S E L F - M E D I C A T I O N IN HOSPITAL: FACT OR F I C T I O N ? RESULTS OF A STUDY IN A FRENCH G E N E R A L H O S P I T A L

Iacques~Barfl,.elemyL& lean Claogilleau~

International literature is abounding in studies about self-medication of outpatients. It has been shown that it could be both desirable for economic reasons but also dangerous since the knowledge of drugs is grossly inadequate in people who self-medicate themselves. But what about self-medication in hospitalized patients?

Abstracts of Poster Presentations

An individual questionnaire was sent to nursing personal in all medical and surgical units of a General Hospital in order to determine whether there was a self-medication (or an attempt to or similar phenomenon) of inpatients and the degree to which they could practice it. Anonymous reply was guaranteed. It appears that this phenomenon must not be considered as a fiction; on the contrary, ordinarily quite secret, the fact is here confessed by the majority of the nurses (88%) who answered to ~ e question and by a minority of auxiliary nurses (17% !). Medical personal can give satisfaction to the patients request or even promote this practice (auxiliary nurses!). This phenomenon is quite different from the so-called and described ~setf-mediuatiun" or even ~self-prescriptiun ", since it involves two actors (except the Doctors) in institutional environment. Maybe for this reason, it seems to be underestimated. The lack of sufficient knowledge of side effects, interactions or even indications and contra-indications of drugs can lead to imprudent administrations with important or vital risks for the patients. The Hospital Pharmacist has been considered for a long time as a specialist in drug management rather than a clinician able to counsel about drugs to be taken (prescribed or unprescribed). This preliminary study stresses -if necessary ?- the essential role he is going to play in the future. Nevertheless, the task remains important for the French Hospital Pharmacist: in spite of lack of means, he has to communicate, to inform, to asert himself in the service next to the Doctors and the Nurses in order to propose his contribution in drug dispensation and safety for the patients.

*Pharmacie Centrale, Centre Hospitalier G(~n~ral, Avenue du G(~n(~ral de Gaulle, BP 609, 03006 - MOULINS, France. zPharmacie Centrale, Centre Hospitalier Universitaire Gabriel Montpied, Place Hem'i-Dunant, 63000 - CLERMONT-FERRAND, France.

" ' A C T I V E ' " INFORMATION QUALITY ASSURANCE

DRUG COST C O N T A I N M E N T IN A N T I B I O T I C T H E R A P Y : AIMS AND EFFECTS OF A M I N I M A L I N F O R M A T I O N E X P E R I M E N T IN A FRENCH GENERAL HOSPITAL

I. Aiz~-'ua._F,._A.~tibel~ K. Aizl/t~ Jacque.g Barthetemy~ & Jean ChopineauZ To promote more rational prescribing practices, the Drug Information Centre (CEVIME) has published a "New Drugs File" (NDF). It contains an evaluation on the therapeutic innov~/tiun degree of new drugs launched in Spain. It is sent round free each month to every General Practitioner (GP) of the Basque Country. In order to know the NDF quality, two activities have been made: I) the pharmacotherspeutic innovation degree given in NDF is compared with F"DA classification for the same new drugs marketed in Spain for 1990-91. 2) A mail questionnaire has been sent to assess readers opinions about NDF. Items included the impact of NDF on their prescribing habits and quality of the information provided in it. 33 drugs were assessed. We have assigned the same pharmacotherspeufic innovation degree as the FDA for 23 drugs (70%). The inquiry shows that 85% of the readers (GPs) read, keep and think that it is useful to prescribe rationally. Conclusion In our country, Drug Information Centre quality assurance programmes are based mainly on the outcomes such as satisfaction with the service. The aim of this programme is to provide an additional criteria as the assessment of the scientific quality comparing NDF with FDA standard classification.

CEVIME, Subdirecci6n de 'Farmacia y PC, Osakidetza/SVS, C/Alava N* 5, 01006

Antibiotics represent an important part ranging from 20% to 25% of the total drug budget in our hospital. This therapeutic class often constitutes an interesting target for drug cost containment. The increasing total pharmaceutical expenditures for 3 years nece~itated stringent cost-saving measures. On our arrival in this Hospital, we submitied five groups of propositions to the Hospital Drug Committee and Pharmaceutical Expenditures Committee to reduce expenditure by mean of simple and repetitive but decisive information (although there are only two Pharmacists in this 820-bed General Hospital) : (1) a rigourous competition between drugs likely to be retained (exclusively the role of the Chief Pharmacist), (2) constitution of a Hospital Formulary including mention of the unit prices and calculated mean daily prices for each antibiotic (++++), (3) instructions to prescribe as soon as possible oral rather than parenteral drugs (quinolones for example), or vancomycin rather than teicoplanin as antistaphylococcal drugs (etc...), recommendations for a rational antibiotic prophylaxis, (4) imposition of individual prescription for the most expensive drugs (+++) (in a general context of non-individual drug dispensation), (5) meetings with Doctors, Administrators and Nurses to inform and to ensure the active involvement of each individual concerned. Significant results were rapidly obtained as early as the first year (1991) with a fall of 520,000 Frs of total antibiotics costs (1991/1990 : -21%), going on in 1992 with an amount of 160,000 Frs. The Hospital Pharmacist is an important actor in a General Hospital, since its central situation leads him to bear the responsibility of drug administration and budget management. Active communication and sustained information are factors which could lead to substantial economic results: those propositions are being extended to other therapeutic classes of drugs with hope they will be as cost-effective as the above-mentioned.

