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Karen Lacey

Rheumatoid Arthritis. Cystic Fibrosis. Anorexia Nervosa and Bulimia Nervosa. Polypharmacy of the Elderly 6. Hypertension and Cardiovascular Disease.

Myocardial Infarction. Gastroesophageal Reflux Disease. Ulcer Disease: Medical and Surgical Treatment. Infectious Diarrhea with Resulting Dehydration. Celiac Disease. Diverticulosis with Incidence of Diverticulitis. Chronic Pancreatitis Secondary to Chronic Alcoholism. Acute Hepatitis. Cirrhosis of the Liver with Resulting Hepatic Encephalopathy. Chronic Obstructive Pulmonary Disease. Type 1 Diabetes Mellitus. Type 2 Diabetes Mellitus.

Gestational Diabetes Mellitus. Renal Transplant.

Introduction

Metabolic Stress and Trauma. Lymphoma Treated with Chemotherapy. The other drug information center of the country is established in at Gondar university specialized hospital GUSH in the northwestern Ethiopia. It is among the pioneer four drug information centers established in the country which are also affiliated with universities and teaching hospitals 4.

Drug information services refers to a service that encompasses the activities of specially trained individuals to provide accurate, unbiased, factual drug information, primarily in response to patient-oriented problems 5 , 6. These days, there has been a rapid expansion in the number and diversity of pharmaceutical market available, complexity of medication therapy, and the need for evidence-based patient treatment.

It all leads to increased demand of consultation regarding therapeutic indication, medicine selection, comparative effectiveness and safety, proper medication use with current evidences and updated literatures. With the existence of abundant literatures as source of drug information, quality is very crucial aspect to utilize the evidence in the clinical setting with paramount confidence 7.

The quality of drug information is determined by its accessibility, reliability, completeness, and applicability to the most of practice perspectives 8.

Therefore, trained professionals needed to ensure the information quality and to make decisions on resource selection, extraction, analysis of drug information and apply the evidences in context of the real practice from the large pool of available data. With this regard, drug information centers have tremendous role as source of applicable and reliable drug information for healthcare settings with professional information filtering and censorship through applying Watanabe et al. The current healthcare practice demands shared clinical decisions of all involved healthcare practitioners and patients.

This might put multiple healthcare discipline professionals and patients in mutual collaboration, need of evidence-based information and medicine. This will help in improved patient adherence and health outcome aided by the receiving of relevant and tailored medicines information which has been developed to high quality standards 1.

Medical Nutrition Therapy: A Case Study Approach / Edition 3

The drug related information demand, pattern of enquiry, functionality and improvement of existing drug information centers are seldom studied in Ethiopia. Hence, such kind of study on drug information queries were supposed to assess the type of requests and medicine information seeking behaviors in the healthcare setup. Gondar University Specialized Hospital GUSH is a teaching tertiary hospital serves for 7 million people in the catchment area of northwest Ethiopia and comprised more than beds for admitted patients.

The hospital has medical, surgical, pediatrics, gynecology-obstetrics, oncology, emergency, ambulatory, dental, ophthalmic, psychiatric departments and various pharmacy units. The drug information center DIC at GUSH is staffed with one trained full-time drug information pharmacist and a library consisting of textbooks, guidelines and equipped with computers and internet facilities along with databases such as Up-to-date.

It is also a practice site for the graduating class pharmacy students every year as part of the clinical clerkship attachment. The DIC was both pharmacist and student-run service since it is practical site for pharmacy students for their DIC clinical clerkship.

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They were providing drug information service for clients under the supervision of the drug information pharmacist and the clinical preceptor. The study query was collected through 2 batches of graduating class of undergraduate pharmacy students as partial fulfilment their drug information clerkship evaluation.

This clerkship attachment was rotation of every 2 weeks for group of 5 students throughout the academic year except July and August which was student vacation. Every student is supposed to collect 8 queries in their 2-week attachment at drug information center by distributing the drug information query forms in different hospital wards, inpatients, physician morning sessions, medical rounds and pharmacies.

Then the students are evaluating the query form through systematic modified approach and provides the appropriate response as wanted via verbal, written, supplying literature or referring under the supervision of drug information pharmacist and approval of clinical pharmacy preceptors who is mentoring at DIC.

The students got appropriate orientation and guidance on the first two days of their DIC attachment about drug information query collection, search strategies, literature evaluation and replying process through modified systematic approach of drug related queries as it is one of their robust academic evaluation processes in DIC. They are not informed about it would use for further research purpose beyond the academic evaluation and the routine practice.

