E L E C T R O N I C A L L Y PRODUCED P A T I E N T I N F O R M A T I O N LEAFLETS Peura Sirpa

In Finland, more than 300 out of 550 pharmacies are using a computer-based drug information system, ELLI. The system is integrated with the software program which the pharmacies use to process prescriptions during dispensing. The ELLI system generates leaflets, which include information of the effects, adverse effects and the proper use of the medicine.

Abstracts

ELLI was developed by the Pharmaceutical Information Centre in i990. The database covers most prescription drugs available in Finland and is continuously updated. ELLI is also available for physicians" desk reference programs and as a separate PC version.

of

The instructions have been written by a group of physicians and reviewed by an

Oral Presentations

The text consists of sections which may be common for several drugs or drug

advisory panel consisting of experts in medicine and pharmacy. As Finland has two official languages, the text may be printed either in Finnish or Swedish.

presentations. For instance, all bets-blocking agents share the same text on adverse reactions and all enteric-coated tablets and capsules are advised to swallow whole. The electronically produced patient information leaflets have several advantages compared with the conventional printed material. The leaflets are easy and quick to produce and they need no storage space. The information i s updated frequently. Patients have been content with the system and the leaflets has been judged to be easy to read and understand. According to the recent study, the ELLI leaflets can be a remarkable aid in increasing the patients' knowledge of their medicationL

1. S. Peura, T. Klaukka, A-M. Hannula, S. Eerik~iinen. information leaflets increase patients' understanding International Journal of Pharmacy Practice (in press).

Electronically produced about antibiotics. The

Social Insurance Institution, P.O. Box 78, 00381 Helsinki, Finland.

P H A R M A C I S T I N V O L V E M E N T IN P A T I E N T D R U G I N F O R M A T I O N ~ o ] ~ h ~

ASSESSING ELDERLY PATIENTS KNOWLEDGE OF THEIR M E D I C A T I O N S A N D I D E N T I F Y I N G S T R A T E G I E S FOR I N T E R V E N T I O N

Dot P. Brnring J.A_ Coorrlbe,S ~ R. Home

In 1988 a group of 170 Dutch community pharmacists, all users of a Pharmacom computerized pharmacy automation system, expressed their feelings about the needs of adequate written patient information by writing leaflets in lay language for all products that could be handed over at the counter. At that time only 50% of the delivered medicines contained a patient package insert (PPI) of industrial origin. Additional leaflets, brochures or photocopies were available for 20%. In 1992 this has been greatly improved and most industries did put great effort in designing PPIs. However, we still think that our patient-information-leaflets have advantages. The key,word is "individualisation". It is possible to generate drug information during filling prescriptions that is directly related to individual circumstances. Individualized "blocks" of information are printed for instructions and warnings related to concomitant use of interacting drugs. It is possible to give individualized information in cases of double medication (about risks of simultaneous ~ of drugs belonging to the same pharmacotherapeutic class) and in cases of a different daily dosage as compared with the previous delivery of the same drug. In the near future the texts will be individualized according to age and gender and it will be possible to generate leaflets in different languages. In our belief, this all means only an small step in the right direction. Informing the patient, in a way he/she is fully aware of benefits and risks of medication and is likely to act according to the directions of use, needs more than handing out a leaflet. Patient counselling by the pharmacist as well as the physician reinforces written information. Pharmacists and physicians (and their assistants) should cooperate in providing the patient with like-worded information. They should also create an atmosphere in which patient counselling is being asked for by the patient.

There is strong evidence that patients require more information about medications t. Knowledge about medications is thought to facilitate safe and appropriate use of medicine and improve adherence 2. Medication knowledge was assessed during hospital stay and two weeks post discharge using a questionnaire, designed and piloted for use in this study. Sixty-four patients were interviewed on the 'Care of the Elderly Unit' and thirty-eight were followed up in their homes. Knowledge about dosing frequency was good, but there were major deficits in knowledge about indication, length of treatment, side effects, and drug name in all groups. Comparison of the thirty-eight patients before and after discharge showed that a stay in hospital did not improve patients knowledge of medication. These results were used to draw up a check list for pharmaceutical care including giving patients individualised information about their medications.

1. S. Gibbs, W.E. Waters & C.F. George, Communicating information to patients about medicine, Journal of the Royal Society of Medicine, 83 (1990) 292-297. 2. P. Ley, Satisfaction, compliance and communication, British Journal of Clinical Psychology, 21 (1982) 241-254.

