FORMULATING EFFECTIVE

RESPONSES AND
RECOMMENDATIONS
 Rational pharmacotherapy can be
promoted by ensuring that drug
information is correctly interpreted and
appropriately applied.
In answering questions...
● Pharmacists responsibility is not simply providing an answer to a
question, rather, to assist in resolving therapeutic dilemmas or
managing patients’ medication regimens.

● Formulating responses and recommendations must be thoughtfully

synthesized using information and knowledge gathered from a number
of diverse sources.

● Managing patient care and resolving complex clinical situations need

added skills and competence in problem solving and direct patient care.
Impediments
1. False perception that many drug information questions do not pertain
to specific patients
2. Perception that seemingly casual interactions with requestors and the
lack of formal, written consultation somehow preclude the need for in-
depth analysis and extensive involvement in patient management
The absence of sufficient background information and pertinent patient
data can greatly impair the process of information synthesis and the ability
to formulate effective responses.
 IDENTIFYING THE
STEP 1 GENUINE NEED
● most queries are not purely academic or general in nature
● it is rational to assume that queries from health care providers
will invariably involve specific patients and unique clinical
circumstances
For example, a physician who asks about the association of liver
toxicity with lovastatin is probably not asking this question
whimsically or out of curiosity. The physician most likely is caring
for a patient who has developed signs or symptoms suggestive of
hepatic impairment possibly associated with the use of this
medication.
● Critical information that defines the problem and elucidates
the context of the question is not readily volunteered but must
be expertly elicited.
○ accomplished through the use of effective questioning
strategies (asking logical questions in a logical sequence)
and other means of information gathering

● Although it is easy to assign blame to the requestor for failing

to disclose all of the necessary information, it is ultimately the
responsibility of the provider of the response to obtain
information completely and efficiently.
● Good communication skills (both listening and questioning) are
essential

● Providing responses and offering recommendations without

knowledge of pertinent patient information, the context of
the request, or how the information will be applied can be
detrimental.
Before Formulating a Response
1. Are the requestor’s name, profession, and affiliation known?
2. Does the question pertain to a specific patient?
3. Is there a clear understanding of the question or problem?
4. Is the correct question being asked?
5. Why is the question being asked? Why now?
6. Are the requestor’s expectations understood?
7. Has pertinent patient history and background information been
obtained?
Before Formulating a Response
8. What are the unique circumstances that generated the query?
9. What information is actually needed?
10.When is the information needed and in what format (e.g.,
verbal, written)?
11.How will the information provided be used or applied?
12.How has the problem or situation been managed to date?
13.Are there alternative explanations or management options that
should be explored?
● Some pharmacists are quick to answer questions without
adequately understanding the context or unique
circumstances from which they evolved.

● They focus exclusively on the answer and ignore or fail to

obtain key information needed to establish the framework of
the question.

● In essence, this can result in a correct response being provided

to address an incorrect question.
STEP 2 GATHERING DATA
Formulating a response requires the use
of a structured, organized approach
whereby critical factors are systematically
considered and thoughtfully evaluated.
 FACTORS TO BE CONSIDERED WHEN
FORMULATING A RESPONSE
● Patient Factors
● Disease Factors
● Medication Factors
 FACTORS TO BE CONSIDERED WHEN
FORMULATING A RESPONSE
● Pertinent Background Information, Special
Circumstances, and Other Factors
○ Setting
○ Context
○ Sequence and time frame of events
○ Rationale for the question
 FACTORS TO BE CONSIDERED WHEN
FORMULATING A RESPONSE
● Pertinent Background Information, Special
Circumstances, and Other Factors
○ Event(s) prompting the question
○ Unusual or special circumstances (including
medical errors)
○ Acuity and time constraints
 FACTORS TO BE CONSIDERED WHEN
FORMULATING A RESPONSE
● Pertinent Background Information, Special
Circumstances, and Other Factors
○ Scope of question
○ Desired detail or depth of response
○ Limitations of available information or
resources
 FACTORS TO BE CONSIDERED WHEN
FORMULATING A RESPONSE
● Pertinent Background Information, Special
Circumstances, and Other Factors
○ Completeness, sufficiency, and quality of the
information
○ Applicability and generalizability of the
information
 ANALYSIS AND
STEP 3 SYNTHESIS
ANALYSIS
● the critical assessment of the nature, merit, and significance of
individual elements, ideas, or factors

● separating the information into its isolated parts so that each

can be critically assessed

● requires thoughtful review and evaluation of the quality and

overall weight of available evidence
SYNTHESIS
● the careful, systematic, and orderly process of combining or
blending varied and diverse elements, ideas, or factors into a
coherent response
Responses to drug information queries often must be synthesized
by integrating data from diverse sources through the use of logic
and deductive reasoning.
SYNTHESIS
● involves the careful integration of critical information about
the patient, disease, and medication along with pertinent
background information to arrive at a judgment or conclusion
 GIVING RESPONSES
STEP 4 AND RECOMMENDATIONS
EFFECTIVE RESPONSE
● adequately address and answer the question
● must include a restatement of the request and
clear identification of the problems, issues, and
circumstances
● should begin with an introduction to the topic
and systematically present the specific findings
EFFECTIVE RESPONSE
● pertinent background information and patient
data should be succinctly addressed

● conclusions and recommendations are also

included in the response along with pertinent
reference citations
DESIRED CHARACTERISTICS OF A RESPONSE
Timely
Current
Accurate
Complete
Concise
Supported by the best available evidence
Well-referenced
Clear and logical
DESIRED CHARACTERISTICS OF A RESPONSE
Objective and balanced
Free of bias or flaws
Applicable and appropriate for specific circumstances
Answers important related questions
Addresses specific management of patients or situations
SPECIFIC RECOMMENDATIONS
● must be scientifically sound, clearly justified, and well
documented

● carefully worded record of the response must be maintained

for follow-up and for legal reasons

● records may be confidentially maintained in a patient’s chart or

in the provider’s secure files
STEP 5 FOLLOW - UP
● should always be provided in a timely manner

● required for assessment of outcomes and, when necessary, to

reevaluate the recommendations and make appropriate
modifications

● it is also a hallmark of a true professional and demonstrates a

commitment to patient care
● allows the provider of the information to know if their
recommendations were accepted and implemented

● allows the provider to receive valuable feedback from other

clinicians and to learn from the overall experience
 Formulating effective responses and
recommendations requires the use of a
structured, organized approach whereby
critical factors are systematically
considered and thoughtfully evaluated.