Vitoria-Gasteiz, Spain. ~Hospital Pharmacist - Pharmacie Centrale, Centre Hospitalier G(~n6ral, BP 609, 03006 - MOULINS, France. ZHospital Pharmacist - Pharmacie Centrale, Centre Hospitalier Universitaire Gabriel MONTPIED, Place Henri-Dunsnt, 63000 - CLERMONT-FERRAND, France. Pharmacy IV(,rld & Scirme Vol~me 15 Nr+ $ 1993

DI 3

"PSYCHOTROPIC

DRUG

DIRECTORY 1993 ~

L I A I S O N BETWEEN G E N E R A L A N D MEDICAL PRACTITIONERS AND COMMUNITY P H A R M A C I S T S

StephcnJ3azirc

S- Be_~ieyt: V_Willi

The "Psychotropic Drug Directory 1993"1 is a novel form of information book aimed specifically at clinically practising pharmacists. Relevant drug information is presented in a problem orientated, concise and fully referenced manner. The book complements the British National Formulary 0BNF-') by supplying data and references needed for the next level of information. The topics included cover the areas of enquiries received, and contributions made, by the author over ten years in psychiatry and are ones where information is often needed but not always readily to hand. Being BNF sized and portable, it provides an enormous body of information to allow questions to be answered authoritatively on the spot. This not only helps to improve patient care by encouraging the positive and rational use of drugs for suffers of mental illness, but also helps to enhance the standing of pharmacists and pharmacy. The book has developed over ten editions from early days as a photocopied booklet for in-honse pharmacy use, through dot-matrix PCW desk-top publishing and distribution, as the "Psychotropic Aide Memoire', to full professional publication. It will show what an amateur, in terms of publication and drug information specialisstion, can do and how the content of such books can develop to take into account fellow pharmacists views and requirements. Over 1,200 copies were sold over three years before professional publication. An appeal is made for other similar books to help clinical pharmacists be more effective in their contributions to other areas of patient care. Indeed, a publisher is awaiting such books. 1. ~Psychotropic Drug Directory 1993 ", Stephen Bazire, Quay Publishing, ISBN 1-85642--080-9. Little Pinmstead Centre, Norwich NR13 SEW, England. Tel: 0603-713355 ext 340.

2

--

Although dispensing will remain the core activity of community pharmacists, recent developments in information teeimology and the presentation of medicines in the manufacturers original packs have resulted in some aspects of the dispensing process to be undertaken by support staff under supervision. One essential area of the dispensing process, which directly involves the expertise of the pharmacist, is in the provision of drug information to patients and prescribers for the safe and effective use of their medicines. The pharmacy profession has endorsed these advisory role propesaist. The result of implementing such proposals would be ~a patient orientated health service which would apply scientific knowledge to improve and promote patient health by means of appropriate drug use and drug related therapy ~. To implement such developments close collaboration with general medical practitioners (GPs) is especially important, since GPs issue most prescriptions and co-ordinate secondary health care of patients. In other countries, communication between doctors and pharmacists is frequent~ and has resulted in pharmacists becoming more involved in decisions on the use of medicines. The objectives of the study were to determine the frequency of contacts between community pharmacists and GPs, to investigate if GPs utitise community pharmacists as a source of drug information and if these factors influence the attitudes of GPs towards extended pharmacy services. A postal questionnaire was sent to a random sample of 1000 community pharmacists with a response rate after postal and telephone follow up of 69.9%. A similar questionnaire was distributed to all general practices in the East Sussex FHSA (152) with a final response rate of 78.8%. All results were analysed using the Minitah statistical package, with p<0.05 taken to be significant and Chi square tests were used to compare data. 1. Pharmaceutical Care: The future for community pharmacy. The Royal Pharmaceutical Society of Great Britain, (1992). 2. B.W. McGuinness, Pharmacy's link with other primary health care professionals, Pharmaceutical Journal, 233 (1984) 391. ~Department of Pharmacy, 2Department of Social Policy, University of Brighton, Brighton BN2 4G J, England, ~Sussex Pharmacy Academic Practice Unit, Southlands Hospital, Shoreham by Sea, BN43 6TQ, England.