John Harris Clinical Pharmacy Unit, Brighton Health Care and University of Brighton, c/o Pharmacy Department, Brighton General Hospital, Elm Grove, Brighton BN2 3EW, England.

Health Base Foundation, Van Eedenstraat 7, 2012 EL Haarlem, The Netherlands.

Ph,Jnna,), I I bdd L:" S~irm'~" Volum e 15 N r ] 199]

D7

P A T I E N T E D U C A T I O N IN COMMUNITY PHARMACIES Ah_G~lom,~,~Ba kket_&2,~onkem

Starting in January 1993 all drugs marketed in Europe must have detailed written product information on either a user leaflet or the drug packaging. As several studies raise serious concern about patients' understanding of written drug information, verbally given information is needed to explain the standardized written drug information. In order to analyse the frequency and contents of the currently given verbal drug information, we collected 200 hours of audiotaped patient contacts in 20 Dutch community pharmacies. The results revealed that in 34.9% of the observed prescription drugs deliveries (n=3662) and in 30.3% of the observed OTC-deliveries (n=773) verbal drug information was given to the patient. This information consisted mainly of drug dosage instructions (prescription drugs) and product advice (OTC's), while 75% of the delivered drug information was given without patients' questioning. The observed one-way communication with patients in these pharmacies limits the possibilities to prevent medication errors which are based upon patients' misunderstanding of written drug information. Pharmacists therefore should stimulate a two-side directed communication by inviting patients explicitly to ask their drug related questions about drug labels and leaflets in the pharmacy.

Department of Pharmaco-epidemiology, Faculty of Pharmacy, Utrecht University, PO Box 80082, 3508 TB Utrecht, The Netherlands.

GENERAL PRACTITIONERS" PRESENT AND FUTURE USE OF ACTIVE DRUG INFORMATION SERVICES P~q...Adamst_ D.K. Ltt~eoJl.abez& F.I. Wctod~ Surveys of the utilization of Drug Information (DI) publications by General Practitioners (GPs) have previously been carried out in England t,2. Currently the Welsh DI service provides active information to GPs in the form of bulletins that are published periodically. The aim of the present investigation was to determine whether GPs received and utilised this active information and to obtain views on their active drug information requirements. Furthermore, information was sought on how GPs envisaged their DI needs will change in the future. tn order to gather this information a questionnaire survey of all GPs in Clwyd Family Health Service Authority was undertaken. A total of 223 questionnaires were despatched and the response rate was 75%. It was found that only 55% of respondents could recall having received a bulletin from the DI Centre, however, 95% of these GPs found the bulletins to be of interest. Diabetes and warfarin bulletins had both been received by 36% of GPs, whilst 78% had received a head lice publication. Disappointingly, only 43% of GPs who had received a bulletin associated it with the Welsh DI Service. When asked about future publications, the majority (73%) of respondents wanted information to be presented in a newsletter format, the preference being for short, concise publications. Forty percent of GPs responding expressed a wish to recieve DI publications quarterly. The most popular subjects requested for inelozion in any future DI publications were the cardiovascular system (45%) and skin (32%). Twenty-one percent of the GPs surveyed envisaged their DI requirements changing over the ensuing 18 months, with particular emphasis being placed upon matters relating to costs. The study revealed that present active D[ services such as bulletins are well received by GPs, however, it appears that the distribution and presentation of the information could be improved. The results of the study will allow future developments in the provision of active information to be more closely tailored to the changing requirements of GPs in Wales. 1. H. Liddell, General practitioners" awareness and use of drug information sources, Pharmaceutical Journal, 244 (1990) 761-763. 2. C.R. Proudlove, LC.. Smith & A.M. Breckenriclge, Medical awareness and usage of a regional drug information service, Pharmaceutical Journal, 230 (1983) 394-396. tWelsh Drug Information Centre, University Hospital of Wales, Heath Park, Cardiff CF4 4XW, Wales, UK. 2Medicines Research Unit, Welsh School of Pharmacy, University of Wales, Cardiff, CFI 3XF, Wales, UK.