The students were not aware of the ongoing observations in order to prevent bias towards the outcome under investigation. The principal investigator did not interfere in the reference selection, way of responding and other drug information service activities except the mentorship and supervision of the whole process during drug information service provision.

The principal investigator only observes the usual query collection, flow of drug information, provides appropriate orientation and academic guidance as per the request. Quality assessment was done for the completeness and originalities of each query. The responses provided checked and ensured whether it reached for the requester. All incomplete query forms which missed two or more variables were not included to this study.

The drug information query form was developed by the team of pharmacists and lecturers from the drug information center and school of pharmacy, University of Gondar. The query form is used for the routine drug related request service comprised with various components of the socio-demographic characteristics of the requestors, the relevant specific patient clinical parameters History, medication regimen, diagnosis, pertinent laboratory findings are among others , the actual drug information request, classification of the request, references consulted, the type of query and researching hour was included.

Statistical analyses were performed using the Statistical Package of the Social Sciences software, version Descriptive statistics used to describe, characterize and classify queries with various elements. Binary logistic regression test was employed to identify predictor variables to type of queries in terms of patient specificity. P-value less than 0.

The study was initiated after obtaining ethical clearance approval from ethical review committee of the school of pharmacy, University of Gondar. The ethical approval was given in accordance with the World medical association declaration of Helsinki- Ethical principles for medical research involving human subjects and the national research ethics review guideline adoption to institutional review boards of Ethiopia.

No personal identifiers were included in the study; socio-demographics of requestors and their questions kept anonymous. Written informed consent was not requested prior to the data collection from the drug related query requestors since it could affect the outcome under investigation.

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But at later stage of the data collection, informed verbal consent was obtained to use the data provided under observation. A total of drug information queries collected in the 2 years period and included in the final analysis. Mean age and weight of the patients in the drug related query was Nearly all Slightly greater than half In-house databases More than half More than a third Nearly one in five Of which, nearly a quarter Most Qualification was the only predictor variable associated to ask either patient specific case queries or general type of questions.

Pharmacists and patients ask patient specific questions in their drug related queries 2. The drug information center training and service provision could be an effective model for teaching evidence-based healthcare to pharmacy students to equip them with the necessary practical skills and knowledge. Students could feel better prepared for their future role as pharmacists because of the knowledge and skills acquired in the practical drug information services during their internship. This learning approach in undergraduate pharmacy education was found to be effective While at the university of Tennessee in the weekly active learning activities in a Drug information and literature evaluation course, students reported that active-learning strategies contributed to their knowledge of materials covered in the Drug Information and Literature Evaluation This observational study identified and characterized the type of drug related inquiries presented in drug information center of Ethiopian university hospital to highlight the practice, need and extent of service provision.

Relative majority This might indicate their good awareness of the available drug information services in the setting. On the other end, clinical pharmacy service is introduced in the hospital wards which might laid pharmacists in forefront of drug information consultation and in turn increase their drug related enquiry 10 , It is quite less than from the multicenter study conducted in Ethiopia which stated Lower utilization of the DICs in Ethiopia by the patients might be due to poor awareness to existing drug information services, lower literacy level and skimpy health seeking behavior.

But the anticipated patient drug related necessity is broader in scope and heterogeneous in its type which will need unreserved effort and demonstrative promotions 15 , 18 , 20 , Almost all requests were obtained directly by visit and most of them were replied orally. This might be the students who visit in the hospital wards, medical mornings and different pharmacy units would probably enable healthcare workers to submit their drug related query while the students proactively invited them for any drug related request. Though it was student facilitated query, it could tell workplace demands of drug information request was high which might suggest periodic work place visit.

Drug information pharmacists should visit different units with in the hospital apart from DIC to collect drug related queries and meet the drug information demand of healthcare professionals. Besides to these, low percentage of requests coming through phone and email in this study showed that quite extensive procedures might discouraged them to meet the drug related needs via such long process.

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Perhaps, it could be justified since there were plenty of options to get drug information with in shorter period of time through personal digital assistances such as mobile apps, internet and other online sources Tertiary drug information sources were used as the most utilized references to respond in the most Of which in-house databases like Up-to-date, internet sites and textbooks were the main references used during the period of this study.

Up-to-date version The Micromedex software license subscription has been used before and expired these days at the DIC of GUSH which might cause the shift to use the more feasible and accessible in-house databases such as Up-to-date and other text books.