3c905 Rmab029
3c905 Rmab029
doi:10.1093/jphsr/rmab029
                                                                                                                                Review
                                                                                               Advance Access publication 2 July 2021
Review
*Correspondence: Swathi Swaroopa Borra, Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of
Higher Education and Research, Ooty, Tamil Nadu 643001, India. Email: swathimasthani@hotmail.com
Abstract
Objective
To understand the utilisation of drug information services provided in India.
Key findings
The quantitative aspects of drug information queries were assessed. Majority of the queries were
raised from the General Medicine Department (43.64%) and by clinicians (41.77%), most of them
were regarding adverse drug reactions (18.17%) and the prime purpose of the enquirer was to up-
date knowledge (46.73%). The three steps for qualitative assessment and evaluation of drug infor-
mation services were assessed and the overall response from the receiver’s perspective was found
to be very good/satisfactory and the provider’s perspective was rendered excellent.
Summary
There is an increased need to expand the scope of drug information services and promote aware-
ness regarding the services and it is recommended that every hospital have a Drug Information
Centre.
Keywords: drug information India; Medicine Information Center; utilization of DIC; assessment and evaluation
© The Author(s) 2021. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved.
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Utilization of drug information services in India, 2021, Vol. 12, No. 3                                                                      453
and unbiased information to healthcare professionals and consumers,         1 and ‘No’ is scored 0. The total score is then graded from grade
the World Health Organization India Country Office collaborated             A–D, where 7–8 points is Grade A  and indicates the quality of
with the Karnataka State Pharmacy Council (KSPC) and initiated              service provided was excellent from the provider’s perspective and
the first independent DIC at the state level, in 1997.[5] DISs was ini-     points below 4 is Grade D and indicates that the service requires
tiated by JSS College of Pharmacy, Ooty, at the institutional level         improvement.[10]
and Trivandrum Medical College at the hospital level.[4] The DIC of             The benefits of DIC include promoting safe and effective use of
the KSPC in coordination with the Delhi Society for Promotion of            medications by detecting and minimizing drug-related issues with
Rational Drug Use (DSPRUD) had developed a standard treatment               prescriptions, promoting good clinical care practices and providing
guideline and an essential drug list for Karnataka. The National            medication use policies, increasing pharmacist productivity to reduce
Human Rights Commission (NHRC) recommends the establishment                 time consumption by healthcare professionals in reviewing drug in-
of DICs in all hospitals.[6]                                                formation, promoting patient compliance and medication adherence
    The objective of the DIC is to identify the minimum criteria for        and aiding in reducing widespread practice of self-medication and
establishing DICs at various levels to guide in recognising the value       medication abuse.[11]
of monitoring and assessment in ensuring the quality of drug in-                The International Register of Drug Information Services (IRDIS),
Speciality Articles regarding Drug Information Centres in India (% of queries) Mean %
                      George B    Rajanandh MG Vishwanth J        Kumar SV Rajanandh MG      Patel H      Kumar MM     Krishnaveni K   Praveen KM   Malik KM     Jeevangi VM   Pradeep P
                      et al.[9]   et al.[13]   et al.[14]         et al.[15] et al.[16]      et al.[10]   et al.[17]   et al.[18]      et al.[19]   et al.[20]   et al.[21]    et al.[22]
General Medicine      –           13                  21.23       42.4        52.6           26           77.85        62.89           34.8         89.76        67.21         35.93        43.64
Surgery               2.55        –                   2.65        –           –              19.35        –            2.82            –            1.95         1.64          –            2.58
Infectious diseases   –           –                   –           –           –              –            –            4.59            –            –            –             –            0.38
Cardiology            6           11.51               –           9           4.6            –            –            –               20.26        –            –             –            4.28
Gastroenterology      –           –                   –           –           –              –            –            –               9.69         –            –             –            0.81
Chest and             –           8.1                 4.42        –           6.2            –            –            –               5.72         –            –             –            2.04
  Tuberculosis
ENT                   –           8.1                 –           –           –              –            –            –               1.32         –            –             –            0.78
Psychiatry            2.55        8.1                 –           –           –              –            –            –               –            –            –             6.05         1.39
Endocrinology         –           7.03                –           –           –              –            –            –               –            –            –             –            0.59
Gynaecology           6.75        6.82                –           –           9.3            –            –            9.18            1.76         –            9.01          11.91        4.56
                                                                                                                                                                                                     Utilization of drug information services in India, 2021, Vol. 12, No. 3
Paediatrics           11.8        6.6                 12.37       12          4.1            15.61        9.84         6.36            –            –            8.2           10.16        8.09
Oncology              –           5.97                –           3.1         –              –            –            –               –            3.41         –             8.01         1.71
Nephrology            21.17       5.75                –           –           3.1            –            –            –               3.96         –            –             –            2.83
Neurology             11.81       5.33                –           –           –              –            –            –               6.6          –            –             5.66         2.45
Dermatology           7.66        4.69                14.14       2.9         2.08           8.47         12.3         –               –            –            –             6.25         4.87
Orthopaedics          –           –                   3.53        –           –              –            –            5.3             15.85        –            6.56          –            2.6
Urology               1.65        –                   –           –           –              –            –            –               –            –            –             –            0.14