T H E R O L E OF C O M M U N I T Y P H A R M A C I E S IN D R U G I N F O R M A T I O N T O HEALTH PERSONNEL

SUPPORT OF DUTCH PHARMACISTS BY PHAKMA SELECTA LW. Foppe van Mil_

The Dutch governement has been looking for a means to influence prescribing Drug information towards doctors is dominated by the pharmaceutical industry. The Norwegian Health Authorities want to strengthen information from other sources to obtain a rational use of drugs. As a consequence of the Norwegian approach to the EEC, the number of registered pharmaceutical specialities will increase. At the same time the marketing of drugs may become more aggressive. The need for information about new drugs and drug therapy will increase. The Health Authorities outline a drug information network based on three levels: 1) Norwegian Medicines Control Authority, University Institutes, etc.

doctors. A system of regular pharrnacotherapeutic consultation has recently been organised, called the Farmaco Therapeutiseh Overleg (FRO). Groups of general practitioners meet with retail pharmacists to discum rational pharmacotherapy, ususslly every 8 weeks. Dutch pharmacist also give more and more information about medicines to the patient. In both cases they need sources to turn to for their pharmacotherapeutic information. A Drug Bulletin and a literature database were developed for this purpose by a independent foundation of pharmacists, called Pharma Selecta. In this lecture the development of the database will be described.

2) Regional Drug Information Centres 3) Local Primary Health Care and local pharmacies The local level is important in improving the quality of drug prescribing and patient care. The community pharmacies could play a role in drug information to other health care professionals, placing drug therapy on the agenda, pass on experience and questions from the local level to higher levels, ensure appropriate prescribing at the primary care and secondary care interface.

Items like purpose, history, choice of sources, the structure and the recent developments in the marketing of the database will be discussed. A sample of the database will be presented for demonstration.

Zuidlaarder Apotheek, Kerkstraat 2, 9471 GB Zuidlaren, The Netherlands.

The Norwegian Association of Proprietor Pharmacists for this reason have discussed the role of our association and the pharmacies in a drug information network. A report concludes: the pharmacies should be involved in drug committees and other local joint activities. disseminating information to the medical profession in meetings and office visits on new drugs and their role in therapy, initiating therapy decisions. developing prescription statistics as a valuable tool. establish two pilot projects to gather experience on this kind of work. The Norwegian Association of Proprietor Pharmacists, P.O. Box 5070, Majorstua, N-0301 Os/o, Norway.

D8

I~h,mmt,y l~,rlJ ~ S~ic,,r

A QUALITATIVE ASSESSMENT OF T H E AWARENESS OF, AND ATTITUDES TOWARDS, THE MERSEY REGION DRUG INFORMATION SERVICE AND ITS DRUG I N F O R M A T I O N LETTER

P R E D I S P O S I N G FACTORS FOR A D V E R S E D R U G R E A C T I O N S I D E N T I F Y I N G P A T I E N T S A T RISK

K.L ~Simiste tL_D,A.~'o r ke.L_& P ~ R o ~ 2

Melanie~nellingL Cheryl Smith~ & David_Luscombed

Introduction The Mersey Region Drug Information Service offers a wide range of services to primary and secondary health care professionals. The main publication produced by the Service is the bimonthly Drug Information Letter, which is intended to provide local advice and guidance on rational, safe, cost-effective prescribing to general practitioners and hospital doctors. Method As a preliminary exercise, a questionnaire was presented in face to face interview with a sample of 21 health care professionals in Mersey Region. It was intended to assess the impact of the Drug Information Letter in terms of influencing prescribing, education and problem solving compared to several national bulletins. The visual impact was also assessed. The questionnaire was modified slightly after the initial survey and then posted to 452 health care professionals within the Mersey Region. Results 91 out of 452 questionnaires were returned. Awareness of the Drug Information Service is mixed, with those professionals working in the primary care sector using it less than those in hospital. The Drug Information Letter is well-known, with 75% of respondents claiming to receive and read it. It is regarded as a useful source of reference and an educational tool, particularly by pharmacists. In the United Kingdom many doctors receive the Drug and Therapeutics Bulletin and this scored slightly higher than the Drug Information Letter amongst general practitioners. Visual impact of the Drug Information Letter is perceived as poor. Conclusion Local, independently produced bulletins are perceived as having a role to play in influencing prescribing. The quality of the information produced by the Service is rated highly but the visual impact of the bulletins is poor, due to limited resources. Steps are being taken to resolve this.