PROVISION OF DRUG INFORMATION T O GENERAL PRACTITIONERS

I A T R O Q U E S T - A MACINTOSH BASED I N T E R N A L D A T A B A S E DESIGNED EXCLUSIVELY FOR A D I e

NickBeaxon Introduction The West Middlesex University Hospital 0N.M.U.H.) is a 600 bed District General Hospital allied to the Westminster & Charing Cross Medical School. The Drug Information Centre at the West Middlesex was established in 1986 and the number of queries has risen to an average of 1000 per year with more than 2000 past queries on a computer data base. The Hospital is now forming stronger links with General Practitioners (G.Ps) in the local community. To further this aim we are considering providing a wider Drug Information Service to local G.Ps. Aims To ascertain whether G.Ps are aware of the D.L services we offer, whether they would use our services, what they would like and the feasibility of extending such a service. Objective To provide a Drug Information Service including New Product Appraisals to G.Ps in the local community. Method A questionnaire was sent to 93 G.Ps who practice in the Isleworth area (TW7) and the adjacent postal districts, including T W I , TW2, TW3, TW4, TW5, TWB, TW9, T W I 1 and UB2. All participants were sent questionnaires in the s a m e week. Practitioners were requested to reply within 3 weeks in a reply paid envelope, lqo reminders were sent. The subject matter of the questionnaire included:l) Introduction about the background to the questionnaire. 2) Questions to ascertain the awareness by G.Ps of the existence of the D.I. Services. 3) Example of a New Product Appraisal for comments. 4) Whether they would be prepared to pay for the extra resources that may be required. 5) Whether they have used the service and would use the service in the future. 6) Any general comments. Results The overall response rate to the questionnaire was 38%. Only 34% of the respondants were aware of a Drug Information Service at the W.M.U.H. and 66% did not know the types of queries covered. The product appraisal was thought to be useful by 74% of the G.Ps. If the service were generally available 94% responding to the questionnaire said they would use the service. With regard to paying an annual fee 60% said yes, 29% said maybe (fee per query?) and 11% would not pay. Of the 34% who were aware of the service 27% of these have used it. Conclusion The survey has improved the level of awareness of G.Ps of the D.I. Service available to them. It is apparent that local G.Ps would like to have general access to the service and some would consider paying for it. Implications for the Drug Information Centre workload is evident since at least 32 G.Ps are potential customers. Consideration must now be given as to how the service may acquire the necessary extra resources.

One important problem at a Drug Information Centre (DIC) is to handle and store the answers so that you can find them easily at a later time. For this purpose we have designed the database latroquesL latroquest is a database exclusively designed for handling drug-related questions/ answers. The database contains possibilities to handle both questions and answers us well as data about the questioners. By pooling the information from the two data flies it is possible to have a rational and cost-effective DIC. Briefly, the responsible investigator writes down the answer in a text-document, which is then easily transferred to the database. Iatroquest is based on the programme 4th Dimensiun. Iatroquest is menu-based and can easily be moditied. Recently, a Server-version has been introduced on the market which makes it possible for many people to work on the same database. Information from the database can be reached via external connection. It is possible to select the part of the database that shall be accessible for external users. Information from the database is easily and rather rapidly searchable. It is also possible to acce~ statistics from the base automatically, which is of great value when it is time to summarise the activity at the DIC. Our experience of Iatroquest is that it is a reliable and user-friendly database with an acceptable search speed.

Sahlgrensta apoteket, Sahlgrenska sjukhuset, Box 75 003, 40 036 G&enborg, Sweden.

Pharmacy - Drug Information, West Middlesex University Hospital, Twickenhana Road, Isleworth, Middlesex. TW7 6AF, England. Volume IS Nr. 3 1993

D 14

I,h,m..~y I ~.'orld ~;. S, ie.~ e

INDEPENDENCE: A Q U A L I T Y CRITERIA?

P H A R M A C E U T I C A L T R A I N I N G U S I N G INTERAC*rIVE M U L T I M E D I A TECHNOLOGY - EVALUATION RESULTS

S._Clavel, B. Sarrut._& C. Doreau H/tkan_F.,milsson As part of the Quality Assurance concept, Drug Information Centres try to define some q.uality criteria. For example, they speak about precision, clarity, objectivity and answering timeL Independence could be another criteria. In the pharmaceutical literature, several deCmitions of independence are proposed~. They all have something in common: that of autonomy as far as pharmaceutical industry is concerned. Nevertheless, the documentation in French Hospital Pharmacies is based on technical brochures given by pharmaceutical industry. So, how can we define more precisely what the independence of information as a quality criteria is? We will be doing a survey with the following aims : - to understand the meaning of independence applied in the field of drug information, to try to define and evaluate this concept of independence. This survey is aimed at pharmacists who work in hospital pharmacy or in Drug Information Services, and take part in the Second European Workshop on Drug Information. During this meeting, we will propose a simple questionnaire, with the following principal pans: general information, organisation, sources and funds. This questionnaire is not anoymous so that we can send a follow up letter to non-responders after the two weeks post-workshop. The results will be an analysis of the filled questionnaires (percentage by item, presentation in histograms). The questionnaire filled by pharmacists, who are the editors of drug bulletins or periodicals, independently from drug information service, will be analysed only if they are in sufficient number. The discussion should be a proposition of methodology or a programme to obtain independent information. Results and discussion will be presented after the Second European Workshop on Drug Information. -

1. American Society of Hospital Pharmacists. Preliminary report of the ASHP Quality Assurance Indicators Development Group, American Journal of Hospital Pharmacy,'48 (1991) 1941-7. 2. A. Herxheimer, How do independent drug bulletins differ from other periodicals? Proceedings of the First European Workshop on Drug Information, (1991) May 15-17, Paris. European Society of Clinical Pharmacy, 1991. 3. G. L66f, Independent drug information representative for general practitioners. Proceedings of the First European Workshop on Drug Information, (1991) May 15-17, Paris. European Society of Clinical Pharmacy, 1991. Service d'information Mtdico-Pharmaceutique, Pharmacie Centrale, AP-HP, 7 rue du Fer ~i Moulin, BP 09,75 221 PARIS Cedex 05, FRANCE. (Phone: +33(1)43371100 Ext 205. Fax: +33(1)43369297).

