All pharmacists must be effective medication information providers regardless of their practice. As defined by the New Mexico Conference, an effective provider perceives, assesses, and evaluates medication information needs and retrieves, evaluates, communicates, and applies data from the published literature and other sources as an integral component of patient care. If the profession is to be successful in accepting patient care responsibilities, all pharmacists must have a certain minimum level of skill to survive in the changing practice environment. Developing the skills of an effective medication information provider is the foundation for the pharmacist to be a lifelong learner and problem solver. The literature is a valuable component of both of these processes and will allow the individual pharmacist to adapt to the needs of a continually changing health care system.
Opportunities abound for pharmacists to use medication information skills in all practice settings either as a generalist or a specialist practitioner. There is still the need for the practitioner to have support from drug information centers to meet special information needs, to serve as a resource on effective medication use, and to assist pharmacy practitioners as well as others in solving medication therapy situations. Individuals with special training as medication information specialists will still be needed to operate the centers and to provide leadership in the area of drug informatics, institutional drug policy, poison control, pharmaceutical industry, and in academia.
References
1. Parker PF. The University of Kentucky drug information center. Am J Hosp Pharm. 1965;22:42–7.
2. Amerson AB, Wallingford DM. Twenty years' experience with drug information centers. J Hosp Pharm. 1983;40:1172–8.[PMID: 6881155]
3. Walton CA. The problem of communicating clinical drug information. J Hosp Pharm. 1965;22:458–63.
4. Lowe HJ, Barnett GO. Understanding and using the medical subject headings (MESH) vocabulary to perform literature searches. JAMA. 1994;271:1103–18.[PMID: 8151853]
5. Institute of Medicine. Health professions education: a bridge to quality. Washington, DC: National Academy Press; 2003.
6. Mehnert RB. A world of knowledge for the nation's health: The U.S. National Library of Medicine. J Hosp Pharm. 1986;43:2991–7.[PMID: 3544826]
7. Walton CA. Education and training of the drug information specialist. Drug Intell. 1967;1:133–7.
8. Francke DE. The role of the pharmacist as a drug information specialist. J Hosp Pharm. 1966;23:49.[PMID: 5907110]
9. Koumis T, Cicero LA, Nathan JP, Rosenberg JM. Directory of pharmacist-operated drug information centers in the United States—2003. J Health Syst Pharm. 2004;61:2033–42.[PMID: 15509126]
10. Rosenberg JM, Koumis T, Nathan JP, Cicero LA, McGuire H. Current status of pharmacist-operated drug information centers in the United States. J Health Syst Pharm. 2004;61:2023–32.[PMID: 15509125]
11. Drug topics red book. Montvale(NJ). Medical Economics; 2004.
12. Kinky DE, Erush SC, Laskin MS, Gibson GA. Economic impact of a drug information service. Ann Pharmacother. 1999;33:11–6.[PMID: 9972378]
13. LaFleur J, Tyler LS, Sharma RR. Economic benefits of investigational drug services at an academic institution. Am J Health Syst Pharm. 2004;61:27–32.[PMID: 14725117]
14. Study Commission on Pharmacy. Pharmacists for the future. Ann Arbor (MI): Health Administration Press; 1975. p. 139.
15. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533–50.[PMID: 2316538]
16. American Society of Health-System Pharmacists. ASHP guidelines on the provision of medication information by pharmacists. Am J Health Syst Pharm. 1996;53:1843–5.
17. Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health care system. Washington, DC: National Academy Press; 1999.