Dentistry             6           –                   –           –           –              –            –            –               –            –            –             –            0.5
Ophthalmology         –           –                   –           –           0.5            –            –            –               –            –            –             –            0.04
Causality             –           –                   –           –           –              –            –            –               –            –            –             5.66         0.47
Nursing               3.45        –                   –           –           –              –            –            –               –            –            –             –            0.29
Pharmacy              –           4.05                –           –           10.9           –            –            –               –            0.49         –             –            1.29
Nutrition             –           2.55                –           –           –              –            –            –               –            –            –             –            0.21
Others                18.62       2.34                41.58       30.2        6.2            –            –            8.83            –            4.39         7.38          10.35        10.82
Type of Enquiry Articles regarding Drug Information Centres in India (% of queries) Mean %
                            George        Rajanandh       Vishwanth      Kumar SV     Rajanandh       Patel H      Kumar MM     Krishnaveni    Praveen         Malik KM     Jeevangi        Pradeep
                            B et al.[9]   MG et al.[13]   J et al.[14]   et al.[15]   MG et al.[16]   et al.[10]   et al.[17]   K et al.[18]   KM et al.[19]   et al.[20]   VM et al.[21]   P et al.[22]
Dosage and administration   27            12.36           20             6            13.02           21.59        18.8         8.8            8.81            12.68        36.03           20.31          17.12
ADR                         24.7          18.55           16.12          21           30.7            7.97         16.39        21.2           12.77           9.76         17.65           21.28          18.17
Drug therapy                15.3          –               –              34           8.8             4.90         –            6.3            11.45           29.27        –               11.91          10.16
Drug interaction            8.2           4.9             8.38           16           4.6             6.48         9.02         40             8.37            1.95         13.98           10.16          11
Indication                  –             27.29           11.61          8            12.5            7.89         21.31        2.5            24.22           0.98         7.35            6.05           10.81
Mechanism of action         –             12.79           –              –            –               –            –            –              3.08            –            –               –               1.32
Drug overview               –             13.43           –              –            –               –            –            –              –               –            –               –               1.12
Contraindications and       –             10.66           –              –            –               –            10.66        –              6.16            –            –               –               2.29
  precautions
Availability and cost       –             –               –              –            –               8.7          –            3.9            2.64            –            1.47            5.66            2.7
Pharmacokinetics and        –             –               7.74           –            –               5.98         9.84         19.1           2.64            0.49         2.94            2.92            4.3
  pharmacodynamics
Toxicology                  –             –               4.51           –            –               –            –            6.4            –               –            0.73            6.25            1.49
Pregnancy and lactation     –             –               –              –            –               7.56         5.74         –              –               –            –               6.25            1.63
Teratogenicity              –             –               –              –            –               –            –            35             –               –            –               5.66            3.39
Identification              –             –               –              –            –               –            –            –              0.44            –            –               –               0.04
Stability                   –             –               –              –            –               –            –            –              –               –            –               1.14            0.09
Compound formulation        –             –               –              –            –               2.74         –            –              –               –            –               2.34            0.42
Dosage adjustment           –             –               –              –            –               15.7         –            –              –               –            –               –               1.31
Drug efficacy               –             –               –              –            –               3.97         –            –              –               –            –               –               0.33
Others                      21.1          –               31.61          15           30.2            –            8.2          5.3            19.37           38.54        19.85           –              15.76
Status of the      Articles regarding Drug Information Centres in India (% of queries)                                                                                                                               Mean
enquirer                                                                                                                                                                                                             %
                   George             Rajanandh           Vishwanth      Kumar SV          Rajanandh          Patel H         Kumar MM      Krishnaveni    Praveen KM      Malik KM     Jeevangi        Pradeep P
                   B et al.[9]        MG et al.[13]       J et al.[14]   et al.[15]        MG et al.[16]      et al.[10]      et al.[17]    K et al.[18]   et al.[19]      et al.[20]   VM et al.[21]   et al.[22]
Clinicians         17.7               13.43               21.23          25                21.3               39.97           71.31         73.14          47.13           37.07        92.62           41.4         41.77
Postgraduates      15.7               –                   –              18                –                  48.17           –             –               0.44           9.76         –                6.05         8.18
Nurses             –                  19.61               –              16                –                  –               4.92          11.66          23.34           16.1         –               17.38         9.08
Interns            –                  44.77               39.82          12                44.7               8.06            20.49         –               7.48           –            –                3.51        15.07