An interactive computer-based multimedia program for continuing education of pharmacy staff has been developed by the Drug Information Department in cooperation with MultiMedia AB, Stockholm, during 1991. The multimedia program comprises information about different types of illness in mouth, oesophagus and ventricle/duodenum, and about the drug treatment of these iliad. Theoretical sections, practical tests and eustumer problems are mixed in a way easy to handle by the user. A drug data base is also connected to the system. The multimedia program has been tested and evaluated in comparison with a traditional training program that uses individual studies with text books in combination with a seminar. The evaluation has involved 171 employees. 72 have gone through the multi-media training and 99 have used the traditional training method. The multimedia group has been assigned a total of 3 hours for the training, while the "traditional" group has spent almost 6 hours. The following factors have been evaluated: - knowledge levels before and 7-10 days after the training - knowledge level after 6 months learning speed attitudes before and after the training COSts Results: - Significantly higher knowledge levels have been achieved by both the traditionally trained group and the multimedia group. - A somewhat higher knowledge level has been observed in the group that has studied for 3 hours using multimedia technology, compared to the group that used traditional training for almost 6 hours. - The learning speed has more than doubled by using multimedia training. - The results from tests using customer situation cases have been dramatically improved in the multimedia group. - The employees in the multimedia group have developed a more positive attitude to computer based training than they had before. The training is experienced as easier, more exciting, funnier, more activating and more versatile. The multimedia program is thought to be easy to work with, user-friendly and interesting. The results from this test shows that the training efficiency can be increased considerably if multimedia training is used instead of traditional training by text books and seminars. Since the training efficiency can be increased, the total training cost can be decreased, at least in the long run. -

-

-

Drug Information Department, National Corporation of Swedish Pharmacies (Apoteksbolaget AB), S-I05 14 Stockholm, Sweden.

T H E S E C T I O N FOR D R U G I N F O R M A T I O N A S C I E N T I F I C S E C T I O N OF T H E S W E D I S H A C A D E M Y O F P H A R M A C E U T I C A L SCIENCES

Q U A L I T Y A S S U R A N C E PROGRAM IN THE C O N S U L T A T I O N AREA OF A DRUG I N F O R M A T I O N CENTRE: SPECIFIC I N F O R M A T I O N PROGRAM

-

H~kan_Emilsson Luengo A.J..Doncel &_Garcia M..Pavon

The solution of consultations which are made to a Drug Information Centre, included in the area of passive information, is one of its priority activities. Information tools provide the setting up of a Quality Assurance Program intimately related to the process of data collection, furnishing it with quickness and objectivity. The instigation of a pilot program with these features in the Drug Information Centre of the College of Pharmacy of Badajoz from Ist January 1992 exploits the data which are obtained in the Data Sheet and get results which allow decisions to be taken to guarantee quality in the passive information area. Our centre proposes automation of the process through the design of a specific information program dedicated to conduct the respective data to the area mentioned above, which will be a powerful tool for the Drug Information Centre, to increase the quality of the service.

The Swedish Academy of Pharmaceutical Sciences has existed in its present form for the past 20 years. The aims of the Academy are to promote scientific and professional developments in the discipline of pharmaceutics, the focal point being to benefit not only welfare and health care services but also the community as a whole. It is an ideological, non-profit-making association. The Swedish Academy of Pharmaceutical Sciences is an "umbrella" organization for groups with special interests, going under the name of scientific sections within the Society. One of these sections is the Section for Drug Information. The Section is led by a section committee elected by the section members. The Section was founded in 1981. Current membership in the Section is around 650, the majority being pharmacists. However, even non-pharmacists who are interested in the activities by the Section are welcomed as members. The activities run by the Section include meetings, symposia, workshops and conferences on various scientific topics within the drug information field. About 4 to 7 activities are arranged every year. You can find some examples of activities arranged during the last years in the following list: -

I. C.A. Repchinsky & E.J. Masuhara, Quality assurance program for a a drug information centre, Drug Intelligence and Clinical Pharmacy, 21 (1987) 816-820. 2. C.J. Smith & L.M. Sylvia, External quality assurance committee for a drug information centre, American Journal of Hospital Pharmacy, 47 (1990) 787-791. 3. M.L. Moody, Revising a drug information centre quality a~urance program to conform to Joint Commission standards, American Journal of Hospital Pharmacy, 47 (1990) 792-794.

Documentation technique Drug information to the patients Compliance in practice Self medication What do we know about drug abuse and doping? Information technique How to make a good poster? Patient information about adverse effects of drugs Sexuality and drugs Modern information technology - interactive computerized systems

Ceutn) de Infomlacitn del Medicamento (CIM), Colegio Oficial de Farmactuticos de

The purpose of all these activities is to further a rational use of drugs and medicines.

i'~adajoz, Ramfin Alharr;in. 13 06002 B;ulajoz, Spain. Section for Drug Information, Swedish Academy of Pharmaceutical Sciences, P.O. Box 1136, S-111 81 Stockholm, Sweden. l+h,lrm,xcy It'.rhl ~:'+S, icme ~o,u~ ,s .+. 3,9+,

D15

PHAKIdACOECONOMICS - A P P L I C A T I O N

FOR A DI SERVICE

THE WELSH ADVERSE DRUG REACTIONS SCHEME: TENTH ANNIVERSARY

B~._Ctadmaa

LE,.~ ought~r~..A.~ichenzL.~P~R.o utledg:eL&_E.L_WA~dz.~

In order to maintain the principles of a comprehensive health service, all those

The Welsh Adverse Drug Reactions Scheme (WADRS) is run jointly by the Department of Pharmacology & Therapeutics, University of Wales College of Medicine and the Welsh Drug Information Centret. Since March 1st 1983 it has acted as a Regional Monitoring Centre for the Medicines Control Agency and provides a responsive feedback and educational service to reporters of adverse drug reactions and extends the role of pharmacists in the activity.