A I M S : To identify and validate patient oriented risk factors for developing adverse drug reactions (ADRs) and to develop an arbitrary system for scoring patients degree of risk. M E T H O D : Using predetermined criteria, risk factors for ADRs were identified from published studies investigating the characteristics of patients reported to have experienced ADRs. An arbitrary weighted scoring system was developed based on eight identified risk factors. A maximum score of 11 was possible. Using data collected from medical records, scores were determined for 47 patients reported to the Oxford ADR Monitoring Scheme and 243 patients not reported. Mean scores for each group were compared and odds ratios were calculated for each risk factor. R E S U L T S : There was a significant difference between scores for ADR patients vemus non-ADR patients (4.46 vs 3.44, p=0.0006). Odds ratios were greater than one for all risk factors except age <70 years. C O N C L U S I O N S A N D F U T U R E W O R K : Risk factors for ADRs have been identified and validated. A more useful system for quantifying risk than arbitrary scoring is needed. A more accurate formula using multiple regression analysis is currently being developed.

IOxford Regional Drug Information Unit, JobJ't Radcliffe Hospital, Oxford, OX3 9DU, England.

~Principal Pharmacist (Drug Information), Mersey Regional Health Authority, Hamilton House, 24 Pall Mall, Liverpool, L3 6AL, England. "-Senior Lecturer, School of Management, University of Manchester, Institute of Science and Technology, Sackville Street, Manchester M60 1QD, England. ~Pharmaceutical Adviser, Mersey Regional Health Authority, Hamilton House, 24 Pall Mall, Liverpool, L3 6AL, England.

D E V E L O P M E N T AND U S E O F T H E " G R O N I N G E R F O R M U L A R I U M "

zClinical Pharmacy Dept, University of Wales College of Cardiff, Cardiff, CFI 3XF, Wales.

C U S T O M E R A P P L I C A T I O N S O F T H E E M S C O P E S SERVICES

I.W. Timm~ AnnetteA-lerholdt In the region of Groningen, a Province in the Northern part of The Netherlands, a drug-formulary has been in use since 1991. The formulary is principally meant for

More and more information services today require customised information in order to

general practitioners (GPs), pharmacists and specialists in the Groningen area. The

meet user needs more accurately and in a more timely manner. The Excerpta Medics

basis for this formulary is laid by a local formulary from a health-care centre with

SDI Service (Selective Dissemination of Information), one of several EMSCOPES

regular consultation between pharmacists and GPs. The development from a local to a

Services, offers customers several different products, tailored in many different ways

regional formulary will be described.

to meet customer-specific needs. The various manifestations of these products are used

Recently a survey was held among GPs in the area, and the results show that the

in many different, often unique, ways by the purchasing information services. The

formulary is accepted as a resource for daily prescribing. Half of the GPs consult the

paper groups these into broad types, and discusses individual examples for each.

booklet more than once a week and 80% of them use it for the choice of drugs.

Advantages and disadvantages for each are given, and further practical applications

The use of the formulary is stimulated by discu~ing it in local pharmacotherapy

and uses for data received via these products are described.

consultation groups of GPs and pharmacists. However, a discussion of the formulary in this way is not a necessary condition for frequent use. A considerable number of

Excerpts Medics, 9 Astor Close, Kingston, Surrey KT2 7LT, England.

GPs use it frequently, but do not discuss it in their pharmacotherapy consultation. Neither is influence on the contents a necessary condition for frequent use and, accordingly, for acceptance of the formulary. Another way to stimulate the use of it is by putting relevant practical information about a drug in the formulary, like dosage, relevant side effects etc. This information must be carefully selected on the importance for treatment of the patient~

Apotheek Lewenborg, Kombuis 173, 9732 GK Groningen, The Netherlands.

