Kalra M, et al: Drug Information Centres - Need of the Hour

health professionals within the institution. [3] In 1973, The list of various drug information centres is given in
INTERNATIONALE PHARMACEUTICA SCIENCIA the number rose to 54 drug information centres in the Table 1. The registering authority for drug information

| Jan-March 2011 | Vol. 1 | Issue 1 | USA. [4] According to a report published in 1995, there centres is the International Register of Drug
Available online http://www.ipharmsciencia.com were about120 full-fledged pharmacist-operated drug Information Services (IRDIS). [10]
©2011 IPS information centres in the United States, which accept
a broad scope of requests from health care
Table 1: List of drug information centres in India.
REVIEW ARTICLE professionals. [5] In India, the concept started at JSS
Independent Drug Hospital Attached Drug Information
Ooty, Trivandrum Medical College, Karnataka State Information Centres Centre with Clinical Services
Drug Information Centers - Need of the Hour ¾ Christian Medical College
Pharmacy Council. Maharashtra State Pharmacy Hospital, Vellore, Tamilnadu
¾ CDMU
¾ Drug Information Centre, Victoria
ABSTRACT Kalra M.a*, Pakhale S.P.,b Khatak Council (MSPC) centre was 3rd Drug Information Documentation
Hospital, Bangalore,
M. a, Khatak S.c Centre, Calcutta
¾ Karnataka Drug Information
With rapid advancement in medical and biological science, huge information about drugs and Centre in India and probably the first one in West Zone ¾ Maharashtra State
Centre, (KSPC)
Pharmacy Council,
diseases has emerged out. Access and authenticity of this vast information is limited therefore
aRamgopal College of Pharmacy, of our country. The provision of accurate and timely Maharashtra
¾ Bowring & Lady Curzon
Sultanpur,Gurgaon-122001. ¾ Andhra Pradesh State
Hospital, Bangalore, Karnataka
rational selection and utilization of drugs has been more complex. The conventional method of ¾
b Dr. Reddys Laboratories Ltd.
drug information to health care professionals is an Pharmacy Council,
Department of Pharmacy
obtaining drug information is through the medical representatives and product literature Qutubullapur, Andhra Pradesh- Practice, Chidambaram,
Andhra Pradesh
500090. important mechanism to promote safe and effective ¾ Karnataka State
Tamilnadu
provided by the manufacturers, which may be incomplete or biased. An important alternative, ¾ Department of Pharmacy
cDepartment Of Pharmaceutical Pharmacy Council
DIC (Drug Information Centre) assists doctors and hospital pharmacists in updating on new drug therapy. Such service is lacking in India. [6] The Practice, National Institute of
Sciences, Raj Kumar Goel Institute of (KSPC),Bangalore,
Pharmaceutical Education and
drugs emerging at international level, in different therapeutic areas. DIC also serve to the poor Technology, purpose of the centre is to provide accurate, current, ¾ JSS, Ooty
Research (NIPER), Chandigarh
¾ Tamilnadu Pharma
people, to bring down the burden of health problem on our society through continuous Gaziabad- 201003. ¾ Jawaharlal Nehru Medical
and unbiased information for the promotion of Information Centre,
College Hospital (JNMC),
education. As per WHO, DIC is defined as a service unit committed to providing drug Chennai
Date of Submission: 09-01-2011 rational drug therapy. [7] The centre also provides
Belgaum, Karnataka
information related to therapies, pharmacoeconomics, education and research programs. A Date of Acceptance: 12-03-2011 ¾ JSS, Mysore, Karnataka
¾ JSS, Ooty, Tamilnadu
DIC provides unbiased information to health care professionals, patients and/or consumers. Conflict of interest: Nil relevant information to physicians and faculty of the ¾ N.R.S. Medical College &
Source of support: None
Many centres also provide workshops or other forms of training to enhance the skills of medical academy on evidence-based medicine at their Hospital, Calcutta
healthcare professionals. DIC is an established concept in clinical practice abroad, in
request.
developed countries but concept is just taking its shape in India in recent years. There are Need of the concept [11]
Recognizing the need to provide organized drug
many centers in south and there is need for centre in northern and other regions. DIC can be 1. The availability of more than 80,000
attached to a hospital which is more beneficial than other typeswhich are industry based and information to health care professionals as well as
formulations makes it very difficult for a person
community based. A complete setup requirement along with good resources is very important. consumers, the WHO India Country Office in
Running a DIC in developing countries is a very challenging job. to remember all the formulations and daily new
collaboration with the Karnataka State Pharmacy
formulations are being added.