18. Vioxx (rofecoxib) information [monograph on the Internet]. Washington: Food and Drug Administration; 2005 [accessed 2007 Jan 18]. Available from: http://www.fda.gov/cder/drug/infopage/vioxx/default.htm
19. Stricker BH, Psaty BM. Detection, verification, and quantification of adverse drug reactions. BMJ. 2004;329:44–7.[PMID: 15231627]
20. Landis NT. ADE rate uncertain, reporting systems inadequate, GAO tells legislators. Am J Health Syst Pharm. 2000;57:515–9.[PMID: 10754757]
21. Grissinger M. Adverse drug reactions: documentation is important, but communication is critical. P&T. 2004;29:5.
22. ASHP guidelines on adverse drug reaction monitoring and reporting. Am J Health Syst Pharm. 1995;52:417–9.
23. Fink JL, Vivian JC, Keller RK, editors. Pharmacy law digest. St Louis (MO): Facts and Comparisons; 1999.
24. FDA issues regulation prohibiting sale of dietary supplements containing ephedrine alkaloids and reiterates its advice that consumers stop using these products [monograph on the Internet]. Washington: Food and Drug Administration; 2004 Feb 6 [accessed 2007 Jan 18]. Available from: http://www.fda.gov/bbs/topics/NEWS/2004/NEW01021.html
25. FDA letter warning health care professionals about kava. Available from: http://www.fda.gov/medwatch/safety/2001/kava.htm
26. Ansani NT, Ciliberto NC, Freedy T. Hospital policies regarding herbal medicines. Am J Health Syst Pharm. 2003;60:367–70.[PMID: 12625219]
27. Wachter RM. The end of the beginning: patient safety five years after "To Err Is Human." Health Aff [serial on the Internet]. 2004 Nov 30 [accessed 2007 Jan 18]: [about 9 p.]. Available from: http://content.healthaffairs.org/cgi/content/full/hlthaff.w4.534/DC1.
28. Johnson ST, Wordell CJ. Internet utilization among medical information specialists in the pharmaceutical industry and academia. Drug Inf J. 1998;32:547–54.
29. Malone PM, Young WW, Malesker MA. Wide area network connecting a hospital drug informatics center with a university. Am J Health Syst Pharm. 1998;55:1146–50.[PMID: 9626377]
30. Berland GK, Elliott MN, Morales LS, Algazy JL, Kravitz RL. Health information on the Internet: accessibility, quality, and readability in English and Spanish. JAMA. 2001;285:2612–21.[PMID: 11368735]
31. Kim P, Eng TR, Deering MJ, Maxfield A. Published criteria for evaluating health related websites: review. BMJ. 1999;318:647–9.[PMID: 10066209]
32. Murray E, Pollack L, Donelan K, Catania J, Lee K. The impact of health information on the Internet on health care and the physician-patient relationship: national U.S. survey among 1050 U.S. physicians. J Med Internet Res. 2003;5:e17.