Volume 15 N r 3 1993

D9

INVENTORY 1993 OF THE EUROPEAN PHARMACEUTICAL PERIODICALS

A U D I T OF T H E SPECIALIST F I L E ON D R U G S IN L I V E R D I S E A S E M.J. Daly t, H. Baxter ~ &_R. SwaUo3e2

P~Bado~rLA._P_icardL~P~Belbenoit2+F. LocheOrLL&~I_Grossct-g3range2 Pharmaceutical periodicals represent one of the most important ways of pharmaceutical information provision. In order to know better this irreplaceable way of information, we made an inventory of the 1993 current pharmaceutical periodicals regularly published at least twice a year within geographic Europe. These periodicals publish papers intended to help, inform and train pharmacists working in community, industry hospitals or research; those exclusively dealing with homoeopathy cosmetology, toxicology or pharmacognosy were excluded. Our methodology led us to consult many information sources; the Ulrich's International Periodical Directory 1990, the Serial Directory EBSCO 1991, the database Serline from NLM (National Library of Medicine), the French Collective Directory (CCN), the lists of the American Society of Hospital Pharmacy and the international subscription office Dawson. The lists of international bibliographic systems such as Index Medicus, Biological Abstracts, Chemical Abstracts, Excerpta Medica, International Pharmaceutical Abstracts, Current Contents were also consulted. Moreover, letters were mailed to many European Drug Information Centres in order to have information about the periodicals to which they subscribed. Our survey was supplemented by mailing a questionnaire to the editors. Then, we made a database on a Macintosh computer with the software 4e Dimension. The results are as follows: 1) 314 periodicals from 29 countries were found 2) 135 scientific, 39 professional, 64 scientific and professional periodicals 3) periodicals are mainly published in the United Kingdom (61), France (60), Germany (44) 4) the distribution level is international (126), national (109) 5) the main languages are English (163), French (66), German (39) 6) the frequency is weekly (9), bi-weekly (6), monthly (86), bi-monthly (74), quarterly (87). Otherwise, the 30 independent bulletins were specially studied. At the end of the work which was as exhaustive as possible, a database makes it possible to have an overview of the characteristics of the European pharmaceutical periodicals. JCentre de Documentation Pharmaceutique, ISPB-Facult6 de Pharmacie, 8 avenue Rockefeller, F69373 Lyon Cedex 08, France; Tel: (33) 78-77-70-66; Fax: (33)7877-71-58. 2Biblioth~que Univershaire section sant~, 8 avenue Rockefeller, F69373 Lyon Cedex 08, France. ~Centre d'Information et de Documentation Pharmaceutiques, Pharmacie Centrale des Hospices Civiis de Lyon, 57 rue Francisque Darcieux, F69561 Saint-Genis, Laval Cedex, France.

UNLICENSED DRUGS: E V A L U A T I O N ON A PATIENT BASIS IN A DRUG INFORMATION CENTRE

Auditing of services is becoming an integral part of pharmacy practice, and we report here some results of an audit of the specialist file on drug use in liver disease. METHOD The service has been available since August 1987, and has answered over 60C enquiries. Statistical data, to December 1992, is presented in table I. A total of 136 audit questionnaires have been sent to enquirers since 1/1/91, requesting further information, with a 100% response rate. RESULTS ENQUIRER %

ORIGIN

%

CATEGORY

Consultant

11.5

Base hospital

24.5

Admin/dose

Junior Dr.

6.0

Yorkshire

Nurse

2.2

Pharmacists: SL James's

8.2

Other

71.8

In Spain, the National Drug Information Centre (DIC) is located in the General Directorate of Pharmacy of the Ministry of Health. In addition to the usual activities of a DIC, this dependence implies other tasks such as the evaluation of foreign drugs for a specific patient.

9.5

6.6

Adverse effect

15.6

London

12.8

Therapy choice

56.4

Other England

43.2

Interactions

Wales

10.4

Pharmacology

11.5

Other

11.5

Scotland

1.7

N. Ireland

0.4

TABLE

1

-

2.4

Enquiry Statistics (n=615)

The audit data indicates that 88% of respondents found the service 'helpful', and 79~ were satisfied with response times. However, 58% could not provide extra clinica data due to the loss of patients to follow-up or lack of access to the clinical team There have been several practical benefits associated with this audit, such as revisec enquiry answering procedures and specific research conducted for enquiries wit} apparently unsatisfactory responses. As a result, auditing is now carried out routineI) for all enquiries received.

1Drug Information Centre and zPharmacy Department, St. James's Hospital, Leeds LS9 7TF, England.