Introduction made counselling and drug information to patients / Council (KSPC) has supporting the establishment of 5
2. The national drug policy is industry focused
Information is key to preventing medication errors. consumers as well as monitor and document adverse drug information centres. These centres have been
rather than health focused thus large number of
Such information leads to enhanced quality of patient drug reactions. Drug Information is the provision of established in Haryana (Sirsa), Chhattisgarh (Raipur),
new drugs is added frequently.
care and thus improved patient outcome. Poor drug written and / or verbal information or advice about Rajasthan (Jaipur), Assam (Dibrugarh), and Goa
3. Lack of awareness of the principles of rational
regulation and lack of independent unbiased drug drugs and drug therapy in response to a request from (Panaji). They started functioning in 2007.Thus, in
drug use among doctors, pharmacists and other
information are the main contributing reasons for other healthcare providers, organizations, committees, India the concept is in a state of infancy.
health care professionals.
irrational drug use in India. About 40% of the health patients or members of the public. Drug Information 4. Widespread sale of prescription and over the
care services budget is consumed by medicines and Service describes activities undertaken by pharmacists Types of DIC’s [8]
counter drugs.
with a limited resource available, it is essential to in providing information to optimize drug use. 1. Hospital based DIC[9]
5. A high level illiteracy and poverty among
promote rational drug use.[1] Drug information from The hospital-based DIC perform various activities
patients.
commercial sources is very often biased and hence History [2] which include answering the in-house call, assist in
6. There are more than 20,000 biomedical
non-commercial, independent, unbiased source of In 1962, the first drug information centre was opened formulary decision, participate in drug use evaluation,
journals available and more than 6,000 articles
drug information is important. The Drug Information at the University of Kentucky Medical Centre and was coordinate adverse drug reaction reporting, publishing
are published every day. It is not possible for a
Centres provides authenticate, unbiased drug intended to be utilized as a source of selected, newsletter, provide in service education, assist in
person to have access to all the information. [12]
information to healthcare professionals; provide tailor- comprehensive drug information for staff physicians Pharmacy and Therapeutic committee (P&T)
7. Lack of adequate drug information due to
Address for correspondence and dentists to allow them to evaluate and compare committee, oversee investigational drug activity.
limited availability or lack of current literature
drugs besides catering to the information needs of 2. Industry based DIC
147, Housing Board Colony, Sector- 7 and also poor documentation, poor funding
Extension, Gurgaon-122001
nursing staff. The staffs of the drug information centre 3. Community based DIC
Mobile Number- 09416369129 available.
E mail- mohini_bajaj@yahoo.com were expected to take an active role in the education of
69 Internationale Pharmaceutica Sciencia Jan-Mar 2011 Vol 1 Issue 1 Internationale Pharmaceutica Sciencia Jan-Mar 2011 Vol 1 Issue 1 70
 Kalra M, et al: Drug Information Centres - Need of the Hour Kalra M, et al: Drug Information Centres - Need of the Hour

8. Lack of unbiased drug information from the - Adverse Drug Reaction Reporting (ADR Program) number of respected medical and pharmacy journals they are looking for. Examples of such services include
sources available. - Investigational Drug Program whose high standards for acceptance and publication Medline, Current Contents, International
- Education and Training make it unlikely that a research article containing Pharmaceutical Abstracts, Index Medicus, Excerpta
Main Objectives: The objectives of DIC are: - Publications (Newsletter, Bulletins, Journal, Column) erroneous data or misrepresented information would Medica, and the Iowa Drug Information Service (which
1. To provide an organized database of specialized - Community Services survive the editorial and review process. [28] Table 2 also includes full-text reprints of articles).
