Upload
motolani-arogunjo
View
285
Download
5
Embed Size (px)
Citation preview
Modified Systemic Modified Systemic Approach to Answering Approach to Answering
QuestionsQuestions
Dr. Angie Eaton-MaxwellDr. Angie Eaton-Maxwell
Pharm 631Pharm 631
September 4, 2008September 4, 2008
ObjectivesObjectives
At the end of this lecture, the student should be At the end of this lecture, the student should be able to:able to:Determine pertinent information when presented Determine pertinent information when presented with at drug information questionwith at drug information questionCategorize the ultimate question and develop an Categorize the ultimate question and develop an efficient strategyefficient strategyFormulate a response appropriate for the Formulate a response appropriate for the sophistication of the requestorsophistication of the requestorIdentify the categories f drug information that are Identify the categories f drug information that are appropriate for follow-upappropriate for follow-up
Systematic Approach (1975)Systematic Approach (1975)
Five stepsFive steps
Step I: Classification of the requestStep I: Classification of the request
Step II: Obtaining background informationStep II: Obtaining background information
Step III: Systematic SearchStep III: Systematic Search
Step IV: ResponseStep IV: Response
Step V: Reclassification Step V: Reclassification
Modified Approach (1987)Modified Approach (1987)
Step I: Secure demographics of requestorStep I: Secure demographics of requestor
Step II: Obtain background informationStep II: Obtain background information
Step III: Determine and categorize ultimate Step III: Determine and categorize ultimate questionquestion
Step IV: Develop strategy and conduct researchStep IV: Develop strategy and conduct research
Step V: Perform evaluation, analysis, and Step V: Perform evaluation, analysis, and synthesissynthesis
Step VI: Formulate and provide responseStep VI: Formulate and provide response
Step VII: Conduct follow-up and documentationStep VII: Conduct follow-up and documentation
Modified ApproachModified Approach
Approach can be used in other settings Approach can be used in other settings outside of the DI outside of the DI
Community pharmacyCommunity pharmacy
Pharmaceutical industryPharmaceutical industry
Institutional pharmacy managementInstitutional pharmacy management
General application in professional General application in professional consultationconsultation
Requestor Demographics Requestor Demographics
1st step1st step
Listen closely to caller to determine level Listen closely to caller to determine level of sophistication and knowledgeof sophistication and knowledge
Determine the requestor’s position, Determine the requestor’s position, training, and anticipated knowledgetraining, and anticipated knowledge
Identify method of delivery of response Identify method of delivery of response (e.g. fax, mail, verbal, and written)(e.g. fax, mail, verbal, and written)
Background QuestionsBackground Questions
Essential step for formulating effective Essential step for formulating effective responsesresponses
Usually the most difficult stepUsually the most difficult step
Why is this person asking this question?Why is this person asking this question?
Always ask if the request is concerning a Always ask if the request is concerning a specific patient’s conditionspecific patient’s condition
Background question inquiry and reply Background question inquiry and reply should be a dialogue should be a dialogue
Background QuestionsBackground Questions
Always ask the requestor how they have Always ask the requestor how they have research the answer.research the answer.
This will avoid duplication of informationThis will avoid duplication of information
Keep in mind that some individuals do not Keep in mind that some individuals do not know how to correctly use all resourcesknow how to correctly use all resources
Intermediaries Intermediaries
Medical studentsMedical students
NursesNurses
PharmacistsPharmacists
Administrative AssistantsAdministrative Assistants
Work with them or bypass themWork with them or bypass them
General QuestionsGeneral Questions
NameNameLocation/pager #Location/pager #AffiliationAffiliationResources already consultedResources already consultedPatient specific or academicPatient specific or academicPatient’s diagnosis, other medications, and Patient’s diagnosis, other medications, and pertinent medical informationpertinent medical informationUrgency of the requestUrgency of the requestSee Appendix 2-3 for specific questionsSee Appendix 2-3 for specific questions
Ultimate Question/Categorization of Ultimate Question/Categorization of QuestionQuestion
Obtaining adequate background information will easily Obtaining adequate background information will easily identify the ultimate questionidentify the ultimate questionMay be the same as the original questionMay be the same as the original question
Example Original Question:Example Original Question:How do I get thalidomide?How do I get thalidomide?
Ultimate QuestionUltimate QuestionWhat are third line therapeutic recommendations for this What are third line therapeutic recommendations for this patient?patient?