BIBLIOGRAPHIC RETRIEVAL ON ADVERSE DRUG REACTIONS AND QUALITY CONTROL FOR THE CONTENT OF A FRENCH DATABASE N. T a g g i a s c ~ o n

E ~ C o ~ , T. Cussta~ P. F e ~

%

& C. D~rgau

INTRODUCTION - The results of a bibliographic retrieval using a database depends on the searching method and quality of information included (choice of indexing articles, use of thesaurus, use of guidelines for contributors)l-~. We evaluated the content of our bibliographic database BIBLIOGRAPHIF to prepare a leaflet which listed adverse drug reaction (ADR) case reports published in the literature in 1991. AIM - Assess the good use of a keywurd term: "NOTIFICATION SPONTANEE ~ (SPONTANEOUS NOTIFICATION) which was added to the thesaurus at the beginning of 1991. The use of this term allows us to index articles describing an ADR case report and not general or review papers on adverse effects. DESCRIPTION OF THE DATABASE BIBLIOGRAPHIF Created in 1985 by APHIF (Association des Pharmaciens d'Ile de France), at this present time this database includes more than 20,000 article references selected from 62 medical or pharmaceutical journals (50% in French). LLsr Health professionals (pharmacists, physicians, students...) ~zmten~: references and indexing of articles on therapeutic use, drug overdose, drug monitoring, pharmaceuties, hygiene, medical devices, hospital pharmacy. Indexing: Each articles is described with 21 kcywords from a thesaurus of 6660 terms, Acce~: by videotex (Minitel) Seatching~tite,tia: articles are retrieved from author name, keyword terra, title of journal, year of publication linked with logical parameters (AND, OR, WITHOUT) C,~:mtributol'~ : One physician and one pharmacist in charge of the database with an indexing group of 20 people (scientific clerk, hospital pharmacist, physician). MATERIAL AND METHODS I) Selection of all references indexed in 1991 with the following kcywords: (Case OR Notification) AND Adverse drug reaction; 2) Re-reading of the original articles, and re-indexing of these selected references with a special form by contributors; 3) Exclusion of non relevant references dealing with drug overdose, interaction, adverse medical device reaction; 4) Correction of the mistakes in the database. RESULTS 286 references were selected, l was in twice, 43/45 had be excluded on account of misunderstanding of the precise meaning of ~Case" or "Notification" or "Adverse Effect~ terms by the contributors. On the 241 relevant references, 7 (5%) had a wrong indexing on the active substance or the adverse effect itself. CONCLUSION - This experience, focussed on the ADR ease reports published in 1991, allowed us to show the need of doing a quality control on the content of a bibliographic dahabase as BIBLIOGRAPHIF. -

The requests for importation of drugs evaluated by the DIC in 1992 are analysed. They are classified into one of the following categories: -

new drugs

- therapeutic lack -

unavailable dosage forms

The methodology of the evaluation is reviewed: information sources, verification of the indication in the country of origin, as well as the unavailability of a similar or alternative drug in Spain and the relevancy of the disease to be treated. The results of the evaluation are mentioned as refused, approved or reiterate applications.

-

CINIME, Ministry of Health, Paseo del Prado 18-20, 28071 Madrid, Spain.

1. J. Kleijnen & P. Knipschild, The comprehensiveness of Medline and Embase computer searches, Pharm Weekbl (Sci), 14 0992) 316-320. 2. C.E. Adams, C. Lefebvre & I. Chalmers, Difficulty with Medline searches for randomised controlled trials. Lancet, 340 (1992) 915-916. S.I.M.P. (Service d'Information M~dico-Pharmaceutique), Pharmacie Centrale, 7 rue du Fer ~i Moulin, 75005 Paris, France.

[~ ] 0

PhamhJCy IVorld & Ncir,tle

COST-EFFECTIVENESS OF A REGIONAL DRUG INFORMATION SERVICE

FROM E P I D E M I O L O G Y T O I N F O R M A T I O N - T H E D E V E L O P M E N T OF A P R O T O C O L FOR T H E T R E A T M E N T O F P O S T O P E R A T I V E PAIN

LA31ak~eL& B. Godraan~

~.~S croccaro.R.X)li~at o,_A.hdcssofi.hdLCasara_&2~.2dartini

Several studies t have demonstrated that the medical profession has responded

From the analysis of the consumption of analgesics in the surgery departments of the

positively to the availability of a drug information service. This has been corn"n-reed

Borgo Roma Hospital (a 900-bed university institution), different pharmacological

following analysis of various internal audits of the service. However, to date, few

approaches for the treatment of postoperative pain have been found. As a result, the

authors have specifically looked at the eust-effectiveness of such a service.