33. Belgado BS. Drug information centers on the Internet. J Am Pharm Assoc. 2001;41:631–2.[PMID: 11486993]
34. Dugas M, Weinzierl S, Pecar A, Hasford J. Am J Health Syst Pharm. 2001;58:799–802.[PMID: 11351921]
35. Ruppelt SC, Vann R. Marketing a hospital-based drug information center. 2001;58;1040.
36. Erbele SM, Heck AM, Blankenship CS. Survey of computerized documentation system use in drug information centers. Am J Health Syst Pharm. 2001;58:695–7.[PMID: 11329762]
37. McCreadie SR, Stevenson JG, Sweet BV, Kramer M. Using personal digital assistants to access drug information. Am J Health Syst Pharm. 2002;59:1340–3.[PMID: 12132560]
38. Brody JA, Camamo JM, Maloney ME. Implementing a personal digital assistant to document clinical interventions by pharmacy residents. Am J Health Syst Pharm. 2001;58:1520–2.[PMID: 11515349]
39. Barrons R. Evaluation of personal digital assistant software for drug interactions. Am J Health Syst Pharm. 2004;61:380–5.[PMID: 15011766]
40. Silva MA, Tataronis GR, Maas B. Using personal digital assistants to document pharmacist cognitive services and estimate potential reimbursement. Am J Health Syst Pharm. 2003;60:911–5.[PMID: 12756942]
41. Reilly JC, Wallace M, Campbell MM. Tracking pharmacist interventions with a hand-held computer. Am J Health Syst Pharm. 2001;58:158–61.[PMID: 11202540]
42. Lau A, Balen RM, Lam R, Malyuk DL. Using a personal digital assistant to document clinical pharmacy services in an intensive care unit. Am J Health Syst Pharm. 2001;58:1229–32.[PMID: 11449881]
43. Lynx DH, Brockmiller HR, Connelly RT, Crawford SY. Use of PDA-based pharmacist intervention system. Am J Health Syst Pharm. 2003;60:2341–4.[PMID: 14652983]
44. Grasso BC, Genest R, Yung K, Arnold C. Reducing errors in discharge medication lists by using personal digital assistants. Psychiatr Serv. 2002;53:1325–6.[PMID: 12364687]
45. Clark JS, Klauck JA. Recording pharmacists' interventions with a personal digital assistant. Am J Health Syst Pharm. 2003;60:1772–4.[PMID: 14503114]
46. Clauson KA, Seamon MJ, Clauson AS, Van TB. Evaluation of drug information databases for personal digital assistants. Am J Health Syst Pharm. 2004;61:1015–24.[PMID: 15160777]
47. Lowry CM, Kkostka-Rokosz MD, McCloskey WW. Evaluation of personal digital assistant drug information databases for the managed care pharmacist. J Manag Care Pharm. 2003;9:441–8.[PMID: 14613442]
48. Elson RB, Connelly DP. Computerized medical records in primary care and their role in mediating guideline-driven physician behavior change. Arch Fam Med. 1995;4:698–705.[PMID: 7620600]
49. Evans RS, Pestotnik SL, Classen DC, Clemmer TP, Weaver LK, Orme JF, Jr. et al. A computer-assisted management program for antibiotics and other anti-infective agents. N Engl J Med. 1998;338:232–8.[PMID: 9435330]
50. Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computer-based clinical support systems on physician performance and patient outcomes: a systematic review. JAMA. 1998;280:1339–46.[PMID: 9794315]
51. Rind DM, Kohane IS, Szolovits P, et al. Maintaining the confidentiality of medical records shared over the Internet and world wide web. Ann Intern Med. 1997;127:138–44.[PMID: 9230004]
52. Frisse ME. What is the Internet learning about you while you are learning about the Internet? Acad Med. 1996;71:1064–107.[PMID: 9177639]
53. Giacalone RP, Cacciatore GG. HIPAA and its impact on pharmacy practice. Am J Health Syst Pharm. 2003;60:433–45.[PMID: 12635449]
54. Blank C. Spending on pharmaceuticals will pass $180 billion by 2008. Hosp Pharma Rep. 1998;12:54.
55. Hoffman JM, Shah ND, Vermeulen LC, Hunkler RJ, Hontz KM. Projecting future expenditures—2005. Am J Health Syst Pharm. 2005;62:149–67.[PMID: 15700889]
56. Altman DE. The new medicare prescription drug legislation. N Engl J Med. 350:1:9–10.
57. Institute of Medicine. Insuring America's health: principles and recommendations. Washington, DC; 2004.
58. Opportunities for the community pharmacist in managed care. Special Report. Washington, DC: American Pharmaceutical Association; 1994.
59. Ellrodt G, Cook DJ, Lee J, Cho M, Hunt D, Weingarten S. Evidence-based disease management. JAMA. 1997;278:1687–92.[PMID: 9388089]
60. Vermeulen LC, Beis SJ, Cano SB. Applying outcomes research in improving the medication-use process. Am J Health Syst Pharm. 2000;57:2277–82.[PMID: 11146972]
61. Top 10 areas of research: report on the most popular fields of drug development. Med Ad News. 2003;137:22:S22.
62. Emilien G, Ponchon M, Caldas C, et al. Impact of genomics on drug discovery and clinical medicine. Q J Med. 2000;93:391–423.[PMID: 10874050]
63. Epler GR, Laskaris LL. Individualization health care and the pharmaceutical industry. Am J Health Syst Pharm. 2001;58:1042.[PMID: 11402480]
