contained fourteen items that described were eventually retrieved producing an 86% the attitudes and practices of respondents response rate. towards internet-based drug information resources. Some of the questions asked here Demographic characteristics of included: how often they needed to search respondents for drug information on the internet, commonly used sources of online drug Table one shows the demographic information and if and how they verified the characteristics of the pharmacists. Most of drug information they obtained from the the study participants were male (55.5%), internet. and had practiced as pharmacists for between 0-39 years (median = 3years). Data Collection and Analysis Majority of respondents were pharmacists practicing in the hospital setting (81.8%), The researchers visited all of the sampled and had the Bachelor of Pharmacy (BPharm) hospitals and community pharmacy outlets qualification as their highest educational during regular work hours and invited all the qualification (80%). In addition, around pharmacists present at the time in these 30% of them reported having previously establishments to participate in the study. If undergone some additional training on Drug they agreed, they were provided with a brief Information Services (DIS) provision information sheet about the study objectives outside their undergraduate learning, usually and given the questionnaire to fill. from workshops or symposia organized by a Respondents were allowed a maximum of wide variety of sponsors. seven days to complete the questionnaires,

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Abdu-Aguye et al., Nig. Journ. Pharm. Sci., October, 2018, Vol. 17 No.2 01-09

Table I: Demographic Characteristics of Study Participants (n=110) Characteristic n (%) Gender Male 61 (55.5) Female 49 (45.5) Age 25 or below 17 (15.5) 26-30 49 (44.6) 31-35 22 (20.0) 36-40 8 (7.3) 41-50 12 (10.8) 51-60 1 (0.9) Over 60 1 (0.9) Area of practice Hospital 90 (81.8) Community 20 (18.2) Highest educational Bachelor of Pharmacy (B. Pharm) 90 (81.8) qualification completed Master’s degree (M.Sc., MBA or MPH) 19 (17.2) PhD 1 (0.9)

Undergone additional DIS Yes 32 (29.9)* training No 75 (70.1) * Values do not sum up to total because of missing values. DIS: Drug Information Services Information Needs of Respondents week, the pharmacists estimated that they would get drug information requests mostly Majority of participants reported needing to from patients (91.3%), followed by requests search for drug information both off (92.7%) from other healthcare practitioners (69.8%) and on (90.5%) the internet at least a few and then doctors (58.6%). times a week. During the course of a normal

98,2% 90,0%

70,0% 70,9% 63,6% 59,1%

40,9% 42,7% 34,5% 33,6%

Medicines Disease information Treatment guidelines Non-drug treatments Complementary and information alternative medicines Non-internet based drug information Internet-based drug information

Figure I: Drug and related information commonly searched for by study participants

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Abdu-Aguye et al., Nig. Journ. Pharm. Sci., October, 2018, Vol. 17 No.2 01-09

Figure I represents the types of drug and sources of drug information were drug related information searched for by leaflets/ product inserts (74.5%), asking respondents. Their major information needs other Pharmacists (65.5%) and textbooks both on and off line were in the areas of (40%). medicines specific information (drug name, dosing, drug use in special populations and Online, majority of study participants related information), information about (85.8%) reported using websites/web pages disease conditions/symptoms and treatment as the major source of drug information they guidelines (both local and international). accessed on the internet (see figure II for Other information searched for by them details of websites frequently visited). included non-drug treatments for diseases Journal articles (61.3%) were next, followed like lifestyle and dietary modifications as by information provided by pharmaceutical well as information on complementary and companies (47.2%) and textbooks (40.0%). alternative medicines for various conditions. About 80% (86) of respondents had medical/drug applications installed on their Sources of non-internet and internet devices. The most common app by far was based drug information commonly the Medscape app (73.3%). Other accessed by participants commonly used applications included: Emdex (25.6%), BNF (22.1%) and Drug Notably, only around half of participants Dictionary (17.4%). (45.3%) reported that all the sources of drug information they needed were available at When participants were asked the type of their workplaces. The main sources of non- journal articles they usually needed to search internet based drug information commonly for when looking up information, around used by them included official drug half (49.5%) reported looking for systematic information monographs (92.7%) like the reviews/meta analyses. Case reports British National Formulary (BNF), Emdex (25.8%), randomized controlled trials (indigenous formulary) and Martindale (the (15.5%) and cohort studies (8.2%) were the complete drug reference). Other popular other types of articles regularly used.