involved in health care need to ensure that allocated resources are .used as effectively and efficiently as possiblej. This increasing emphasis on demonstrating value for money for activities undertaken formed a key part of the recent NHS reforms. Pharmacocconomic re..search identifies, measures and compares the costs (all input costs) and consequences of pharmaceutical products and services. Pharmaeoeconomic analyses undertaken can help not only with the evaluation of drugs for formulary inclusion but they also enable the Drug & Therapeutics Committee to look more broadly at the effects of any formulary changes on overall Unit/Hospital budgetsL Drug Information Pharmacists have a critical role to play therefore in helping to guide Units and Hospitals on the most efficient way to reach a desired outcome. This necemarily entails looking at a much broader picture when computing costs and not just the initial purchase price of products~. These issues and their impact on future activities of Drug Information Pharmacists will be explored.

1. J.B.L. Howell, Re-examining the fundamental principles of the NHS, British Medical Journal, 304 (1992) 297-9. 2. R.J. Lipsey, Institutional Formularies - The Relevance of Pharmacoeconomic Analysis to Formulary Decisions, PharmacoEconomics, 1 (1992) 265-281. 3. B. Godman, Pharmacocconomie Studies and Decision Making. Pharm. Weekblad So. Ed. 14 (1992) E23.

Health Economics, Medical Sciences Liaison (MSL) Division, Upjohn Limited, Fleming Way, Crawley, Sussex, RH I0 2LZ, England.

In 1981 (prior to the establishment of the scheme) the adverse reaction reporting rate per million population in Wales was 156. This rate increased to 313 in 1991. The corresponding figures for England were 272 and 420. Thus the absolute reporting rate is still lower than in England despite evidence of greater prescribing figures in Wales2. Thirty-seven percent of all reports to the WADRS have been from hospital doctors, 62% from general practitioners and 1% from dentists. Sixty-two percent of these reports involved female patients. The largest number of reports were in the BNF Code 2 grouping which includes those drugs acting on the cardiovascular system. In 1992, 20% of reports from hospital doctors were to recently introduced black triangle (~') drugs and 74% were of serious reactions to established drugs, the corresponding figures for general practitioners were 38% and 48%. Forty-five percent of all reporters requested further information about other reports associated with the suspected drug. Although the last ten years of the WADRS have seen an increase in the reporting of adverse drug reactions in Wales, additional strategies are being targeted to enhance reporting rates since under-rsporting remains a problem. 1. M.G. Spencer, Adverse Drug Reactions - monitoring side effects. The Welsh Adverse Drug Reactions Scheme. Proceedings of the Guild, 21 (1986) 58-61. 2. D.A, Jones, P.M. Sweemam & P.C. Elwood, Drug prescribing by GPs in Wales and in England. Journal of Epidemiology and Community Health, 34 (1980) 119-123. tWelsh Drug Information Centre, University Hospital of Wales, Heath Park, Cardiff, CF4 4XW, Wales, UK. 2Department of Pharmacology & Therapeutics, University of Wales College of Medicine, Heath Park, Cardiff, CF4 4XN, Wales, UK.

POST-MARKETING DRUG SURVEILLANCE IN BELGIUM: THE SITUATION IN 1992

DATA ON THE MOST MARKETED DRUGS IN FRANCE ARE TO BE FOUND IN THE AMERICAN MICROMEDEX DATABASES

M. Heyndritckxk&Aq_ De Clercq3 The Post-Marketing Surveillance (PMS) of drugs is currently a topical subject, especially since, from 1[1/1993 PMS has become compulsory for all countires of the European Community.

~b~olic.e,~,.~.LebauL~

M. LeA~tfs

The databases from Micromedex Inc. are very useful in a busy Drug Information Centre (DIC), since they Offer well updated and evaluated full-text data on

The situation in Belgium has recently been evaluated t.

therapeutics. How wide does this American source cover the French drug use system'?.

The national system for PMS is based on free reporting from specialists (doctor, dentist, pharmacist) to a central organisation in Brussels (National Centrum voor Geneesmiddelenbewaking ] Centre National de Pharmacovlgilance). The reporting involves specially designed yellow forms, inserted in the "Folia Pharmacotherapeutica', the centre's monthly magazine. Every year about 500 forms are received by the National Centre which might indicate under-reporting. More than 90% of the reporting originates from general practitioners, i.e. less than 10% from the hospital setting. This amazing fact stimulated us to organise an inquiry about PMS in Belgian hospitals.

We conducted a comparative study using Drugdex ~ on CD-ROM along with the Vidal;

An inquiry-form was designed and sent to 50 randomised pharmacists (out of 368) and all university hospital-pharmacists (7) in order to obtain information on existing reporting-systems or to find out why no system had been developed. The results pointed out that the PMS is as good as non-existent in Belgian hospitals (even in the academic ones). In the opinion of the majority of the contacted pharmacists, PMS is important but they had never thought of introducing a system in their own hospital. At the moment, four hospitals are developing a reporting-system but hopefully more will follow this example in the near future.

