The needs and sources of drug information among pharmacists in Hong Kong

Transcription

1 ]ouml of Clinical Pharmacy and Therapeutics (1) 1, - The needs and sources of drug information among pharmacists in Hong Kong T. Y. K. Chan" MBChB FRCP, K. K. c. Lee+ BSc MPhil and J. A. J. H. Critchley" MBChB PhD FRCP "Department of Clinical Pharmacology, The Chinese University of Hong Kong, Prince of Wales Hospital and tdepartment of Pharmacy, The Chinese University of Hong Kong, Shatin, New Temtories, Hong Kong SUMMARY The objective of this study was to determine the drug information needs of pharmacists in Hong Kong, the sources of drug information available and the constraints limiting their ability to fulfil drug information needs at practice sites. A questionnaire survey was carried out in January 1 of community ( retail pharmacies, 1 outpatient clinics) and 44 hospital pharmacists working in Hong Kong. The information sought included: place of practice, availability of reference texts, journals or periodicals at practice sites, types of clinical pharmacy services provided, frequency and types of drug information questions received, sources of drug information used, needs for a drug information service, and constraints limiting their ability to fulfil drug information needs at practice sites. Ninety-four pharmacists (hospital -%, community.%) responded. Hospital pharmacists generally had more reference texts and journals/ periodicals at practice sites than community pharmacists. The majority of pharmacists in this survey were involved in a variety of clinical pharmacy services, including the delivery of drug information to other health-care professionals and the general public. Community pharmacists were most often asked questions about over-thecounter drugs, drug dosage and drug identification. Hospital pharmacists were most often asked questions about drug identification and availability of drugs. The most important drug information sources for both the community and hospital pharmacists were their own knowledge and work-place reference texts. Few pharmacists Correspondence: Dr Thomas Y. K. Chan, Department of Clinical Pharmacology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. 1 Blackwell Science Ltd frequently used the service provided by the national Drug and Poisons Information Bureau (DPIB). The scarcity of drug information sources was perceived as an important constraint by both community and hospital pharmacists when fulfilling drug information needs at practice sites. Lack of time was considered an equally important constraint by the hospital pharmacists. A national drug information service was generally felt to be necessary. In conclusion, inadequacy in drug information sources was perceived to be a very important constraint limiting the pharmacists surveyed in fulfilling drug information needs at their individual practice sites. However, many were unaware that the drug information requested was already available. Regular attempts to publicize this territory-wide DPIB are obviously needed. INTRODUCTION As part of their professional responsibility, pharmacists play an important role in the provision of information on drugs to heal th-care professionals and the general public. However, the number of drugs and the complexity of modem therapeutics have increased. In addition, few practising pharmacists have the time or resources to answer adequately all the questions they are asked. For these reasons, formalized drug information services have been established in many countries to assist pharmacists and other health-care professionals (1-)- In Hong Kong, the temtory-wide Drug and Poisons Information Bureau (DPIB) was established in January 1 by the Department of Clinical Pharmacology of the Chinese University of Hong Kong (, ). The DPIB is based at the Prince of Wales Hospital. In 11, pharmacists accounted for 1% of the enquiries received by the Bureau (). Whether there has been an

2 T. Y. K. Chan et al. Reference texts Marfindale: The Extra Pharmacopoeia Hong Kong Index of Medical Specialties British National Formulary Pharmaceutical Codex Goodman and Gilman's The Pharmacological Basis of Therapeutics British Pharmacopoeia The Merck Index Rernington's Pharmaceutical Sciences Physician's Desk Reference Chinese Pharmacopoeia Joumalslperiodicals Hong Kong Pharmaceutical Journal The Phannaceufical Journal American Journal of Health-System Pharmacy Annals of Phannacotherapy lournal of Clinical Pharmacy and Therapeutics Clinical Pharmacy Community [n=4) 1 Hospital (n=) Table I. Percentage of community. and hospital pharmacists with reference texts or joumalslperiodicals readily available at practice sites under use and lack of awareness of such a service among some practising pharmacists is not known. Neither is it known if the types of support provided to pharmacists in Hong Kong regarding the delivery of drug information are adequate. The purpose of this study was to determine the drug information needs of pharmacists in Hong Kong, the sources of drug information available and the constraints limiting pharmacists' ability to fulfil drug information needs at practice sites. SUBJECTS AND METHODS In January 1, Hong Kong pharmacists working at community sites (retail pharmacies, outpatient clinics 1) and hospitals ( ~ ~ 4were 4 ) sent a questionnaire accompanied by a letter explaining its purpose. Pharmacists working in other areas of the profession were not targeted because they are less likely to have direct contact with patients or other health-care professionals. The questionnaire sought the following information: the place of practice, availability of reference texts, journals and periodicals at practice sites, types of clinical pharmacy services provided, frequency and types of drug information questions received, sources of drug information typically used, and the constraints limiting their ability to fulfil drug information needs. Some of these questions were adopted from a similar survey of pharmacists in Quebec, CaAada (). RESULTS Responses were analysed in March 1. Ninety-four questionnaires (.1%) were returned. The response rate was higher for hospital-based pharmacists (.%) than for community-based pharmacists (.%). The respondents consisted of men and women who had qualified from the U.K. (n=44), Taiwan (n=), Australia (n= IS), United StatedCanada (n=), and other countries. Hospital pharmacists generally had more reference texts, journals and periodicals at their work-place than community pharmacists (Table I). Few pharmacists in either sector subscribed to journals on clinical pharmacy or pharmacotherapy, except journals published by their professional societies, such as the Hony Kony Phrrrrnnceriticnl ]uurnnl and the Phamnceritical ]uiimnl. The types of clinical pharmacy services provided by community and hospital pharmacists are summarized 1 Blackwell Science Ltd, Joiinid of C/irricd PCuirrtirrcy rirrd Tlimipeiitics. 1, -