64. Special feature: direct-to-consumer advertising. Med Mark Media. 1996;15:8.
65. Piturro M. D-T-C thrives. Managed Health Care News. 1998;14:1.
66. Young D. FDA examines direct-to-consumer advertising data. Am J Health Syst Pharm. 2003;60:2420–1.[PMID: 14686217]
67. Basara LR. The impact of a direct-to-consumer prescription medication advertising campaign on new prescription volume. Drug Inf J. 1996;30:715–29
68. Larner AJ. Use of Internet medical websites and of NHS direct by neurology outpatients before consultation [abstract]. J Neurol Neurosurg Psychiatry. 2002;72:140.
69. Silberg W, Lundberg GD, Musacchio RA. Assessing, controlling, and assuring the quality of medical information on the Internet. JAMA. 1997;277:1244–5.[PMID: 9103351]
70. Wyatt J. Measuring quality and impact on the world wide web. BMJ. 1997;314:1879–81.[PMID: 9224133]
71. Practice and Policy Guidelines Panel, National Institutes of Health Office of Alternative Medicine. Clinical practice guidelines in complementary and alternative medicine an analysis of opportunities and obstacles. Arch Fam Med. 1997;6:149–54.
72. McQueen CE, Shields KM, Generali JA. Motivations for dietary supplement use. Am J Health Syst Pharm. 2003;60:655.[PMID: 12701546]
73. Pal S. Herbal sales reach mainstream market. US Pharm. 1999;24:12.
74. Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990–1997: results of a national survey. JAMA. 1998:280:1569–75.
75. Shields KM, McQueen CE, Bryant PJ. National survey of dietary supplement resources at drug information centers. J Am Pharm Assoc. 2004;44:36–40.[PMID: 14965151]
76. West PM, Lodolce AE, Johnston AK. Telephone service for providing consumers with information on herbal supplements. Am J Health Syst Pharm. 2001;58:1842–6.[PMID: 11596701]
77. Meade V. Patient medication information hotlines multiply. Am Pharm. 1991;NS31:569–71.
78. Troutman WG. Consensus-derived objectives for drug information education. Drug Inf J. 1994;28:791–6.
79. Ferrill MJ, Norton LL. Drug information to biomedical informatics: a three tier approach to building a university system for the twenty-first century. Am J Pharm Edu. 1997;61:81–6.
80. Gora-Harper ML, Brandt B. An educational design to teach drug information across the curriculum. Am J Pharm Educ. 1997;61:296–302.
81. Miller S, Clarke A. Impact of postdoctoral specialty residencies in drug information on graduates' career paths. Am J Health Syst Pharm. 2002;59:961–3.[PMID: 12040736]
82. Forrester LP, Scoggin JA, Valle RD. Pharmacy management company-negotiated contract for drug information services. Am J Health Syst Pharm. 1995;52:1074–7.[PMID: 7656096]
83. Fox ER, Tyler LS. Managing drug shortages: seven years' experience at one health-system. Am J Health Syst Pharm. 2003;60:245–53.[PMID: 12613233]
84. Woodruff AE, Hunt CA. Involvement in medical informatics may enable pharmacists to expand their consultation potential and improve the quality of health care. Ann Pharmacother. 1992;26:100–4.[PMID: 1606329]
85. Vanscoy GJ, Gajewski LK, Tyler LS, Gora-Harper ML, Grant KL, May JR. The future of medication information practices: a consensus. Ann Pharmacother. 1996;30:876–81.[PMID: 8826577]
86. Warren PN. Pharmacists to the fore. Managed Health Care News. 1997;13:20H–20I.
87. Zinberg S. Practice guidelines—a continuing debate. Clin Obstet Gynecol. 1998;41:343–7.[PMID: 9646966]
88. Field JM, Lohr KN, editors. Guidelines for clinical practice: from development to use. Washington, DC: National Academy Press; 1992.