WIKIPEDIA.ORG 46,2% MAYOCLINIC.ORG 39,6%

MEDSCAPE.ORG 74,5%

DRUGS.COM 38,7%

MEDLINEPLUS.GOV 50,0%

PUBMED.GOV 43,4%

GOOGLE.COM 74,5%

Figure II: Websites regularly visited by participants to obtain drug information

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Abdu-Aguye et al., Nig. Journ. Pharm. Sci., October, 2018, Vol. 17 No.2 01-09

Respondents’ practices when searching and evaluating internet based drug information

Table II: How respondents searched for and evaluated drug information obtained online (n=106) Item Variable n (%) How do you mostly search for Type search term into search engine 83 (78.3) drug info on the internet? Visit specific websites 20 (18.9) Other 3 (2.8) Do you usually try to assess the Yes 77 (73.3)* quality of information obtained No 28 (26.7) from websites? How do you assess this quality? Checking for dates on the webpages 21 (27.6)

Checking for funding sources/ownership of the 06 (7.8) websites

Checking whether the webpage is referenced/ has 27 (35.1) references

Checking for author names on webpages 17 (22.4)

Checking for the presence of quality certifications on 29 (37.1) the webpage

Crosschecking information obtained with that gotten 60 (79) from another website *Values do not sum up to total because of missing values. Only 106 (96.4%) of the 110 respondents internet (28, 26.7%), their main reasons for reported ever using the internet as a source not doing so included the fact that they only of drug information, and table two describes ever visited reputable websites (13, 46.4%) their practices when looking for drug and they had never thought there was a need information online. Majority of the study to do so (11, 39.3%). participants (96.2%) reported searching the internet mostly by using their personal DISCUSSION devices. Their main search method was to Findings from this study indicate that the use search engines like Google, Bing and pharmacists had a wide range of information others to generate links for terms of interest needs, and used several drug information (78.3%). Over 70% of them said that they resources both on and off the internet. When usually tried to assess the authenticity of retrieving information from the internet, information they obtained off websites. search engines like Google were used, and When these respondents were asked how many respondents tried to assess the they assessed authenticity (the question had authenticity of information they obtained. multiple response options and they were allowed to choose as many options as The information needs of the pharmacists applied), the most popular method was captured in this study while diverse, crosschecking with other websites (77.9%). generally followed previously established For those respondents who reported not trends. Similar studies have shown that verifying information they got off the drug-specific information is often the

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Abdu-Aguye et al., Nig. Journ. Pharm. Sci., October, 2018, Vol. 17 No.2 01-09 highest ranked information need of health now widely accepted that information professionals (Adibe, 2010; Tahamtan et al., provided by pharmaceutical companies is 2015; Alamri et al., 2017), and that was also not always beneficial for patients. A the case in this study. A lot of the systematic review by Spurling et al (2010) pharmacists in this study also reported studied the relationship between exposure to needing to search for other information promotional material from pharmaceutical including disease specific information and companies and the quality, quantity, and treatment guidelines. Disease specific cost of prescribing by physicians. Their information is often required to fully study found evidence of higher prescribing understand drug therapy and possessing frequencies, higher treatment costs and general knowledge on treatment guidelines lower prescribing quality in doctors exposed is routine for most pharmacists. to promotional materials when compared to others who were not exposed. They Health professionals in developing countries recommended that health practitioners avoid have been reported to complain about information from pharmaceutical inadequate access to drug information companies. Furthermore, when participants resources (Andualem et al., 2013; Tahamtan were asked the type of journal article they et al., 2015), and this may explain their often needed to search for first when looking higher dependence on suboptimal sources of for drug information, as is to be expected drug information including drug they mostly chose systematic reviews and/ leaflets/product inserts and asking other meta analyses. Interestingly however, the colleagues. A similar situation was also seen next favored article type were case reports, in this study as less than half of our in contrast to the widely established participants felt that all of the resources they hierarchy of evidence (Petrisor and needed were readily available at their Bhandari, 2007). workplaces. More than half of them also reported regularly using drug leaflets/ Currently, the internet contains an avalanche product inserts and asking their colleagues. of information, and a huge volume of drug Studies have shown that while drug and medical literature is available online. leaflets/product inserts are commonly used However, the unregulated nature of the sources of drug information by pharmacists internet raises concerns about the quality, (Diobi et al., 2013; Gelayee et al., 2017), the completeness and reliability of these information contained in them is often resources (Brunetti and Hermis-DeSantis, incomplete and poorly presented (Adibe et 2010). Pharmacists in our study admitted al., 2015; Joseph et al., 2017). In the same using webpages/websites as sources of vein, although consulting other pharmacists information although most of them reported may provide quick and concise answers in trying to assess the quality of the some situations, it may not be suitable for information they obtained from them. To others. This is because information from evaluate internet based drug information, human sources is often based on previous pharmacists need to look for the experience and may not necessarily reflect presence/absence of certain information that current best practices. can be broadly categorized into four factors; professionalism of website, disclosure, Online, other than websites/webpages, appropriateness of content and standard of participants mostly looked for journal information (Brunetti and Hermis-DeSantis, articles and information provided by drug 2010; Peterson-Clark et al., 2010). companies. This is worrisome because it is Pharmacists in our study did not seem to be