Drug Information Centre, in collaboration with the Therapeutic Committee, has

Over the past two years (December 1990 - December 1992) North West Thames

carried out an epidemiological study to evaluate the patterns of postoperative pain

Regional Drug Information Centre has 8,628 documented calls in our data base (60 -

treatment, both pharmacological and non-pharmacological, in relation to the type of

70% of all enquiries received). These have been condensed down into 20 categories

operation and the type of anaesthetic used, The information gained from this

(adverse effects, drug evaluation, pregnancy, reviews, etc). This represents some

epidemiologieal analysis showed the absence of any protocol regarding postoperative

400-500 enstomer contacts each month in addition to help with educational courses,

pain treatment. In particular, the following points were observed: a general tendency

etc. A scoring sys!em devised by Mike Spencer is currently being used to rate the

towards the use of " n e w " generation analgesics; an extensive use of pyrazolone

importance of some of the enquiries. At the same time, the potential for additional

derivatives; a limited use of non-pharmacological treatments; a poor attitude of some

health care resource consumption should the advice given not be followed is also

physicians to fully understand the importance of analgesic prescriptions. As a result

being explored in an attempt to start evaluating the cost-effectiveness of DI services.

the Drug Information Centre has decided:

Where possible, we are also trying to ascertain whether the advise was acted upon.

1. to distribute and discuss these results

The preliminary results will be presented at this meeting.

2. to establish a protocol of postoperative pain treatment in conjunction with a group

I. Cost-benefit and cost-effectiveness: Methodologies for evaluating innovative pharmaceutical services. American Journal of Hospital Pharmacy, 35 (1978) 133-40.

3. to publish this protocol in the Bulletin issued by the Pharmacy Drug Information

of surgeons, anesthetists and nurses

Centre

Borgo Roma Drug Information Centre (BR-DIC), Hospital Pharmacy Services, 37100 'Drug Information Centre, North West Thames Regional Health Authority, Northwick

Verona, Italy.

Park Hospital, Watford Road, Harrow, Middlesex, HA1 3UJ, England. :Health Economics, Medical Sciences Liaison (MSL) Division, Upjohn Limited, Fleming Way, Crawley, Sussex, RH 10 2LZ, England.

Q U A L I T Y A S S U R A N C E P R O G R A M M E BY C O M P U T E R O F T H E P A S S I V E I N F O R M A T I O N IN A D R U G I N F O R M A T I O N C E N T R E

DRUG I N F O R M A T I O N S U P P O R T FOR T E R M I N A L CARE

Colin Hardman Sara_Erias The Drug Information Centre of the Official Council of Pharmacists of Madrid have had 40,000 queries a year in the last years. We are three pharmacists working full-time and this number of queries makes us work too fast and we need a computer system and an internal file system to be able to recover fast information when the query is repeated. We created a computer system trying to do a quality assurance of our queries and answers. We work with five variables: 1) Who makes the query: Hospital Pharmacist, Community Pharmacist, Physician, etc. We have 9 different types. 2) What is the query about: we have 13 different types with several sub-types. 3) Who prepares the answer: We are three pharmacists. 4) How much time do we spend in answering: l:less that one hour, 2:less that 24 hours, 3:more than 24 hours. 5) How many books or computer systems we need to use. A: We use the most common books like Martindale, British National Formulary (BNF), Vidal, Rote Liste, Catfilogo del Consejo General, etc. B: We also need to use more specific books about: Side Effects, Pregnancy and Lactation, Internal Medicine, etc. C: We also need computer systems like: Medline, Iowa Drug Information Service (IDIS), Micromedex, etc. In all the above fields we are doing a statistical study making graphs with the Harvard Graphics System.

Symptom control in the care of patients with malignant disease has improved in recent years with the availability of published experience of practitioners both as textbooks and articles in the literature. Most patients will gain some degree of relief from their symptoms from standard, but often specific, approaches. Occasionally, it will be difficult to control a particular symptom and standard literature review systems in drug information have helped to locate articles which have provided extra methods. Examples which have proved useful are flecainide ~ for certain nerve-related pains, octreotide: for intractable vomiting due to small-bowel obstruction and haclofen or nifedipine for hiccup ~. These are unlicensed uses in the UK and the prescriber needs to be aware of this. The increasing use of continuous sub-cutaneous infusion techniques has also made available agents such as ondansetron 9 for vomiting and midazolam~ for restlessness. General articles on the use of this technique have also noted the use of sub-cutaneous dexamethasene for corticosteroid-responsive symptoms*. Each problem has been treated individually by standard drug information literature techniques and applied to the needs of that particular patient.

