Adapted from: Wright SG, LeCroy RL, Kendrach MG. A review of the three types of biomedical literature and the systematic approach to answer a drug information request. J Pharm Pract 1998;11(3):148-162.
Step 2: Obtain Background Information
Step 3: Determine and Categorize the Ultimate Question
Step 4: Develop Strategy and Conduct Search
Step 5: Perform Evaluation, Analysis, and Synthesis
Step 6: Formulate and Provide Response
Step 7: Conduct Follow-Up and Documentation
Example
Determine a method for delivery of the response
Request background information
Example
Develop a time line for response
Categorize the question
Examples of question classifications
Example
Select and prioritize resources based on the probability of locating the desired information
Conduct a systematic search
Example
Confirm information with other references to assure consistency between various resources
Restate the question and any pertinent background information
Methods of documentation (examples)
Reasons for documentations (examples)
Methods of follow-up
Reasons for follow-up
Example
Updated Mar 99
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Step 1: Secure Demographics of Requestor
The requestor's "profession" (e.g., physician, pharmacist, nurse, lay person) should indicate educational experience and knowledge base; therefore, the individual receiving the query can use this information to determine the appropriate mannerism (in terms of educational level) to formulate and deliver the response.
If a patient and a physician inquired about how the new medication Prandin® works (i.e., pharmacology), the depth of the response would differ for each individual. For example, a pharmacist should not inform a lay person that the new medication is the first agent approved in the meglitinide class and is a non-sulfonylurea insulin releasing oral hypoglycemic agent for type 2 diabetes mellitus. This would not be an appropriate response because the lay person would be unfamiliar with this terminology. Similarly, the pharmacist would not communicate to the physician that the new medication "acts by improving the way your body processes sugar." The physician would require a more scientific description of the product.
Gather information from the requestor that will allow you to reply to the request. Examples of information to gather include the following: the requestor's address, phone number, pager number, and fax number.
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Step 2: Obtain Background Information
Example
For instance, a pharmacist is asked, "what is the dose of amoxicillin (Amoxil®)?" This question could be answered quickly (and potentially inaccurately) by stating that the normal dosage as 500 mg every eight hours. The question also could be answered by gathering background information concerning the origin of the question. A pharmacist would not provide the most commonly dispensed dose of amoxicillin as the dose for all individuals and conditions. The dose of this antibiotic depends upon a number of factors. Determine if the question is in regard to a specific patient or general research in the treatment of a disease state. If the question is patient specific, important information to acquire would include the patient's age, weight, allergies, type of infection, concurrent disease states, other medications, and preferred dosage form (e.g., oral suspension, capsules, or chewable tablets). For example, amoxicillin may not be the best agent to select for the infection. In addition, the dose of amoxicillin can be 500 mg every eight hours for a severe infection or 2 grams as a single dose one hour prior to dental procedures for bacterial endocarditis prophylaxis. Other issues to consider with the antibiotic are dose adjustment for renal impairment and interactions with concomitant medications.
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Step 3: Determine and Categorize the Ultimate Question
Information gathered from the background questions concerning the request for the dose of amoxicillin (Amoxil®) allowed the actual question to be revealed as the dose and frequency of amoxicillin before a dental procedure for bacterial endocarditis prophylaxis in an 18 year old male
Completely understanding the scope of the "true" question also aids in developing a realistic estimate of the time required to compose a response
Return to Step 3 Systematic Approach Outline
Return to Step 3 Systematic Approach Outline
Step 4: Develop Strategy and Conduct Search
Return to Step 4 Systematic Approach Outline
Step 5: Perform Evaluation, Analysis, and Synthesis
Return to Step 5 Systematic Approach Outline
Step 6: Formulate and Provide Response
Provide the information and recommendation (if applicable)
Return to Step 6 Systematic Approach Outline
Step 7: Conduct Follow-Up and Documentation
For instance, a prescriber inquires about the relationship between elevated homocysteine levels and coronary heart disease (CHD). Furthermore, the caller requests information concerning prescribing folic acid to decrease homocysteine levels. After following the modified systematic approach, evidence that documented a relationship between elevated homocysteine levels and CHD was located. In addition, preliminary therapeutic trial information supported daily supplementation of folic acid to lower homocysteine levels. A few weeks later, additional information that further established the efficacy of folic acid in lowering homocysteine levels was published. Follow-up should be provided to the prescriber due to the recent information affirming the prior response.
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