3 Drug information needs of pharmacists in Hong Kong Table. Percentage of community and hospital pharmacists who routinely provided clinical pharmacy services Service Community (n=4) Hospital (n=) Patient counselling on drug therapy 1 Prescribing non-prescription drugs Communication of information to physicians and 1 ' other health-care professionals Pharmaceutical calculations 44 Educational activities (eg. teaching, publication) 44 4 Participation in medical rounds NA Adverse drug reaction reporting Patient medication histories 1 NA not applicable. in Table. Most pharmacists provided patient counselling services regarding drug therapy and gave drug information to other health-care professionals. Some pharmacists in private hospitals did advise the general public about the choice of non-prescription drugs, but much less frequently than community pharmacists. The frequencies of the different types of drug information questions received by community and hospital pharmacists are shown in Table. The most important drug information sources for both the community and hospital pharmacists were their own knowledge and reference texts (Table 4). Few pharmacists in either sector frequently used the service provided by the DPIB. However, a national drug information service was considered important by more than % of community pharmacists for the following drug information categories: adverse effects of Chinese medicines, adverse reactions to drugs, drug interactions and contraindications (Table ). More than % of hospital pharmacists rated the following categories important: adverse effects of Chinese medjcines, adverse drug reactions, drug identification, drug interactions, pharmaceutical compatibility and stability, and whether Chinese medicines contain Western drugs (Table ). Inadequate drug information sources was the constraint most frequently cited by both community and hospital pharmacists (Table ). DISCUSSION The results of this study indicate that reference texts, journals and periodicals available at work places differed considerably between community and hospital pharmacists. As expected from the nature and complexi ty of the enquiries, hospital pharmacists were generally better equipped. The relative importance of Hong Kong Index of Medical Specialfies (HKZMS; MIMS Asia) to both groups was not surprising as it has listed products that are widely available in Hong Kong. However, because of the relatively small amount of information on indications, side-effects, cautions and drug-drug interactions in HKIMS, other dmg information sources are often required. It is also obvious from this study that most pharmacists in Hong Kong, particularly those working in the community setting, did not have easy access to journals and periodicals on clinical pharmacy or pharmacotherapy. Such resources would provide more up-to-date drug information than the standard texts. In Hong Kong, there were approximately pharmacists per million of population in 1. Currently, there are only five pharmacists working in the Prince of Wales Hospital, which served 1. million people in 1. Due to the small number of pharmacists and the nature of their work, the relative importance of the various aspects of clinical pharmacy services may differ from those in other countries (). This is particularly true for hospital pharmacists who currently seldom participate in drug utilization reviews or medical rounds in Hong Kong. However, despite their workload, the respondents in this survey still provided a wide range of clinical pharmacy services as listed in Table. This emphasizes the importance of ready access to drug information sources through a 4-h drug and poisons information service such as the DPIB provides. ( 1 Blackwell Science Ltd, lurrnlnl of Cliriicnf Pltrrmtncy r i d Thernpttics, t 1, -

4 1 T. Y. K Chn et al. Table. Frequency of different types of drug information questions received by 4 community and hospital pharmacists Percentage of community pharmacists Percentage of hospital pharmacists Very Very very Very Type of questions often Often Few few Never often Often Few few Never Western drugs Over-the-counter drugs Dosage Drug identification 4 Availability of drugs Comparing the efficacy of different drugs Adverse drug reactions 14 Foreign drugs ' 14 Contraindications Poisoning Legislation Drug interactions Therapeutics and pharmacology Pharmaceutical compatibility and stability Pharmaceutical calculations Pharmacokinetics ~ Chinese herbdproprietary medicines Contain Western drugs? Adverse effects Table 4. Sources of drug information used by 4 community and hospital pharmacists Percentage of community pharmacists Percentage of hospital pharmacists Sources Very very Very Very often Often Few few Never often Often Few few Never Own knowledge 1 4 Reference texts Pharmacist colleagues Other health-care professional colleagues Journals/periodicals DPIB Self-medication is a very common practice Because community pharmacists primarily received among the general public in Hong Kong (1). questions from the public while hospital pharmacists In addition to dispensing prescription drugs, % predominately received questions from other healthof the community pharmacists in this survey had to care professionals, the frequency and the types of advise the general public regarding non-prescription drug informa tion questions they were asked differed drugs. considerably (Table ). As expected, community I Blackwell Science Ltd, lorrrnnl uf CIiriicnl P/~nmim-y mid Tlterpeictics, 1, -