Pharmacists        –                  12.15               –              13                13.5               –               3.82          9.18            4.4            35.12        –                7.03         8.18
Nutritionists      –                  5.9                 –              –                 –                  –               –             –                –             –            –                 –           0.49
Others             2.1                4                   –              15                20.3               –               –             6.07           17.17           1.95         7.38            23.63         8.13
Purpose of enquiry      Articles regarding Drug Information Centres in India (% of queries)                                                                                                                          Mean
                                                                                                                                                                                                                     %
                        George            Rajanandh          Vishwanth J      Kumar SV        Rajanandh          Patel H       Kumar MM      Krishnaveni K Praveen         Malik KM     Jeevangi VM     Pradeep P
                        B et al.[9]       MG et al.[13]      et al.[14]       et al.[15]      MG et al.[16]      et al.[10]    et al.[17]    et al.[18]    KM et al.[19]   et al.[20]   et al.[21]      et al.[22]
Update knowledge        45.3              43.71              31.61            44              43.03              39            69.67         38.86          52.86          53.66        56.56           42.57        46.73
Better patient care     52.8              36.24              26.47            24              44.9               61            30.33         31.81          21.58          35.61        31.15           24.21        35.01
Education/Academic      1.66              20.04              37.5             33              12.02              –             –             28.26          –              –            10.65           14.06        13.1
All of the above        –                 –                   4.41            –               –                  –             –               –            –              –             1.64            9.14         2.1
Others                  –                 –                    –              –               –                  –             –              1.06          25.55          10.73          –               –           3.11
academic purposes. Accreditation Council for Graduate Medical               Future prospects of DIS in India[25]
Education (ACGME) describes medical knowledge as one of its                 DIC can help reduce physician workload by keeping track of med-
six clinical core competencies for physicians, it is essential for the      ical records of patients with comorbid or chronic conditions by
physicians to update knowledge on the evolving biomedical, clin-            contacting and conducting follow-up on possible patients to en-
ical, epidemiological and social behavioural sciences and apply this        hance their health outcomes.[25] Provision of information about
knowledge to improve patient-specific outcomes.[24]                         complementary and alternative medicines such as Ayurveda, Yoga
    Comparisons of various studies revealed that qualitative assess-        and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) could
ment was not performed in all the studies. As a result, it should be        expand the scope of DICs in developing countries, where a large
ensured that a quality audit is conducted to assess the functioning         number of patients extensively use these medicines. DICs within
of the services.                                                            academic centres in India can provide such information by collab-
                                                                            orating with the existing in-house departments of complementary
Limitations                                                                 and alternative medicines.[8] TDM services, ADR detection, cooper-
The limited data on qualitative assessment of DISs is because ma-           ation with forensic scientists for illicit product identification, fo-
jority of the papers did not conduct the assessment as there is no          rensic pharmacology, post-mortem toxicology and expert testimony
standard checklist or recommendations till date. Lack of reference          have all been attempted successfully in Denmark and can be im-
articles that assess the cumulative utilisation of various DISs in India    plemented in India as well. Other initiatives like online and offline
has made it difficult to produce a comparative result of the review.        outreach education, where pharmacists/pharmacologists are trained
Utilization of drug information services in India, 2021, Vol. 12, No. 3                                                                                                     459
with details of medical knowledge to interact with physicians and                  	             5.	Chauhan  NS, Raveendra  R, Geetha  J. et  al. Drug Information
to share the best prescription practices as a way of encouraging                                     Centre(DIC)-An Indian Scenario. Indian J Pharm Pract 2009; 2: 21–7.
evidence-based medicine methods and rational drug use, can be                      	6.	 Chandola  A, Ratnakar,  Kandari  S, Joshi  Y. Status of drug information
                                                                                                     centre and services in India: an overview and challenges. Int J Pharm Sci
practiced.[8]
                                                                                                     Rev Res 2020; 64: 60–4. https://doi.org/10.47583/ijpsrr.2020.v64i02.010
                                                                                   	7.	 Umashankar  MS, Lakshmi  KS, Kumar  BA, Porselvi  A. Review of the
                                                                                                     benefits of drug information centre services: a new transpiring practice to
Conclusion
                                                                                                     health care professionals in hospitals. J Chem Pharm Res 2017; 9: 28–38.
To our knowledge, this is the first cumulative review on the util-                 	8.	 Patil AN, Padhy BM, Prasanthi SK, Rohilla R. Drug information center in
isation of DISs provided in India. In our review, we understood                                      India: Overview, challenges, and future prospects. Int J Pharma Investig
that the DISs is utilised in few hospitals, but the number is limited.                               2018; 8: 1–6. https://doi.org/10.4103/jphi.JPHI_103_17
Hence, there is a need to promote awareness regarding the services                 	9.	 George B, Rao PG. Assessment and evaluation of drug information serv-
and it is recommended that every hospital have a DIC. Qualitative                                    ices provided in a South Indian teaching hospital. Indian J Pharmacol
                                                                                                     2005; 37: 315–9. https://doi.org/10.4103/0253-7613.16856
and quantitative assessment of DIS is essential in improving the
                                                                                   	10.	Patel  H, Adepu  R, Sapthagiri  R, Gurumurthy  P. Drugs and therapeutic
overall performance of the service. By understanding the deficien-