Drug Information Specialists

K. Alicia Brand, PharmD; Michelle L. Kraus, PharmD

Disclosures

Am J Health Syst Pharm. 2006;63(8):712-714. 

All pharmacists provide some level of drug information, whether to other clinicians or to patients. In fact, a recent survey found that 96.4% of 491 hospitals have staff pharmacists who routinely answer drug information questions,[1] and a separate survey of colleges of pharmacy showed that 89% of first professional pharmacy degree programs require at least one didactic course in drug information.[2] While most pharmacists are equipped with knowledge regarding the practice of drug information, the ever-expanding list of pharmaceuticals, as well as the overwhelming amount of clinical data, makes it difficult for practitioners to stay current with recent developments. This also results in the need for more advanced problem-solving skills in order to answer the more complex questions that challenge practitioners today.

Training in Drug Information Practice

Drug information specialists are pharmacists whose primary responsibility is the provision of drug information. As with any specialty, formalized training beyond that received in pharmacy school is not required; however, this focused training does improve the practitioner's clinical credibility and ability to compete with others for employment opportunities. These two intangible attributes may also be obtained with time and experience.

The American Society of Health-System Pharmacists (ASHP) provides residency accreditation in drug information. There are currently 31 ASHP-accredited drug information specialty residencies located throughout the United States. These residency programs are housed in community, academic, and industrial settings and offer a variety of learning opportunities. Although there are additional drug information residency programs that are not ASHP accredited, the standards and objectives for such accreditation may be used to describe the clinical skills set of the drug information specialist which go beyond the minimum standards required of all pharmacists.[3]

Most drug information residency programs provide the resident with 12 months of directed, postgraduate practical experience in the provision of comprehensive drug information. During this 12-month period, the resident is exposed to various aspects of drug information practice that range in scope and complexity, with the ultimate goal of training the resident to become a competent drug information specialist. Many of the competencies required of a drug information resident are specific to executive issues, such as the development and management of a drug information center, but there are many more competencies that construct the foundation of a drug information specialist's clinical practice. Drug information specialists must be up-to-date with relevant drug-related literature in order to provide the most current information. They are often tasked as a pharmacy representative to pharmacy and therapeutics (P&T) committees. Responsibilities may include preparing medication-use policies and procedures, improving a health system's adverse-drug-reaction reporting and medication-use evaluation programs, and creating and distributing newsletters containing pertinent medication-use information. The drug information specialist must have advanced literature search and assessment skills to develop drug monographs. Additional responsibilities often include developing patient safety initiatives, ensuring compliance with Joint Commission on Accreditation of Healthcare Organizations's standards, and appropriately utilizing drug-contracting opportunities to decrease drug expenditures. Drug information specialists may also work in pharmacy informatics.

Career Opportunities in Drug Information

As previously mentioned, drug information specialists work in a variety of settings, each with its own unique scope of practice. Academic drug information centers staffed by drug information specialists offer pharmacy students practical experience in utilizing available medical media and developing literature-search strategies. Of 88 colleges of pharmacy surveyed, 20% require a drug information practice experience and 70% offer the experience as an elective.[2] These centers are often located within colleges of pharmacy or university hospitals. Most offer their services to a limited range of health care professionals, such as those within certain facilities or within the region or state. Others offer their services to community pharmacists and patients. Many health maintenance organizations (HMOs) and group purchasing organizations (GPOs) have contractual relationships with academic drug information centers, which in turn offer their services to the respective members of the organizations. In addition, HMOs, GPOs, and pharmacy benefit management companies (PBMs) have internal drug information departments that assist their members on a grander scale by providing many of the items utilized by P&T committees in making medication-use decisions. Many PBMs also provide consumer-based drug information via the Internet that is prepared by drug information specialists.

Proprietary and generic drug manufacturers are staffed with pharmacists who provide drug information specifically for the drugs manufactured by the respective companies. Although there is some information they cannot legally share and all information received should be critically evaluated, they do maintain a database of clinical studies, both published and unpublished, that provides hard-to-find information. These drug information specialists are available to health care professionals and the public and should be contacted if a patient has an unexpected adverse drug reaction. In addition, drug information specialists have practical knowledge of clinical trial design and often provide valuable insight as medical writers and in governmental agencies analyzing drug efficacy and safety claims.

An Underutilized Resource

Drug information specialists are trained to provide clear, concise, and accurate drug information in a variety of settings. Not only do they provide quality service, but pharmacist-provided drug information, adverse-drug-reaction monitoring, and formulary management have been associated with significant reductions in the total cost of care in hospital settings, as well as reductions in patient deaths.[4] The presence of a drug information center providing these services in 232 hospitals reduced total cost of care per hospital by $5,226,128.22 (p = 0.003), including a $391,604.94 reduction in drug costs per hospital, and was associated with a total of 10,463 fewer deaths.[4] Disappointingly, an online survey of health care professionals showed that only 1% of respondents contact a drug information center when the need arises.[5] Another recent survey found that only 5.9% of 491 hospitals have a staff position dedicated to the provision of drug information and 4.1% have a formal drug information center.[1] Granted, contacting a drug information specialist may not be the fastest way to obtain drug information in an emergency situation; nonetheless, this underutilization raises several questions.

Today, the Internet provides a plethora of information for both health care professionals and their patients. Many practitioners probably use the Internet when seeking answers to questions. However, at least one study judged significantly more responses obtained from a drug information center as accurate when compared with those received from a Usenet newsgroup (p = 0.001).[6] Also, there is no quality control for these types of newsgroup services and other similar medical information sources housed on the Internet, and practitioners may be jeopardizing their own credibility when using these resources. Another source of information is facility-housed references, including print and electronic products. Electronic drug information products are becoming increasingly popular. A recent survey showed that 60.4% of 491 hospitals subscribed to some sort of electronic product.[1] Two interesting surveys on drug information references have been conducted.[7,8] In one survey, 40.9% of 22 respondents said they were not satisfied with the drug information resources to which their pharmacy currently subscribed.[7] In another survey, 38% of 71 respondents said they used a drug information reference at least 10 times a day, and another 35.2% used such a reference 3-5 times daily.[8] This discrepancy shows that practitioners regularly use some sort of drug information reference, even though they are not always satisfied with the information obtained.

With so many pharmacists retrieving information from drug information references, the underutilization of drug information specialists as a resource cannot be attributed to a lack in the number of questions that need to be answered. Perhaps practitioners do not know how to find drug information specialists. Industry-based specialists can be contacted via the manufacturer's Web site, and the Physicians' Desk Reference provides a listing of contact information for drug manufacturers.[9] Drug Topics's Red Book contains a list of academic drug information centers, and many colleges of pharmacy provide these services to the pharmacies in their respective states.[10] It is also worth contacting HMOs or GPOs, where applicable, to learn about the services they provide.

Drug information specialists are a valuable resource available to support appropriate drug use and improve quality of patient care. New practitioners are urged to take advantage of the expertise of drug information specialists, either within or outside of their own institutions.

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