information on medicines and therapeutics to Answering patients’ questions related to-[17] lists some English-language journals that have strong
meet the drug information needs of - One of the 5 R’s: Right drug, Right dose, Right dosage editorial policies and peer review processes that Tertiary or general sources present documented
practitioners. form, Right route, Right patient. include conf1ict-of-interest disclosure requirements to information in a condensed format. Examples include
2. To educate pharmacy students to serve as - Drug Interaction minimize the possibility of biased or unsupportable formulary manuals, standard treatment manuals,
effective providers of medicines information. [13] - Availability / Substitute conclusions being reported. textbooks, general reference books, drug bulletins, and
3. To provide accurate and unbiased medicines - Drug Identification drug compendia. It is advisable to obtain the most
Table 2: Primary Information Sources
information service to the pharmacists, - Formulary Decision current edition available when using secondary or
Medical and Therapeutic Drug and Toxicology Information
physicians and other health care professionals in - Drug Identification Journals and Pharmacology Journals tertiary sources.
British Journal of Clinical
Annals of Internal Medicine
the hospital and community. Requirements for establishing Drug Pharmacology Tertiary references, written by individuals or groups,
Clinical Pharmacology and
4. To promote patient care through rational use of Information Centre [18] British Medical Journal
Therapeutics are often developed with the input of consultant
medicines. 1. Organization and Space - The various Journal of the American European Journal of Clinical
[19] reviewers and may be widely peer reviewed. In general,
Medical Association Pharmacology
parameters are considered while determining the Lancet Human and Experimental Toxicology the more thorough the peer review process is, the
Types of drug information queries[14] requirements of space and organisation. These factors New England Journal of Journal of Toxicology and Clinical sounder the information is likely to be. In many
Medicine Toxicology
Different levels of drug information are required by include- Type of activities offered, Space available, Medical Toxicology and Adverse countries, the most widely available tertiary resources
Drug Experience
healthcare providers and recipients. Medical Budget, Staff, Resources are formulary manuals and standard treatment
Pharmacy Journals Journals in Specific Areas
practitioners and pharmacists need access to the manuals produced by the health system. List of most
American Journal of Hospital American Journal of Emergency
information required by regulatory authorities for new 2. Resource [20] - The can be classified based on the Pharmacy Medicine respected tertiary resources is in Table 3.
drugs. Healthcare workers who have limited era in which they emerged: [21] Annals of Pharmacotherapy Annals of Emergency Medicine
British Journal of Obstetrics and
prescribing authority require a subset of this DIC – Resources: Pre-Computer Era Clinical Pharmacy
Gynaecology Table 3: List of most respected tertiary resources.
information together with protocols for diagnosis and References can be categorized into: [22] DICP-Annals of
Critical Care Medicine Essential Drugs Lists and Therapeutic Formularies
Pharmacotherapy
treatment. All health providers require information - Primary (journals) [23] Journal of Clinical and Journal of Antimicrobials and
Hospital Pharmacy Chemotherapy British National Formulary, updated every six months
resources for therapeutic decision support, - Secondary (indexing & abstracting) Journal of Clinical Pharmacy National list of essential medicines (2003), Issued by Directorate
Journal of Infectious Diseases
and Therapeutics General of Health Services
implementation and monitoring of outcomes. People - Tertiary (general reference books) [24] Journal of Paediatrics and Child Ministry of Health & Family Welfare, Government of India
Pharmaceutical Journal UK
Health The WHO Model Lists of Essential Drugs: The Use and Selection of
receiving medication need instructions for use of Primary sources: [25] They are the foundation on
Drugs. Technical Report Series 615, 641, 722, 770, 850 (1977,
prescribed and over-the-counter medicines. Additional which all other drug information is based. These 1979, 1983, 1985, 1988, 1992, 1995), World Health Organization,
Secondary sources function as a guide to or review Geneva
information may be necessary for high-risk groups include journal publications on drug-related subjects, WHO Model Prescribing Information: Drugs Used in Anesthesia,
of the primary literature. Secondary sources include Parasitic Diseases, Mycobacterial Diseases, Sexually Transmitted
(e.g. paediatrics, geriatrics, pregnancy and such as reports of clinical drug trials, case reports, and Diseases, Skin Diseases
review articles, meta-analyses, indexes (Index
breastfeeding) and in some diseases (e.g. diabetes, pharmacological research. Evaluating primary
Medicus), abstracts (International Pharmaceutical Drug information provided by manufacturers is
kidney and liver dysfunction). [15] Strategies to literature is difficult. [26] The most reliable evidence
Abstracts), and combinations of abstracts and full-text secondary or tertiary information. The type and quality
promote adherence include once-daily dosing, and comes from reports on randomized controlled trials.