89. Harrison MAJ, Draugalis JR, Slack MK, Langley PC. Cost-effectiveness of regional poison control centers. Arch Intern Med. 1996;156:2601–8.[PMID: 8951304]
90. Gong SD, Millares M, VanRiper KB. Drug information pharmacists at health-care facilities, universities, and pharmaceutical companies. Am J Hosp Pharm. 1992;49:1121–30.[PMID: 1595739]
91. Riggins JL. Pharmaceutical industry as a career choice. Am J Health Syst Pharm. 2002;59:2097–8.[PMID: 12434723]
92. Overstreet KM. Medical education and communication companies: career options for pharmacists. Am J Health Syst Pharm. 2003;60:1896–7.[PMID: 14521042]
93. Moghadam RG. Scientific writing: a career for pharmacists. Am J Health Syst Pharm. 2003;60:1899–1900.[PMID: 14521044]
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Wednesday, March 26, 2008
Pharmaceutical Industry
The pharmaceutical industry provides many career opportunities for pharmacists in a variety of areas including drug discovery, product development, information technology, training and development, scientific communications, health outcomes research, regulatory affairs, professional affairs, medical information services, and clinical research. Within the area of medical information services, the pharmacist participates in typical types of activities such as answering drug information questions, reporting and monitoring ADRs, and providing information support to other departments. Other positions in medication information services include disease specialist, health outcomes associate, labeling associate, and medical or scientific writer. Pharmacists providing medication information in the pharmaceutical industry may also provide support for individuals responsible for drug formularies or participate in quality improvement efforts with the medication use process. In addition to providing written information on the drug product produced by the manufacturer, there are opportunities to provide additional information at pharmacy and therapeutics committees or state drug use review (DUR) boards. Pharmaceutical companies have extensive scientific data on their products; some of which are not available through other published sources or may require a formal FOI (freedom of information) request. Medication information specialists may also serve as reviewers for journal articles, evidence-based guidelines, and published drug monographs. Medication information specialists may interact with sales and marketing, participate with regulatory affairs issues, and handle product complaints.
Pharmacists with specialized training can take a leadership role in evaluating current research, helping to manage ongoing research, or designing studies to help answer questions about new indications for future use of the product. The impact of new medications on the health care environment is also felt within the pharmaceutical industry. The area of health outcomes research is fairly new and growing and offers tremendous opportunity for pharmacists to share their knowledge of the health care environment, research design, technology, and economics from the perspective of the pharmaceutical industry. As the sophistication of drug products and information management (e.g., electronic new drug applications [NDAs]) has increased, so have the opportunities for pharmacists to practice in the pharmaceutical industry and focus on using the skills of a medication information specialist.
Pharmacists with specialized training can take a leadership role in evaluating current research, helping to manage ongoing research, or designing studies to help answer questions about new indications for future use of the product. The impact of new medications on the health care environment is also felt within the pharmaceutical industry. The area of health outcomes research is fairly new and growing and offers tremendous opportunity for pharmacists to share their knowledge of the health care environment, research design, technology, and economics from the perspective of the pharmaceutical industry. As the sophistication of drug products and information management (e.g., electronic new drug applications [NDAs]) has increased, so have the opportunities for pharmacists to practice in the pharmaceutical industry and focus on using the skills of a medication information specialist.
Poison Control
Poison information is a specialized area of medication information with the practitioner typically practicing in an accredited poison information center or an emergency room. Similar to the mission of traditional drug information centers, poison information centers exist to provide accurate and timely information to enhance the quality of care of patients. There are, however, several differences between a traditional drug information center and poison control center. Health professionals generate most consultations received in drug information centers, whereas, in a poison control center, most are generated from the public. Poison information centers must be prepared to provide information on the management of any poison situation, including household products, poisonous plants and animals, medications, and other chemicals. Because of the type of information that the specialist provides, nearly all requests for information to a poison control center are urgent, with an average response time of 5-minutes, compared to anywhere from 30 minutes to days for drug information centers depending on the urgency of the call and complexity of information required. A specialist in poison information therefore requires expertise in clinical toxicology, as well as an ability to obtain a complete history that correctly assesses the potential severity of exposure, an understanding of where to search for this type of information, and the ability to communicate the information and plan in a comprehensive, concise, and accurate manner to consumers with varied levels of education. Because of the unique expertise of this type of specialist, a national certification examination is offered through the American Association of Poison Control Centers (AAPCC, http://www.aapcc.org/). In addition to a poison control center providing information regarding individual patients, centers in the United States also contribute data to a larger program through the Toxic Exposure Surveillance System (TESS), which is coordinated by the AAPCC. These data can be used to compare safety profiles for similar products, to develop risk assessment guidelines for specific substances, to target national prevention programs, and to conduct postmarketing surveillance on products (e.g., chemicals).