1. A.J. Dunlop, J.M. Hockley & T. Tate et. al., Flecainide in Cancer Nerve Pain, Lancet, 337 (1991) 1347. 2. D. Khoo, J. Riley & J. Waxman, Control of Emesis in Bowel Obstruction in Terminally Ill Patients, Lancet, 339 (I992) 375. 3. Anon, Intractable Hiccup: Baclofen and Nifedipine are Worth Trying, Drug and Therapeutics Bulletin, 28 (1990) 33. 4. P. Mulvenna & C. Regnard, Subcutaneous Ondansetron, Lancet, 339 (1992) 1059.

1. P. Golightly & N. Lopez, Quality Assurance in Drug Information, Proceedings of the First European Workshop on Drug Information, Paris, May 1991. 2. Quality Assurance Programmes for Drug Information Services, Drug Information Pharmacists Group ('O.K.) 1~' ed. (1990).

5. D.M. Bottomley & G. Hanks, Subcutaneous Midazolam Infusion in PaIliative Care, Journal of Pain and Symptom Management, 5 (1990) 259. 6. S.B. Dover, Syringe Driver in ternainal Care, British Medical Journal, 294 (1987) 553.

3. Normas de calidad en los Centrns de lnformacibn del Medicamento PAM, 14 (1990) 352-356. Centro de lnformacibn del Medicamento, Colegio Oficial de Farmac6uticos de Madrid, e]Santa Engracia N ~ 31,28010 Madrid, Spain.

Drug Information - Pharmacy Department, County Hospital, Sewell Road, Lincoln LN2 5QY, England.

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INFORMATION ABOUT SIDE EFFECTS OF DRUGS IN THERIAQUE, A FRENCH FULL-TEXT DATABASE M.C. Husson Since 1984, the French National Drug Information Centre CNIMH has developed a full-text drug database named Th~riaque. Seven modules have been progressively developed, and are now available to the users: 1) The Drug File (about 8000 drugs in total) 2) Drug Interactions 3) Physico-cheminal (in)-compatabilities 4) Contra-indications and precautions 5) Posologies 6) Indications 7) Side Effects The eighth module will deal with pharmaeokinetics. All the side effects linked to drug administration at the usual therapeutic dose, or in ease of overdosage, are described through several parameters: the nature of the side effect, belonging to a thesaurus organised into a hierarchy, the frequency, the circun~tances of it arising, and the management. Side effects are assigned to a pharmacological or a chemical class, or specifically to a drug. All this information is coded. Free texts including some details and bibliographic references are added to each information sheet. The validation includes the choice of the sources of information, the procedures for selecting and entering data, and the entered data. It has been provided by a groups of hospital pharmacists and by some French Pharmacovigilance centres. Centre National d'lnformation sur le M~dicament Hospitalier, CNIMH, 7 rue du Fer Moulin, 75005 Paris, France.

PROVISION OF INFORMATION IN THE PHARMACEUTICAL FIELD IN RUSSIA

Galina V. Shardakoxa

The Government of the Russian Federation, in the framework of the adopted State Programme of the RSFSR for Improvement of Drug Supply and Development of Pharmaceutical Industry in 1992-1995, envisaged establishing a system for the provision of information in the field of manufacture and sale of pharmaceuticals. This includes: 1) An information service on the activity of manufacturing plants, organisations and institutions related to the development, production, trial and sale of drugs (establishing data banks). 2) Formation of inter-departmental and inter-regional information structures related to drug supply on the territory of the Russian Federation. 3) Carrying out systematic scientific information analysis of the market situation and studying demand and supply of drugs and consumption levels. 4) Development of a unified classification and coding system for drugs. 5) Provision of information service of work for determining and establishing an optimal structure of pharmaceutical consumption under the conditions of transition to market economy relations. 6) An information service to health care specialists and the population regarding matters of drug supply. The objectives of the Russian Centre for Pharmaceutical and Medico-Technical Information ("Pharmedinfo") include the creation of an integrated system for pharmaceutical information using modem information technology and the analysis of scientific information on the clinical pharmacology, pharmaceutical and chemical characteristics of drugs. One of the principal databases developed is the automated information retrieval system on drugs called "Lekinform". The Centre undertakes market research and studies domestic and foreign pharmaceutical markets, carries out organisation of advertising and exhibitions, and publicity. Russian Centre for Pharmaceutical & Medico-Technical Information ("Pharmedinfo") Ministry of Health of the Russian Federation, 101497 Moscow, GSP-4 .Pnshkinskaya st. 7, Russia.