Once the ultimate question has been confirmed then categorize Once the ultimate question has been confirmed then categorize the questionthe question
Useful in the development of the search strategyUseful in the development of the search strategy Useful in determining the necessary resourcesUseful in determining the necessary resources
Categorization of QuestionCategorization of Question
AvailabilityAvailability
IdentificationIdentification
General Product General Product InformationInformation
Laws/Policy & Laws/Policy & Procedure/P&TProcedure/P&T
CostCost
Foreign/InvestigationalForeign/Investigational
Compatibility/Stability/Compatibility/Stability/Administration RateAdministration Rate
Drug InteractionsDrug Interactions
PharmaceuticsPharmaceutics
PharmacokineticsPharmacokinetics
Therapy EvaluationTherapy Evaluation
DosageDosage
Adverse EffectsAdverse Effects
Poisoning/ToxicologyPoisoning/Toxicology
TeratogenicityTeratogenicity
LactationLactation
Search StrategySearch Strategy
Depending on the categorization of the Depending on the categorization of the question (e.g. Adverse Effect)question (e.g. Adverse Effect)
Prioritize the resourcesPrioritize the resources Ease of accessEase of access Degree of comfortDegree of comfort
Data Evaluation, Analysis, and Data Evaluation, Analysis, and SynthesisSynthesis
Information obtained must be objectively Information obtained must be objectively critiqued critiqued
Literature Evaluation and Statistical Literature Evaluation and Statistical AnalysisAnalysis
Formulation and Provision of Formulation and Provision of ResponseResponse
Unethical to misrepresent the resultsUnethical to misrepresent the resultsInform the requestor when one course of action Inform the requestor when one course of action is more desirableis more desirableMust present conflicting dataMust present conflicting dataMust be delivered within an appropriate time Must be delivered within an appropriate time frameframeMust be delivered with an appropriate level of Must be delivered with an appropriate level of sophisticationsophisticationResponder must be prepared for additional Responder must be prepared for additional questionsquestions
Format for Logical Argument in Format for Logical Argument in Response FormulationResponse Formulation
Step I:Step I: Present the competing viewpoints Present the competing viewpoints and considerationsand considerationsStep II: State the assessment of the literature or Step II: State the assessment of the literature or information reviewed and claim the superior information reviewed and claim the superior viewpointviewpointStep III: Succinctly refute the major strengths Step III: Succinctly refute the major strengths and present weaknesses of the inferior viewpointand present weaknesses of the inferior viewpointStep IV: Defend the major weaknesses and Step IV: Defend the major weaknesses and promote the strengths of the superior viewpointpromote the strengths of the superior viewpointStep V: Reiterate the final assessment in Step V: Reiterate the final assessment in support of the superior viewpoint.support of the superior viewpoint.
Follow-Up, Follow-Through, and Follow-Up, Follow-Through, and DocumentationDocumentation
Follow-UpFollow-Up
Process of verifying the appropriateness, Process of verifying the appropriateness, correctness and completeness of a correctness and completeness of a responseresponse
Good businessGood business
Patient specific requests Patient specific requests
““Soft” dataSoft” data
Follow-Through Follow-Through
Process of readdressing a request based Process of readdressing a request based on the availability of new dataon the availability of new data
Provide updates when new literature Provide updates when new literature becomes availablebecomes available
DocumentationDocumentation
Reduces the liability Reduces the liability
Promotes the development of continuous Promotes the development of continuous serviceservice
DI Form or extensive review and DI Form or extensive review and summation of all processes completedsummation of all processes completed
Ultimate question, resources searched, Ultimate question, resources searched, the response and follow-up.the response and follow-up.
Formulating Effective Responses and Formulating Effective Responses and Recommendations: A Structured ApproachRecommendations: A Structured Approach
Desired Characteristics of a ResponseDesired Characteristics of a ResponseTimelyTimelyCurrentCurrentAccurateAccurateCompleteCompleteConciseConciseWell ReferencedWell ReferencedClear and logicalClear and logicalObjective and balancedObjective and balancedFree of bias or flawsFree of bias or flawsApplicable and appropriate for specific circumstancesApplicable and appropriate for specific circumstancesAnswers important related questionsAnswers important related questionsAddresses specific management of patients and situationsAddresses specific management of patients and situations
Response Response
Restatement of the request Restatement of the request
Begin with introduction of the problem, Begin with introduction of the problem, issues, and circumstancesissues, and circumstances
Introduce the topic and systematically Introduce the topic and systematically present specific findingspresent specific findings
Pertinent background informationPertinent background information
Conclusions and recommendationsConclusions and recommendations
ReferencesReferences
Sample CaseSample Case
Can ranitidine cause thrombocytopenia?Can ranitidine cause thrombocytopenia?
Develop an approachDevelop an approach Requestor informationRequestor information Patient informationPatient information
PMHPMH
SHSH
Current MedicationsCurrent Medications
AllergiesAllergies
LabsLabs
Sample CaseSample Case
Restate the questionRestate the question
Dear ____,Dear ____,
Thank you for inquiry concerning the use of Thank you for inquiry concerning the use of ranitidine as a potential cause of ranitidine as a potential cause of thrombocytopenia.thrombocytopenia.
- If it is drug specific remember to use registered If it is drug specific remember to use registered or trademarks with brand namesor trademarks with brand names
- BonivaBoniva®® or ™ or ™
Sample CaseSample Case
A review of …. Indicates that ____ has/has not A review of …. Indicates that ____ has/has not been reported as a cause of thrombocytopenia. been reported as a cause of thrombocytopenia. However, there are reports that show that ____ However, there are reports that show that ____ has been infrequently associated with has been infrequently associated with thrombocytopenia.thrombocytopenia. Sum up the findingsSum up the findings Discuss the prevalenceDiscuss the prevalence OnsetOnset D/C ?D/C ?
Sample CaseSample Case
Analysis and SynthesisAnalysis and Synthesis Although these factors have been reported in Although these factors have been reported in
other cases, the most likely cause of other cases, the most likely cause of thromobocytopenia for this patient is _____.thromobocytopenia for this patient is _____.
Response and RecommendationResponse and Recommendation Continue regimenContinue regimen D/C particular drugsD/C particular drugs Change dosageChange dosage
QuestionsQuestions