Despite the impact that regional poison control centers have on reducing morbidity and mortality with poison exposures, they are also facing increasing emphasis on economic justification. One study used decision analysis to compare the cost-effectiveness of treatment of poison exposures with the services of a regional poison control center to treatment without access to any poison control center. The average cost per patient treated with the services of a poison control center was almost half of that achieved without services of a poison control center. These results were consistent regardless of exposure type, average inpatient and emergency department costs, and clinical outcome probabilities.
Despite the impact that regional poison control centers have on reducing morbidity and mortality with poison exposures, they are also facing increasing emphasis on economic justification. One study used decision analysis to compare the cost-effectiveness of treatment of poison exposures with the services of a regional poison control center to treatment without access to any poison control center. The average cost per patient treated with the services of a poison control center was almost half of that achieved without services of a poison control center. These results were consistent regardless of exposure type, average inpatient and emergency department costs, and clinical outcome probabilities.
Health Maintenance Organizations (HMOs)/Pharmacy Benefit Management Organizations (PBMs)/Managed Care Organizations (MCOs)
A key opportunity identified in a strategic planning meeting in 1994 by the Consortium for the Advancement of Medication Information, Policy and Research (CAMIPR) was the growing role for medication information specialists in the area of medication policy development/research and technology. Since pharmaceuticals account for approximately 10% of health care dollars, which is up from 7% 5 years earlier, this offers tremendous opportunities for the medication information specialist to provide leadership in the development and implementation of mechanisms to support the cost-effective selection and use of medications in HMOs, PBMs, and managed care organizations. The specialist may coordinate activities relating to formulary development and implementation, ADE reporting and analysis, and therapeutic guideline development. Medical and pharmaceutical outcomes research has been an increasing interest among health care providers, payers, and regulatory agencies. With appropriate training (e.g., specialized residency in medication information practice or managed care experience) and expertise, opportunities are growing for the medication information specialist in the insurance industry, HMOs, managed care organizations, pharmacy benefits management companies, state and national government agencies (e.g., Medicaid and Medicare), as well as other groups interested in the cost-efficient use of medications.
A pharmacist in any of these organizations has the opportunity to evaluate new information for medications on the market and assess its true value in a target group of patients. Prior to approval by the FDA, drugs undergo testing in a limited number of patients. Once approved, experience in patients escalates and previously unrecognized, rare adverse events may be identified. The drug may also be found to be useful for conditions not described in the labeling. Perhaps one of the most important functions of postmarketing surveillance is in the area of ADR reporting. This type of analysis can answer questions about drug interactions, identify potential new indications for the product, and study patients in a broader population. Organizations with a relatively large patient population offer opportunities to study these issues under the leadership of a medication information specialist.
Opportunities also exist to establish guidelines for selected disease states (e.g., management of patients with diabetes mellitus) or classes of drugs (e.g., selection of appropriate antibiotic for surgical prophylaxis). Practice guidelines are becoming an increasingly important part of the biomedical literature. These clinical guidelines are systematically developed to assist practitioners and patients with decisions about health care in an effort to improve the quality and consistency of health care while minimizing costs and liability. Evidence-based practice guidelines are developed through systematic reviews of the literature appropriately adapted to local circumstances and values. Key questions to consider when reviewing a practice guideline have been proposed. These questions primarily rely on how accurately the guideline reflects the research used to produce it. More information on therapeutic guidelines can be found in .