1. M. Heyndrickx, Thesis: Health Care Sciences; Geneesmiddelenbewaking~stand van zaken in Belgie anno (1992); V.U.B. Brussels.

dictionary. All the drugs and the related trade names found in the French source but not in the American were retrieved: 258 were found, among which 48 ranked in the top 500 most sold drugs. Only 3 of the 258 missing drugs seem to be of possible therapeutic relevance (Fotemustine, Gadoterate, Vinorelbine). When combining the search with the Martindale data of the same Micromedex CD-ROM update, only 7 of the former z~8 remained unfuund, Aceprometazine remaining the only one among the top 100. Therefore using the Drugdex database appears to be an efficient method to find information related to the therapeutic use of drugs in France.

1. Drugdex, Micromedex Inc., Denver, CO, USA. (CD-ROM expiring 30th November 1992).

BGeneral Hospital Middelheim, B-2020 Antwerp, Belgium.

2. Dictionnaire Vidal 1992, ~ditions OVP, Paris, France.

:Academic Hospital V.U.B., B-1090 Brussels, Belgium. Pharmacie Centrale, Centre R~gional d'information sur le Medicament, 1 rue Henri Le Guilloux, 35033 Rennes Cedex, France.

D] 6

Pharmacy Itbrld & &icm~"

DRUG INFORMATION TO IMPROVE P A T I E N T ' S CARE

H._KreckelJ ~D~3u

DRUG INFORMATION STUDIES IN EUROPE M arie-E._M aguire_&P~ E.5)2Arc~

ZkL&_U~Pzokosctd

In February 1992 we started a unit-dose drug distribution system in two satellite pharmacies with the intention to improve patients' care by all means of Clinical Pharmacy. Drug information is one of the components. In cooperation with the Department of Medical Informatics we developed a computer system (SPHINX - Satellite Pharmacy Mangagement and INformation System on UniX). First task to solve was to handle the follow up of patients' medication charts. We enter all prescriptions in SPHINX and print out charts for the use on the ward.

A study of 31 drug information centres in 16 European countries ~ has been extended to include a further 8 countries - Bulgaria, Czech and Slovak: Federative Republic, the former German Democratic Republic, Hungary, Poland, Romania, Slovenia (Yugoslavia) and Turkey. A standard questionnaire in four languages, English, French, German and Italian was mailed to g countries. Centres were catalogued from information provided by the

SPHINX allows all kinds of statistical use (i.e. asking about the quantity of the use of

World Health Organisation, Frdrration International Pharmaceutique, National

specified drugs, the amount of antibiotics used on the wards or used in patients with defined diseases, combining diagnosis with the use of drugs).

Pharmaceutical Associations and European Society of Clinical Pharmacy Membership

To improve the administration of drugs by the nurses we print out lists (i.e. heparin administration, i.v. admixtures) and inform them about the correct time of administration (in the morning, at noon, in the evening, at bedtime - drugs to be taken before, with, after the meal) by comments marked on the medication chart.

Six countries replied and 4 countries (6 centres) agreed to take part. Two centres in

List.

Poland were visited personally. Replies are awaited from Bulgaria and Turkey. Location, staff, drug information services and procedures are listed.

Patients' laboratory data are available by on-line data access to the clinical laboratory. The data are used for our aminoglycoside drug monitoring programme. It is planed to

I.M.E. Maguire & P.F. D'Arcy, Present drug information services in Europe

establish a computerized detection system for drug interactions using laboratory tests

including 'The two pharmacists of Verona'. International Pharmacy Journal, 4,

(i.e. drug levels) and laboratory test abnormalties (i.e. as elevated serum potassium, creatinine levels) to produce warnings on the screen which will inform the pharmacist to take care of the problem in order to prevent adverse drug reactions. In the future SPHINX will be used to check patients' medication charts for known allergies (drugs, preservatives in drugs) based on a data link to "Rote Liste", a commercially available drug information base provided by the pharmaceutical industry.

(1990), 49-56.

The School of Pharmacy, The Queen's University of Belfast, 97 Lisburu Road, Belfast, BT9 7BL, Northern Ireland.

IDepartment of Pharmacy, 2Department of Medical Informatics, Justus-LiebigUniversity, Schubortstr. 87-89, D (W) 6300 Giessen, Germany.

DIFFERENT DRUG KNOWLEDGE AMONG ASTHMATICS DEPENDS ON CATEGORY OF TREATING PHYSICIAN - A QUESTION OF DRUG INFORMATION?