reprints. of information provided by drug manufacturers vary
drug selection and dosing to minimise adverse effects. Proper evaluation of these trials requires considerable
Secondary information resources are essentially considerably from country to country, depending on
Other information that would be useful to consumers experience, and systematic reviews of combined trials
derivations of the primary literature. Some review governments' regulations and ability to enforce them.
is whether a particular drug is a banned or hazardous (meta-analyses) may be necessary. This work is being
articles summarize the results and conclusions of a DIC - Resources: Computer Era
drug, or its combination useless and irrational, and undertaken by the Cochrane Collaboration. [27] In
number of reports from the primary literature. Computer assisted search and retrieval
advice regarding traditional remedies. judging primary literature, one cannot assume that the
Bibliographic, abstracting, or indexing services provide - Online service
Answering health care professionals’ questions results of a study or a research paper are valid simply
listings or compilations of published articles. Some list - Compact Disk-Read Only Memory (CD-ROM)
related to-[16] because it has been accepted for publication. However,
the addresses of the principal authors; others contain DIC – Resources: Internet Era
- Pharmacy and Therapeutic committee (P&T) it is useful to consider the source of a study or paper
abstracts of articles, along with key words or subject
- Drug Use Review (DUE) / Evaluation when one seeks to determine its quality. There are a
headings to help users find the articles or references
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 Kalra M, et al: Drug Information Centres - Need of the Hour
Sometimes called National Information Infrastructure,
the information superhighway, Infobahn.
Using of Electronic Mail by health care professionals
Access to pharmacy-related World Wide Web (www).
3. Personnel [29]
The number of personnel required depend on the
range of activities offered and the hours of service. A
centre aim to provide a direct service during periods of
major demand by its clients. For patient-related
enquiries this is likely to be when clinic consultations
occur and during peak periods for hospital functions.
The professional staff should include a full-time
clinical pharmacist or a clinical pharmacologist.
Clinical training and experience is essential for
effective communication with clinicians. Other
important attributes are computer skills, literature
analysis, editing and library management.
The manager of a drug information centre should have
experience with service delivery as well as managerial
skills. [30] The manager’s responsibilities include:
• establishing and maintaining a viable financial
base;
• staff recruitment and coordination;
• training;
• promoting the service;
• identifying and maintaining appropriate
resources;
• data management and reporting;
• quality assurance and improvement;
• liaison with colleagues, professional
organisations (e.g. FIP Pharmacy Information
Section), networks, university departments of
pharmacy practice, and government agencies;
• strategic development.
Medical and non-medical specialists may be required
as additional resource personnel. As the centre
expands, it may be necessary to include some of these
specialists as advisers on a part-time basis. It is also
necessary to have secretarial assistance and support
staff for maintaining equipment and cleaning. There
should be a career structure for all professional staff
with the possibility of additional training and
advancement. Twinning arrangements between
73 Internationale Pharmaceutica Sciencia
established centres and developing centres can
facilitate the exchange of staff for education, training
and sharing of experience.
4. Policy and Procedures (P&P)
Policy means general outlines (framework) and
Procedures means detailed outlines (how to). Both
helps in smoothing the operation of the DIC. P&P
development depends on type of the DIC and scope of
service. It is subdivided into Administrative and
professional guides. It is important to have well
defined P&P as it serve as a guide for training new
employee, give insurances the task has been carried
properly. It is means of evaluating job performance
and is an important elements in case of conflict. It also
answers the various questions like What, when, where
it should be done and who should do it and how.
5. Equipment [31]
Basic equipment required for a centre include:
• Furniture - desks, chairs, shelving;
• Communications - telephones, facsimile,
internet access;
• Computers - including external data backup,
printer;
• Software - for word processing, spreadsheets,
databases and presentations;
• Photocopier;
• Textbooks and electronic information resources.