5 Drug information nee& of pharmacisfs in Hong Kong Table. The evaluation of the need for a drug information service among 4 community and hospital pharmacists in different question categories Percentage of community pharmacists Percentage of hospital pharmacists Question categories Important Average Limited No need Important Average Limited No need Western drugs Over-the-counter drugs Dosage Drug identification Availability of drugs Comparing the efficacy of different drugs Adverse drug reactions Foreign drugs Contraindications Poisoning Legislation Drug interactions Therapeutics and pharmacology Pharmaceutical compatibility and stability Pharmaceutical calculations Pharmacokinetics I I1 1 1 I I4 4 I Chinese herbs/proprietary medicines Contain Western drugs? Adverse effects ingredients in herbs Pharmacology of herbs 1 I Table. Constraints limiting pharmacists ability to fulfil drug information needs at the practice sites Constraints Percentage of pharmacists affected Community Hospital (n = 4) (n=) Inadequate drug information sources Lack of support from the administration 1 Insufficient budget Lack of time Large workload pharmacists were often asked questions con- practitioners prior to 14, questions concerning cerning over-the-counter drugs. Due to the lack of drug identification were asked more frequently in labelling for medicines dispensed by private general Hong Kong than in other countries (). It is also not (( 1 Blackwell Science Ltd, Joitrrird of Clrrirml Plrnrmocy rttd Tlirmpntlrrs, 1, -

6 T. Y. K, Chn et a!. surprising that questions on Chinese medicines were asked much more frequently here than elsewhere (11). The most important drug information sources for both the community and hospital pharmacists in this survey were their own knowledge and work-place reference texts (Table 4). Journals and periodicals were rarely used for up-to-date information because there was no ready access to such sources. Due to their closer contact with other health-care professionals, hospital pharmacists more frequently sought help from these colleagues. The needs of pharmacists in fulfilliig their duty as drug information providers vary. It was striking that the adverse effects of Chinese medicines was ranked the most important need for a national drug information service by both community and hospital pharmacists. This finding may reflect the complexity of the subject, the lack of suitable reference texts, and the lack of teaching on the subject at the undergraduate level. Pharmacists surveyed also considered that a national drug information service would be useful to help answer questions on Western drugs (Table ). Surprisingly, few frequently used the exist'ing DPIB service (Table 4). This finding may be due to the fact that they were unaware of such a service. Thus, inadequacy in drug information sources was perceived to be a very important constraint limiting the pharmacists surveyed in fulfilling drug information needs at their individual practice sites. However, many were unaware that the drug information service requested was already available. Regular attempts to publicize this territory-wide DPIB are obviously needed. Lack of time was considered an equally important constraint by the hospital pharmacists and further emphasized the need or immediate telephone access to the DPIB. REFERENCES 1. Burholder D. (1) Some experiences in the establishment and operation of a drug information centre. American Journal of Hospital Pharmacy,, -1.. Blackbum JL, Laxdal OE, Dempsey MI. (1) Saskatchewan dial-access drug information service. Canadian Medical Association Journal, 11, -1.. Davies DM, Ashton CH, Rao JG, et al. (1) Comprehensive clinical drug information service: first year's experience. British Medical Journal, I, Allison A, Froese EH, Hall J, et al. (1) A drug information service for a developing country- Zimbabwe. Phannacy International,, Alvan G, Ohman, SjZjqvist F. (1) Problemorientated drug information a clinical pharmacological service. hncet,, Atkinson HC, Begg EJ. (1) The Christchurch Hospital Drug Information Service organisation and an audit of the first questions answered. New Zealand Medical Journal, 1, -.. Cohen MAH, Chan G, Davies DM. (1) Drug and Poisons Information Service at the Prince of Wales Hospital at the Chinese University of Hong Kong-the first year's experience. Journal of the Hong Kong Medical Association, 41, 4-.. Chan TYK, Critchley JAJH, Chan JCN, et al. (1) The Drug and Poisons Information Bureau at the Chinese University of Hong Kong. Journal of the Hong Kong Medical Association, 4, -.. Mailhot C, Giacona-Dahl N. (1) Drug Information Services in Quebec: determination of community and hospital pharmacists' needs. Drug Intelligence and Clinical Pharmacy, 1, Chan TYK, Critchley JAJH. (11) Adverse drug reaction monitoring in Hong Kong. Journal of the Hong Kong Medical Association, 4, Baldwin CA, Anderson LA, Phillipson JD, et al. (1) Drug information-herbal concern. Pharmaceutical ]ocmrna/,, Blackwell Science Ltd. ]o~~rnril uf Clijiicnl Pliornmcy rind Tlitmpiitics. t 1, -