S A F E T Y OF D R U G S IN P R E G N A N C Y - T H E D O C T O R ' S DILEMMA'?. S ~ e p ~

G.L55P~S,SjSbergL&J. Struwe~ Asthma is a chronic disease with often life-long treatment with several types of drugs. It is of great importance that patients with asthma take their drugs correctly in order to prevent acute asthma attacks. One condition for good compliance is that the patient is well informed about the disease and the drugs to be taken. We performed a study to investigate if there are any differences in drug knowledge among patients depending on the kind of physician treating their asthma. In our study we looked at patients treated by four different categories of physicians - General Practitioners (GP), private practising physicians or company physicians, paediatricians and specialists in pulmonary diseases. Method: 50 patients treated by either GPs, private practising physicians or company physicians, paediatricians and specialists in pulmonary diseases were recruited in the study. The patients were included during a 6 week period in all the pharmacies in Eskilstuna at the time they presented a prescription for an anti-asthmatic drug. They were asked to complete a questionnaire in the pharmacy while waiting for their medicines. If they wanted to complete the questionnaire at h.ome and send it to the pharmacy, they could do so. The response rate to the questionnaire was good, between 70%-94% for the four different categories of physicians. Results: When comparing drug knowledge among patients treated by the four different categories of physicians, there was a remarkable difference. Patients having a paediatrician or a specialist physician managing their asthma, know much more about the effect, side effects and how to use their drugs in an appropriate way, than the patients having the other categories of physicians. The difference in drug knowledge among the patients is mainly explained by the different way physicians work. Paediatricians and specialists probably spend more time informing the patient about the disease and the treatment of the disease. Most of the patients also get further information from a specially trained nurse in connection with their visit to the doctor. Conclusion: Patients with asthma having a paediatrician or a specialist physician managing their disease know more about their drugs and how to use them than patients having a GP or a private practising physician. We believe that the differences are mainly explained by differences in the physicians verbal information to the patient. A lot of patients with asthma need more information about their disease and the drugs they have to take in order to optimize the treatment. The pharmacist plays an important role in increasing the knowledge of drugs and their administration. Drug information should be uniform and given by both physician, pharmacist and nurse in order to obtain a well informed patient, which is the most important requirement for a successful pharmacntberapy. tHospital Pharmacy, ZDepartment of Paediatrics, ~Department of Pulmonary Diseases, Miilarhospital, S-631 88 Eskilstuna, Sweden.

Recent surveys in the USA and UK have indicated that 35-95% of all pregnant patients will take some form of medication during their confinement. On average each patient receives 4 or 5 different preparations, most commonly dietary supplements, antacids, antiemetics or analgesics. The decision to prescribe, dispense or consume any preparation during pregnancy must be made after careful consideration of all the available evidence and evaluation of the risk to benefit ratio. The role of the pharmaceutical company must therefore be to provide honest and frank information on the safety of its compounds when taken by pregnant patients. To do this it is necessary to collect information on animal data, possible adverse effects and details of normal, healthy pregnancies. This information must be readily available to licensing authorities and prescribers alike and should be current and regularly updated. In order to facilitate this data collection and distribution, SmithKline Beecham have developed the Safety in Pregnancy Electronic Register Method (S.P.E.R.M.) - a computerised database to hold as complete a record as possible of the use of all SmithKline Beecham products in pregnancy. The in-built tracking system prompts the operator to follow-up reports in a timely manner and the database can be interrogated in a number of ways to provide a variety of reports for internal and external personnel. A response rate of approximately 60% is achieved, providing an expanding collection of information which has received favourable comments from health professionals across the country. With the introduction of CIOMS II reports (Council for International Organisations of Medical Sciences), it will be necessary for all pharmaceutical companies to furnish data on use of its drugs in pregnancy. It will become increasingly important for similar systems to be put in place in order to provide prescribers with better information and to enable them to resolve "The Doctors Dilemma" by considering the available evidence and not basing their decision on supposition or ~gut feeling".

Product Safety, SmithKline Beecham Pharmaceuticals UK, Mundells, Welyn Garden City, Herts, AL7 IEY, England.

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D1 7

DRUGS IN THE PUERPERIUM: INFORMATION FOR THE MATERNITY

EVALUATION OF THE THERAPEUTIC FORMULARY

NURSE

IN A UNIVERSITY HOSPITAL IN FRANCE

G.H.~ReuYcrs.L~.A. van~dcr~Stali~n& L.T.W. de J o t l g : x a t i _ ~ g Pharmacists play an important role in informing and educating patients as well as medical professionals, including maternity nurses, about drugs. During a drug utilization study in pregnancy it became evident that maternity nurses had questions about drugs. This formed the start of our research project, which finally resulted in the booklet "Drugs in the puerperium". In making this booklet we passed through the following phases: an exploration, a revision, a pretest and an evaluation. During the exploration phase we studied the target group, their need for new drug Information, what kind of information they are interested in and the way they prefer to receive the information. Firstly, we talked with people working for an organization involved with maternity care, the ~Provinciale Grordnger Vernniging Het Groene Kruis'. Secondly, we sent a questionnaire to all maternity nurses working for this organization (n=250); 42% responded. Thirdly, we interviewed ten of the nurses and f'mally four teachers. We found that 85% of the maternity nurse* thought it was necessary to make new information material. They preferred written information (76%) above other possibilities like continuing education (24%) or a lecture (4%). Most of them indicated that they would like to have a reference book. Regarding the contents they were interested in information about drugs frequently used in the puerparium, such as oral contraceptives, vitamin K, antibiotics, lactation inhibiturs and homeopathic medicines. They were especially interested in drug use during lactation and possible risks for the infant, adverse effects and alteruitives for drug use. With these results we decided to write information material with the aim to develop a reference book about frequently used medicines in the puerperium, which maternity nurses can use for looking up questions they might be asked in practice. For a revision of the first concept of our booklet we put together a group of seven professionals, including two midwifes, two chief-maternity nurses, a teacher and two Information counselors. We asked them whether the information was correct and practical and whether the style and structure of the text was suitable. This resulted in additional information and another sequence of the different themes in our booklet. Next we organized a pretest with five maternity nurses. We asked their opinion about the comprehensibility of the text, the illustrations, the lay--out, the completeness of the information etc. It turned out that they were largely satisfied with the booklet.. Soon the booklet will be offered to all maternity nurses in the district of Gruningen. After one year an evalnatioh has to be carried out to check whether the aim of this booklet has been reached.