Approach to answering DI queries: [32] The
manner in which information is communicated is as
important as the substance of the information. For
information to be effective it must be accurate, reliable,
accessible, user-friendly and provided at a basic and
comprehensive level, depending on the consumer’s
requirements. The purpose of the service is to provide
accurate, current and unbiased drug information in the
promotion of rational drug therapy. The steps involved
are: [33]
1. Analyse the type of drug information[34]
2. Understand the background of the question
3. Understand the real need of the physician
4. Follow systematic approach
Jan-Mar 2011 Vol 1 Issue 1
Kalra M, et al: Drug Information Centres - Need of the Hour
Steps of Modified Systematic Approach: [35] The experience lead to development of more number of
first step is to secure demographics of requestor then DIC's and encouraging networking of DIC's in India.
to obtain the background information then to Drug information centres can be regarded as the
categorise question. The next step is the conduct of gateways to drug information and can be of great help
search for the topic and then to perform evaluation[36] in validating drug information, but drug information
and finally provide the response. A very important step practitioners must be well trained especially in
is to conduct follow-up and documentation of the analyzing the quality of scientific publications and
information so that retrieval is easy. underlying research. Highly successful programs in
Southern India had demonstrated that future of
Challenges for Running A DIC in Developing clinical pharmacy and drug information in India is
Countries: The various factors affect the efficient very bright. Government and private hospitals should
running of a DIC in developing countries like lack of come forward to establish DIC and to provide patient
recognition, because most people misunderstand their focussed services through efficient drug information
role, improper permanent financial support, only few centres.
DI Officers are employed and exclusively dedicated to
the service. The most important is under staffing, ill- References-
defined quality assurance programs, outdated drug 1. Promoting rational use of medicines: core
information sources and inappropriate facilities for components. WHO Policy Perspectives on Medicines,
working. The lack of clinical and managerial skills adds September 2002.
2. Hansen KN, Nahata MC, Parthasarathi G. Clinical
to list.
Pharmacy in India, In: BG Nagavi. A textbook of
clinical pharmacy practice, essential concepts and
Promotional Activities: The promotional activity
skills. 1st ed. Orient Longman, 2004, pp-1-8.
important for the working of a DIC are Q/A services, 3. Parker PF. The University of Kentucky drug
Patient counselling, SDI, ADR reporting, Drafting information center. Am J Hosp Pharm 1965;22(6):42-
guidelines, supporting working of Drugs & Therapeutic 7.
Committee (DTC), contributing to Rational Use of 4. Beaird SL, Coley RM, Crea KA. Current status of drug
Drugs (RUD) Projects, release of Bulletins or news information centers. Am J Hosp Pharm
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5. Malone PM, Kier KL. Pharmacy and therapeutic
days is Media.
committee. In: Malone PM, Mosdell KW, Kier KL,
Stanovich JE, eds. Drug Information: A Guide for
Conclusion
Pharmacists. Stamford, CT: Appleton & Lange; 1996.
Pharmacist’s role is expanding by the advert of DIC p. 227-81, 448-57.
and clinical training has also played a major 6. Lakshmi PK, Gundu Rao DA, Gore SB, Shyamala
contribution. In addition, new technologies and Bhaskaran. Drug information services to doctors of
resources, increasing ease of access of information has Karnataka, India. Ind J Pharmacol 2003; 35: 245-
played a leading role in pharmaceutical care. The DIC 247.
has provided itself to be an impressive resource, which 7. Merritt GJ, Garnett WR, Eckel FM. Analysis of a
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1977; 34(1):42–46.
of people involved in the health system from patient to
8. Gong SD, Millares M, VanRiper KB. Drug information
provider and also contribution through providing
pharmacists at health-care facilities, universities and
access to up-to-date information. There has been a pharmaceutical companies. Am J Hosp Pharm
steady increase in the number of enquiries indicating 1992;49(3):1121-30.
an increase in awareness of the center, as a source of 9. Health Systems Development (HSD) Essential Drugs
unbiased drug information among the doctors. This and Medicines, Drug Information Centes,
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