Modified Systematic Approach to Answering J A M I L A H A L S A I D A N, M S C.
Learning Outcomes: Discuss the modified systemic approach to providing answers to questions Determination of the most important background information Categorizing the ultimate question Developing an efficient search strategy
Learning Outcomes cont.: Utilization o the most relevant and up to date data found from the search Formulating an appropriate response Listing categories of drug information questions that are appropriate for follow up
Introduction Answering questions effectively, posed by the public or by other HCP, is an essential component of pharmacy practice. In 1975, Watanabe et al. presented a systematic approach for responding to drug information requests. It included five steps. The systematic approach has since been modified by Host and Kirkwood to include seven steps. However, the basic concepts of Watanabe et al. have remained the gold standard for answering DI queries.
The modified systematic approach has adapted by others and used for the combined purposes of quality assurance and student evaluation in clerkships. The systematic approach principles have been utilized in assuring quality for drug information responses, training in drug information skills, as well as in developing and enhancing programs.
Is the utility of the modified systematic approach limited to the confines of a drug information center? These approaches can be applied in any area while practicing pharmacy, including community pharmacy, industrial pharmacy, institutional pharmacy management, as well as general application in any type of professional institution.
Systematic Approach (1975) Step I: Step II: Step III: Step IV: Step V: Classification of the request Obtaining background information Systematic search Response Reclassification From Watanabe et al, 1975
Modified Systematic Approach (1987) Step I Secure demographics of requestor Step II Obtain background information Step III Determine and categorize the ultimate question Step IV Develop strategy and conduct search Step V Perform evaluation, analysis and synthesis Step VI Formulate and provide response Step VII Conduct follow up and documentation Source: From Host and Kirkwood
Step One: Securing Requestor Demographics Accept the initial question The way the question is presented, as well as the question subject matter itself provide some insight but this is not enough It is important to directly determine the requestor s: -Position- training- anticipated knowledgesecuring a mechanism for the delivery of the response
Step One: Securing Requestor Demographics cont. The professional background of the caller dictates the depth or focus of research to be conducted and determines the language to be used in the formulation of the final response
Step One: Securing Requestor Demographics cont. Example pt and CV specialist asking about drug availability (investigational medication) Different frame of reference to the request The approach to the request and the final response will differ to each requestor. Mechanism for delivery of the response Verbal Written Phone Number (s), Pager Fax number, mailing address (can be postal address or location, email address)
Step Two: Obtain Background information: Essential to using the modified systematic approach Historically, this is the most difficult step (for both students and practicing pharmacists) When has adequate background information been obtained? When an individual can truly answer the question why is the requestor asking for this information The background information must be sufficiently comprehensive
Step Two: Obtain Background information cont. The questions must be appropriate for the circumstances General information is necessary (condition, or academic) Other questions specific to the nature of the request Background information, when performed optimally, should be a dialogue Rarely will one obtain adequate background information by forcibly demanding such information
General questions for obtaining background information: The requestor s name The requestor s location/ or pager number The requestor s affiliation (institution or practice) if HCP The requestor s frame of reference (i.e., title, profession, occupation or rank) The resources that the requestor already consulted Whether the request is patient specific or academic The patient s diagnosis, other medications, and pertinent medical information The urgency of the request (i.e., negotiate the time response) Refer to Appendix 2-3 in textbook for specific questions Source- Adapted from Table 2-3, Textbook
Step Two: Obtain Background information cont. The resources that the requestor already consultedthis is often neglected or overlooked. However it can help determine the baseline sophistication of the requestor as well as to verify the information present in that resource. With practice, obtaining background information can become a polished skill and this information utilized appropriately to respond efficiently to questions.
Step Two: Obtain Background information cont. Special challenge for obtaining background information: Requestors who are intermediaries in the transfer of information. Not the true end of the response Intermediaries may include: Look it up!!!! When dealing with intermediaries, one must decide to work with them OR bypass them One should not allow an intermediary with incomplete or inaccurate background information to drive the consultative process
Step III Determine and categorize the ultimate question: Determination of the ultimate question is important in the utilization of the systematic approach It depends largely on the adequacy of the background information obtained It is very important that the requestor confirms the ultimate question prior to categorization and the development of a search strategy
Step III Determine and categorize the ultimate question: Sometimes the pharmacist should know why the question is being asked, and whether it is patient related This should be done tactfully without sounding condescending (arrogant, snobbish) Common goal of attaining and answering the requestors query
Step III Determine and categorize the ultimate question: Once the ultimate question is decided and acknowledged, the question is categorized Categorization is useful:- initial development of search strategy, determination of resources and maintenance of staff training Categorization schemes vary from one practice to another
Determine the ultimate question Categorize the ultimate question Search strategy
Step IV Search Strategy: Once the ultimate question is categorize, it will prompt search in the proper resource E.g.- if question categorized as adverse effect, the adverse effect oriented resources will be used Then resources are prioritized according to probability it will contain the information/data, NOT prioritized according to ease of use
Step V: Perform evaluation, analysis and synthesis At this step, the information retrieved must be objectively critiqued Critique and evaluate literature using special skills When done properly will differentiate the professional from the technician Analysis of the found information must be done with the requestor demographics in mind, as well as the category of the question to ensure that the answer formulated will be useful and relevant.
VI: Formulation and Provision of Response: As a consultant, one has a professional responsibility to clearly inform the requestor when one course of action is clearly more desirable than another. Although we can not know for certain how another individual will use the information provided, as responders we should think about how the soon to be provided information will be used If literature contains conflicting data that must be presented to the requestor, a logical argument should be supplied (EVIDENCE)
VI: Formulation and Provision of Response cont: This is important so as to place the complete scenario in front of the decision maker(person who asked the question) and not lose the trust in the future or appear biased
VI: Formulation and Provision of Response cont.: The final provided response should be : succinct (concise) but comprehensive be provided in a timely manner, At a level that the requestor can appreciate and understand, correct spelling and grammar If verbal response used, make sure presented confidently, correct pronunciation
VI: Follow Up and Documentation: Follow up is the process of verifying the appropriateness, correctness, and completeness of a response following communication Certain circumstances necessitate follow up: Patient specific requests (therapeutic assistance or dosing recommendations) Providing follow up has led to decisions that can enhance future provision of information
VI: Follow Up and Documentation cont.: Follow through is the process of readdressing a request based on the availability of new data or a change in the situation or circumstances that were decisive in the formulation of the first response Perceived as good practice E.g. Decision to use Novel Therapy
VI: Follow Up and Documentation cont.: Thorough documentation is essential for reducing liability and potentially promoting the development of a continual service As a simple form or extensive summary of the response including steps taken and resources utilized 1; Ultimate question 2; the material searched (with findings) 3; the response 4; Follow up (if any)
VI: Follow Up and Documentation cont.: Documentation might be necessary for reimbursement or payment issues Liability and legal issues Documentation of patient outcomes (improved or deteriorate) Purpose of Statistics
In conclusion, despite the differences in practice modes and availability of resources, the systematic approach made in 1975 is applicable today Of course has gone some modifications but the logic behind the original approach still holds true.