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Abdu-Aguye et al., Nig. Journ. Pharm. Sci., October, 2018, Vol. 17 No.2 01-09 very aware of the things to look out for CONCLUSION (authors’ credentials, date, ownership of websites etc.) instead preferring to cross- The drug information needs of the check the information they found with that pharmacists surveyed in this study were obtained from other websites which would fairly wide and they used a wide range of probably be more time consuming and drug information resources both on and off potentially limit their search. Also, when the internet. The use of some potentially asked to identify websites they often visited unreliable sources of drug information to obtain drug information, a good including high dependence on product proportion identified Google, seemingly inserts and asking other colleagues as well suggesting that several of them did not know as poor practices when utilizing internet- the difference between a website and a based resources were also observed. To search engine. In the same vein, almost half enhance their abilities to search for and identified Wikipedia as another frequently retrieve quality drug information, improved visited website. While some data supports training on drug information services (with a the use of Wikipedia as an accurate and specific focus on the use of the internet as a comprehensive source of drug-related DI resource) should be incorporated into information (Kräenbring et al., 2014), both undergraduate and postgraduate another study posits that drug information pharmacy training and continuing on Wikipedia lacks the accuracy and professional education programs. completeness of standard clinical references REFERENCES and should not be used for clinical decision making (Reilly et al., 2017). Adibe, M.O. (2010). Assessment of Attitude and Behavior of Health Professionals Towards Provision Limitations of this study include the fact that of Drug Information Services in Enugu only pharmacists from one Nigerian state State. International Journal of Drug Development & Research. 2(3), 555-564. were surveyed, thus limiting the generalizability of the results. In addition, Adibe, M.O., Igboeli, N.U., Ubaka, C.M., desirability bias (a tendency for survey Udeogaranya, P.O., Onwudiwe, N.P. and Ita, O.O. respondents to answer questions in a manner (2015). Evaluation of Information Contained in Drug Advertisement and Promotion Materials in that will be viewed favorably by others) Nigeria. Trop J Pharm Res. 14(3), 539-544. cannot be totally ruled out. Finally, because the aim of the study was to generally explore Alamri, S.A., Al Jaizani, R.A., Naqvi, A.A. and Al the information needs and sources of drug Ghamdi, M.S. (2017). Assessment of Drug information used by pharmacists, we did not Information Service in Public and Private Sector Tertiary Care Hospitals in the Eastern Province of assess the nature of drug information Saudi Arabia. Pharmacy (Basel). 5(3), 37. requests received or the influence of pharmacist demographic characteristics on Andualem, M., Kebede, G. and Kumie, A. (2013). study objectives. Future studies on this topic Information needs and seeking behaviour among health professionals working at public hospital and may need to inquire into the specific nature health centres in Bahir Dar, Ethiopia. BMC Health of DI requests made to Nigerian pharmacists Serv Res. 13, 534. in other to better assess the appropriateness of the DI resources used. Brand, K.A. and Kraus, M.L. (2006). Drug information specialists. Am J Health Syst Pharm. 63(8), 712-714. Brunetti, L. and Hermes-DeSantis, E. (2010). The Internet as a Drug Information Resource. US

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