A pharmacist in any of these organizations has the opportunity to evaluate new information for medications on the market and assess its true value in a target group of patients. Prior to approval by the FDA, drugs undergo testing in a limited number of patients. Once approved, experience in patients escalates and previously unrecognized, rare adverse events may be identified. The drug may also be found to be useful for conditions not described in the labeling. Perhaps one of the most important functions of postmarketing surveillance is in the area of ADR reporting. This type of analysis can answer questions about drug interactions, identify potential new indications for the product, and study patients in a broader population. Organizations with a relatively large patient population offer opportunities to study these issues under the leadership of a medication information specialist.
Opportunities also exist to establish guidelines for selected disease states (e.g., management of patients with diabetes mellitus) or classes of drugs (e.g., selection of appropriate antibiotic for surgical prophylaxis). Practice guidelines are becoming an increasingly important part of the biomedical literature. These clinical guidelines are systematically developed to assist practitioners and patients with decisions about health care in an effort to improve the quality and consistency of health care while minimizing costs and liability. Evidence-based practice guidelines are developed through systematic reviews of the literature appropriately adapted to local circumstances and values. Key questions to consider when reviewing a practice guideline have been proposed. These questions primarily rely on how accurately the guideline reflects the research used to produce it. More information on therapeutic guidelines can be found in .
Medical Informatics in a Health System
With the growth and development of new technologies (e.g., information systems), there are tremendous opportunities for an informatics specialist—an individual who has advanced medication information skills with a keen understanding of computer and information technology. This individual can help support the concepts of pharmaceutical care by improving the efficiency of workflow and increasing access to patient-specific information and the medical literature through technology by remote-site availability. This individual may also be involved in the area of institutional drug policy management. As more information is computerized (e.g., medical records), data that were accessible only through a paper record will be available for those professionals who understand the type of data that are needed for quality improvement efforts, and are able to get information efficiently out of the system. As database designs evolve and become user friendly and computer systems become more sophisticated, there are increasing opportunities for applying computer technology using clinical decision support systems to enhance many aspects of the medication use process. Clinical decision support systems can integrate patient-specific information, perform complex evaluations, and present this information to a clinician in a timely manner. These systems can be used to support initiatives with ADR reporting and analysis programs, formulary management, and continuous quality improvement efforts.
Opportunities in Specialty Practice
As the role of the practicing pharmacist changed regarding medication information activities, so has the role of the specialist. The role of the medication information specialist has changed from an individual who specifically answers questions to one who focuses on the development of medication policies and provides information on complex medication information questions. A specialist in medication information can provide leadership in a contract drug information center, medical informatics, health maintenance organizations (HMOs) and pharmacy benefit management organizations (PBMs), managed care organizations, scientific writing and medical communications, poison control, pharmaceutical industry, and academia. In a recent survey that examined the career paths of pharmacists who completed a drug information specialty residency in 2000 and 2001, the types of careers were diverse. However, the most common positions were in industry (32%), academia (21%), medical writing (12%), and as a specialist in an institution (9%). A specialist in medication information can be involved in multiple activities in establishments listed in the following section.
Contract Drug Information Center (Fee-for-Service)
The need for accurate information pertaining to drug therapy is more acute today than ever before in the history of health care. One estimate suggests that prescription drug expenditures will increase at an average rate of 11.1% between 2002 and 2012. Within the next decade health care costs will increase at an alarming rate, with total expenditures reaching the $2.1 trillion mark. A majority of these costs will be shouldered by the private sector with a significant increase in prescription drug costs. Drug information practitioners are in an enviable position to provide a service that will improve patient outcomes and decrease health care costs through the provision of unbiased information that supports rational, cost-effective, patient- and disease-specific drug therapy. One of the best ways to deliver such information is by contracting with a drug information service with formally trained health care professionals. Potential clients include managed care groups, contract pharmacy services, pharmacy benefits managers, buying groups, small rural hospitals, chain pharmacies, and independent pharmacies. Several different fee structures have been used. A client may be charged a simple fee per question, or may be offered a detailed menu of services (written medication evaluations, continuing education programs, guideline development for particular diseases) with the final cost dependent on the number and types of services chosen by the contracting party.
