Dozens of times each day, drug information specialists at Thomas Jefferson University Hospital (TJUH) contact physicians to suggest changes in their pharmaceutical product-related orders. These can be minor changes, such as sorting out misspellings, or they might be potentially life-saving changes, as in correcting the dose of an aminoglycoside, or alerting a physician to a possible drug interaction. On an annual basis, our drug information specialists contact physicians nearly 10,000 times per year (and we have been tracking these data for some time). It is fair to say that these numbers increase every year along with the number of products on our formulary and the complexity of the conditions of the patients who receive care at TJUH.
How do our drug information specialists keep up to date and provide timely information to our ordering physicians? How does our pharmacy stay abreast of all the latest developments in pharmacotherapy and track both traditional over-the-counter (OTC) products and a legion of alternative medicine-related compounds?
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At the Jefferson Health System level, we have a pharmacy taskforce, which I have described previously. Through my membership on this taskforce, I have learned a good deal about the hard work of our constituent pharmacy directors and their drug information responsibilities. One tool that many pharmacies are relying on, not surprisingly, is the Internet. Proprietary firms have organized and launched powerful search engines to seek out drug-drug interactions and to constantly update our accumulating knowledge about new products and their post-marketing experience. I’d like to describe one such product, entitled Facts and Comparisons, which is a wholly owned division of the publishing giant Lippincott Williams & Wilkins. Facts and Comparisons has at least six key components. I will describe these in turn and make some comments about the future of comparable tools.
One component of Facts and Comparisons is the listing of approximately 22,000 prescription drugs and 6,000 OTC drugs; this list is called Drug Facts and Comparisons. This system is organized by therapeutic class, and the user can search by generic name, trade name, or drug class. It includes hundreds of comparative charges and details the actions, indications, interactions, adverse reactions, and related information on a product-by-product basis. My review of Drug Facts and Comparisons convinced me how easy it was to navigate, as I searched for monographs describing particular products in some detail. I was also interested in select OTC drugs, and the descriptions were as advertised—authoritative and complete.
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The second component, entitled Drug Interaction Facts, outlines “thousands of possible drug interactions in a browser-based format.” It is quite handy in that the screen enables a user to search for drug-drug or drug-food interactions by drug class, generic name, or trade name. This is particularly useful for conducting single- or multiple-drug interaction queries. I learned that St. John’s Wort has been reported to decrease the efficacy of theophylline, warfarin, and digoxin—three commonly prescribed medications. Drug Interaction Facts also ranks the severity of interactions and alerts the user to the most serious interactions first.
Although it is nearly impossible for primary care doctors to keep track of every alternative medicine formulation, the section entitled Review of Natural Products is an excellent source of information on nearly every natural product currently available. Updated continuously, Review of Natural Products provides “detailed information including botany, history, chemistry, pharmacology, medicinal uses, toxicology, and patient informa-tion.” This section is linked to nearly 300 fully referenced monographs, along with accompanying patient information sections that detail the use and side effects of all of these products. Again, the review of St. John’s Wort was comprehensive and authoritative.
In busy primary care practices, it is very difficult to provide patients with unbiased drug information material for their private perusal. The section entitled Med Facts is a ready source of printed patient information sheets. These can be customized and printed for each patient with the pharmacy’s name and address, patient name, and a special linked message. It strikes me as an ideal supplement to counseling on compliance and related issues.
Another useful component of Facts and Comparisons is the section called Drug Product ID. This contains over 1,000 pictures of tablets and capsules, and allows one to search for an image either by drug name or by the drug’s imprint index. Think of it as an online, easily searchable Physicians’ Desk Reference (PDR) in color.