A Retrospective Analysis of InpharmD's Drug Information Inquiries


A Retrospective Analysis of InpharmD's Drug Information Inquiries 

Background:

Drug information is a specialty area within the realm of clinical pharmacy that has evolved as technology and clinical practice have changed over time. Due to the nature and complexity of clinical literature, there is a need for the refinement of drug information practice standards as a whole. Notably, a standard taxonomy to classify drug information inquiries is lacking. With a standard taxonomy, drug information specialists have the potential to better understand the information needs arising in practice, leading to improved literature search, formulation of inquiry responses, and development of future clinically-focused materials. By categorizing drug information inquiries within InpharmD’s repository according to a standard taxonomy, we have the ability to determine the greatest clinical needs of healthcare providers.

Objective and Design:
A retrospective, database analysis was conducted to analyze the types and frequencies of drug information inquiries posed by healthcare practitioners in an institutional and ambulatory setting. Healthcare practitioners included physicians, physician’s assistants, pharmacists, nurse practitioners, and public health advocates. Drug information inquiries were posed using InpharmD’s mobile- and web-based drug information platform that provides on demand answers to drug information inquiries.

Methodology:
Analyses consisted of two separate commercial pilots, each with an individual health system, and two extended analyses (3-months and 4-months) composed of all inquiries posed by users from any health system during the time period. Inquiries were compiled retrospectively via InpharmD’s platform by the development team, and questions were subsequently classified according to a prespecified taxonomy based on a ‘researchable question’ (the interpretation of the clinicians’ inquiry by the drug information specialist). COVID-related questions were also identified due to the timing of the analysis and presence of COVID within the healthcare landscape. When a compound question was encountered or when multiple drug information questions were asked within the same inquiry, the inquiry was duplicated based on the number of inquiries asked within the single submission in order to evaluate each part of the question individually. The following taxonomy was utilized to classify questions and determine the quantity of each question type:

1 Diagnosis

            1.1 Cause/interpretation of symptom

            1.2 Lab tests/diagnostic scales

2 Treatment

            2.1 Drug treatment related questions

                        2.1.1 Dosage/Pharmacokinetics

                        2.1.2 Drug of choice/Efficacy/Comparative efficacy

                        2.1.3 Adverse events/Safety/Comparative safety

                        2.1.4 Interactions

                        2.1.5 Miscellaneous

                                    2.1.5.1 Compounding

                                    2.1.5.2 Stability

                                    2.1.5.3 Administration

                                    2.1.5.4 Physical characteristics

                                    2.1.5.5 Mechanism of action

                                    2.1.5.6 Cost

                                    2.1.5.7 Pharmacogenomics

                                    2.1.5.8 Shortage

                                    2.1.5.9 Patient education          

            2.2 Non-drug treatment related questions

3 Epidemiology

            3.1 Prevalence/incidence

            3.2 Causation/association

            3.3 Course/prognosis

4 Nonclinical

5 P&T

            5.1 Monograph

            5.2 Class review

            5.3 Miscellaneous

  

Results:
A total of 249 and 154 drug information inquiries were registered within the InpharmD drug information platform during the first (March 30, 2021 to August 31, 2021) and second (November 4, 2021 to February 1, 2022) commercial pilots. A total 781 and 509 drug information inquiries were posed during the 4-month extended analysis (March 1, 2021 to June 30, 2021) and 3-month extended analysis (November 4, 2021 to February 1, 2022), respectively. Treatment-related questions (category 2 of taxonomy) were the most frequently asked during the first commercial pilot (n= 209), while epidemiology questions (category 3 of taxonomy) were the least frequently asked among analyzed inquiries (n= 7). Of treatment-related inquiries, questions relating to drug efficacy (category 2.1.2 of taxonomy) were the most frequently asked (n= 80). Similarly, treatment-related questions (n= 135) were the most frequently posed inquiries during the second commercial pilot. However, of treatment-related questions, inquiries related to dosage/pharmacokinetics (category 2.1.1 of taxonomy) were most frequently asked (n= 48). Both the 4-month and 3-month analyses also observed the most frequent inquiry type to be treatment-related (n= 610 and n= 477, respectively). Inquiries related to efficacy were the most frequent treatment-related drug information requests during both the 4-month and 3-month analyses (n= 232 and n= 188, respectively). A total of 37 and 28, compound questions were asked during the first and second commercial pilots, respectively, while a total of 110 and 31 compound questions were asked during the 4-month and 3-month analyses, respectively. COVID-related questions were fairly infrequent. Notably, P&T inquiries were common during all analyses due to InpharmD incorporating P&T as an available service for users.

Discussion and Limitations:
This analysis is limited by its retrospective design and subjective classification of drug information inquiries. Additionally, several taxonomy categories contained multiple subclasses that were related, which was used to simplify data collection, however, future analyses would likely benefit from separating out these subclasses (e.g., category 2.1.2 Drug of choice/Efficacy/Comparative Efficacy). The analysis periods were short compared to the overall life of InpharmD’s drug information database operation. Regardless, with a large percentage of efficacy-related questions in each analysis period, it can be assumed that the most frequent type of question likely wouldn’t if analyzed over a vaster length of time. Inquiries were not asked by a homogenous group of healthcare providers, making it difficult to determine whether treatment-related inquiries would be the most prominent among other healthcare professionals. The higher percentage of treatment-related inquiries is likely a result of the majority of InpharmD users being pharmacists. A high percentage of compound inquiries were posed throughout each analysis, indicating inquiries asked by InpharmD users were frequently multifaceted and required comprehensive responses.

Conclusion and Future Perspective:
During our analysis, efficacy-related inquiries were the most frequently asked questions by healthcare providers in both data sets. Epidemiology and diagnosis inquiries were the least frequently asked questions. This is likely due to the majority of questions being asked by pharmacists in all data sets. Overall, it appears healthcare providers are in high demand for drug information related to drug of choice, general drug efficacy, comparative efficacy, and off-label efficacy. The overall goal of the formulated responses to these efficacy questions is to improve patient outcomes by providing evidence-based medicine. It would be practical to evaluate how the answers to these inquiries affect patient outcomes. However, this would require access to electronic medical records within individual health systems, likely hindering such analyses. The goal of InpharmD’s responses to drug information inquiries is to improve healthcare decision-making through evidence-based medicine, thus, an analysis of how InpharmD responses to drug information inquiries affect real world patient outcomes may be worthwhile with this research in the future.


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