Systematic Approach for Answering a Drug Information Request:
The Seven Steps

Note~~~The outline for answering a drug information request is presented below. Within each step, there are links that provide further explanations and examples. The seven steps are colored red.

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 1: Secure Demographics of Requestor

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

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Step 1: Secure Demographics of Requestor

Secure requestor demographics
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.

Example

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.

Determine a method for delivery of the response

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

Request 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

Example

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

Develop a time line for response

Completely understanding the scope of the "true" question also aids in developing a realistic estimate of the time required to compose a response

Categorize the question

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Examples of question classifications

Example

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Step 4: Develop Strategy and Conduct Search

Select and prioritize resources based on the probability of locating the desired information

Conduct a systematic search

Example

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Step 5: Perform Evaluation, Analysis, and Synthesis

Confirm information with other references to assure consistency between various resources

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Step 6: Formulate and Provide Response

Restate the question and any pertinent background information

Provide the information and recommendation (if applicable)

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Step 7: Conduct Follow-Up and Documentation

Methods of documentation (examples)

Reasons for documentations (examples)

Methods of follow-up

Reasons for follow-up

Example

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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Updated Mar 99