Services provided within these contracts may include providing answers to drug information requests, preparation of new drug evaluation monographs, formulary drug class reviews, development of MUE criteria, providing journal reprints, pharmacoeconomics evaluations, writing a pharmacotherapy newsletter, and providing continuing education programming. Additional services the center may make available are access to online resources, access to in-house question files for sharing information on commonly asked questions, and direct access to the center's Internet home page for review of medical use evaluations, formulary reviews, and newsletters. One center reports providing information on drug shortages to the American Society of Health-System Pharmacists through a grant. Frequently, the contracting drug information center also has responsibilities for pharmacy services (drug information, drug policy) as part of an entire health system.
Contract Drug Information Center (Fee-for-Service)
The need for accurate information pertaining to drug therapy is more acute today than ever before in the history of health care. One estimate suggests that prescription drug expenditures will increase at an average rate of 11.1% between 2002 and 2012. Within the next decade health care costs will increase at an alarming rate, with total expenditures reaching the $2.1 trillion mark. A majority of these costs will be shouldered by the private sector with a significant increase in prescription drug costs. Drug information practitioners are in an enviable position to provide a service that will improve patient outcomes and decrease health care costs through the provision of unbiased information that supports rational, cost-effective, patient- and disease-specific drug therapy. One of the best ways to deliver such information is by contracting with a drug information service with formally trained health care professionals. Potential clients include managed care groups, contract pharmacy services, pharmacy benefits managers, buying groups, small rural hospitals, chain pharmacies, and independent pharmacies. Several different fee structures have been used. A client may be charged a simple fee per question, or may be offered a detailed menu of services (written medication evaluations, continuing education programs, guideline development for particular diseases) with the final cost dependent on the number and types of services chosen by the contracting party.
Services provided within these contracts may include providing answers to drug information requests, preparation of new drug evaluation monographs, formulary drug class reviews, development of MUE criteria, providing journal reprints, pharmacoeconomics evaluations, writing a pharmacotherapy newsletter, and providing continuing education programming. Additional services the center may make available are access to online resources, access to in-house question files for sharing information on commonly asked questions, and direct access to the center's Internet home page for review of medical use evaluations, formulary reviews, and newsletters. One center reports providing information on drug shortages to the American Society of Health-System Pharmacists through a grant. Frequently, the contracting drug information center also has responsibilities for pharmacy services (drug information, drug policy) as part of an entire health system.
Educating for the Need
The education of pharmacists continues to evolve in scope and depth. Many areas identified as needed by the drug (medication) information specialist are now incorporated into pharmacy curricula and taught to all pharmacists. In 1991, a consensus conference in New Mexico was held to define a set of objectives for didactic and experiential training in drug information for the year 2000. Twenty-three educators and practitioners participated in the conference. There were several key concepts that were developed including (1) drug information should be a required component of the pharmacy curriculum and include both didactic and competency-based experiential components (2) drug information concepts and skills should be spread throughout the curriculum, beginning the day students enter pharmacy school and (3) problem solving should be a major technique in drug information education, with the goal of developing self-directed learners. Developing these skills should provide the foundation for the pharmacist to be a lifelong learner and problem solver. Based on the work of this conference, as well as changes in the health care system, and the movement toward outcome-based education, colleges of pharmacy are redesigning their curricula to provide a more comprehensive and integrated approach to teaching medication information concepts and skills. Communication skills are taught formally to facilitate the pharmacist's ability to transmit information to both health professionals and patients. Medication information and policy development are integrated throughout the three goal areas addressed in the pharmacy practice residency standards. Specialty practice residencies in medication information are also available in a variety of practice sites at (http://www.ashp.org/directories/residency/).
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