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S.~?.iavelLC. ~ g n a a d !

The Saint Antoine Hospital pharmacy has produced a therapeutic formulary in keeping with the logical development of a communication strategy directed towards medical prescribers. The object of such a formulary is to answer a clinical service necessity: so, all the available medicinal forms can be listed and prescriptions out of the handbook can be reoriented toward available therapies. It allows one to know exhaustively all the available medicinal forms and so, guides the prescribing towards available products; it informs the prescribers about the cost of different treatments, and finally gives technical or administrative indicatiom. For a second time, the assessment of this formulary has started in the clinical services in order to appreeitate its impact. A questionnaire has been prepared by the pharmacy, and addressed to all physicians. The questions aim at determining the real use of this formulary and especially its part in the decision-making of therapeutic prescriptions. Any critical comments about the form and substance were requested in order to amesa what will need to be changed. The open form of the quer'innnaire will allow the interviewed to explain their choice and suggest modifications. Thanks to the results obtained from the statistical study, the next edition of this formulary will be perfected for its next printing.

tDepartment of Pharmcy, Saint Antoine Hospital, 184 rue du Faubourg, Saint Antoine, 75571 Paris, France. ZDepartment of Documentation, Pharmacie Centrale de Htpitaux, 7 rue du Fer ~t Moulin BP 09, 75221 Paris, France.

Department of Pharmacology and Pharmacotherapeutics, Section Social Pharmacy. University of Groningen Ant Deusinglaan 2, 9713 AW Groningen, The Netherlands.

A LOW COST, HIGH SPEED. ON-LINE COMMUNICATION LINK BETWEEN THE OXFORD REGIONAL DRUG INFORMATION UNIT AND A REMOTE DISTRICT DRUG INFORMATION UNIT

~1A2.

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"

DATAEASE, A DATABASE PROGRAM USEFUL IN A DRUG INFORMATION CENTRE

E..3Eomqv~t,.H. LyrvaJ.L&.B.Ohmma

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AIM: To establish a reliable, low cost, high speed, two-way communication link, over 50 kilometrus in distance, between a microcomputer in the West Berkshire District Drug Information Unit (DIU) and the local area network (LAN) situated in the Regional DIU using the region-wide X25 network installed in the Oxford Region as part of the Department of Health communication initiative,

The Drug Research and Information Centre (I)RIC) was established in 1974 at the Department of Clinical Pharmacology, Huddinge University Hospital. Since that time, the total number of documented questions has accumulated and now reaches almost 9,000.

METHODS: Asynchronous serial connections at 19,200 baud were established between a dedicated microcomputer on the Regional DIU LAN and the X25 network at the John Radcliffe Hospital and between a microcomputer in West Berkshire District DIU and the X25 network at the Royal Berkshire Hospital. Carbon Copy, a remote access communication software package was installed on both the district and regional microcomputers connected to the X25 network. The regional microcomputer was set up as the host and the district microcomputer as the remote user.

The daily work has created a need for registration of the questions. Towards the end

RESULTS/BENEFITS: Activation of the Carbon Copy software on the district microcomputer enables the district microcomputer to remotely control the regional microcomputer and performs as though it is a node on the regional LAN. This provides a reliable, fast and elegant, low cost communication connection, without incurring the high costs and inconvenience of modems and telephone charges. In addition, this link allows interactive access and file transfer and enables immediate on-line access to regional databases, thus preventing duplication of effort and maximising available expertise.

needs was also created.

JOxford Regional Drug Information Unit, John Radcliffe Hospital, Oxford, OX3 9DU, England. zWest Berkshire District Drug Information Unit, Royal Berkshire Hospital, Reading, RGI 5AN, England.

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of the 1980s, we considered replacing the manual register being used at that time with a computerised system. After a review of available database programs, we decided to use Dataease software. A relational-database was developed for registration of information concerning the questions and answers handled in the DRIC. A data-conection form suitable for our

We use the program for statistics, e.g. type and origin of question, drugs involved and people responsible for the answer. The Dataease program is also used to study material collected from questionnaires in connection with research projects. We have found that Dataease is a useful and comprehensive database program which fulfils all of the requirements for registration and revision of the data concerning the questions and answers handled in the DRIC.

Drug Research and Information Centre (DRIC), Department of Clinical Pharmacology, Huddinge University Hospital, 141 86 Huddinge, Sweden.

I)harm,IQ, I I'odd U~S~hmv

MONITORING D R U G U S E IN P R E G N A N C Y : A COMPANY APPROACH T~__W~te

Drugs should be used with caution in pregnancy, weighing up the possible risks against the potential benefits. At the time of the launch of a new drug, however, very little can be known about the possible risks to the human foetus. Janasen Pharmaceutical have implemented a system for the monitoring and collection of data relating to the use of the company's drugs during pregnancy. Analysis of these data enables the provision of an increasing amount of information to the health professional and ultimately to the patient. The design of our system should be of imerest to all pharmacists involved in the data processing or enquiries relating to drug use in pregnancy.

Medical Information Department, Janssun Pharmaceutical Ltd, Grove, Wantage, Oxon. OX12 0DQ, England.

I Jhnrmat y I k'orld ~ Science

Volume15 Nr. 3 1993

91 9