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Background
In a 1999 report, the Institute of Medicine described the health care system as fractured and not easily repaired (1). An important component of this report focused on the need for developing alternative approaches to "translating" new information into enhanced outcomes for patient management. Our proposal focuses on the development of a new model that utilizes a central resource (i.e. PIC) that facilitates formulary selection optimizing and monitoring the therapeutic and economic outcomes during chronic pharmacotherapy. Another component of this assessment is the lack of "connectivity" among health care providers with specific recommendations indicating that information technology would be an important component of any new system that would be created to address patient safety issues (2-7). The PIC will create a model with integrated information technology, new information flow, and expert informational analysis.
Traditionally, pharmacists have provided drug information services, often from "centers" within hospitals (8,9). While acknowledged as valuable contributions, decreasing budgets and a growing need for "bedside" information led to the decline of drug information centers within hospitals and virtually no information services within ambulatory patient care settings.
The increase in new drug discovery and the trend to more rapid drug development often leads to a scenario where health care providers struggle to keep current with information on approved drugs as well as new drug research findings that are presented at biomedical research conferences. However, without a mechanism to obtain information, patients are often prescribed medications according to the experience of the prescriber. Thus, rather than prescribing medications based on the latest drug research findings, most prescribers utilize outdated references or rely on industry representatives for information. This has led to biased and incomplete recommendations resulting in a lack of focus on the patient's best interests while also ignoring the cost of the medications being prescribed.
Previous reports have described the potential for pharmacists and library faculty to provide pharmacoinformatics services to bridge the information technology gap but there is currently no model where pharmacists and library faculty collaborate to provide pharmacoinformatics through a joint effort that maximizes the contributions of each profession (10). In this collaborative initiative with the University at Buffalo Health Sciences Library, the PIC provides a single point of contact for accessing new drug research results, current drug treatment guidelines and expert advice on combining multiple medications in complex drug regimens. In conjunction with the University at Buffalo ePharmacotherapy Networks, the PIC network facilitates information flow among electronic drug information sources, pharmacotherapy specialists and a group of health care systems.
Rationale
Healthcare providers have minimal access to formal, unbiased pharmacotherapy information systems. Physicians, nurses, dentists, and pharmacists have ongoing needs that exceed just accessing drug information and often require the provision of "expert" medication review and pharmacologic recommendations. Although emerging Electronic Health Records (EHR) and Computerized Physician Order Entry (CPOE) initiatives will impact on medication errors through large-scale screening, the PIC provides a complimentary program that can be integrated with these tools to augment rational therapeutics and facilitates monitoring of patient outcomes and economic metrics.
References
- Institute of Medicine. To Err Is Human: Building a Safer Health System. Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, Editors; Committee on Quality of Health Care in America, November 1999.
- Altman DE, Clancy C, Blendon RJ. Improving patient safety--five years after the IOM report. N Engl J Med. 2004 Nov 11;351(20):2041-3.
- Ortiz E. Federal initiatives in information technology to improve patient safety and quality of care. Stud Health Technol Inform. 2003;92:59-71.
- Gorman P. Information needs in primary care: a survey of rural and nonrural primary care physicians. Medinfo. 2001;10(Pt 1):338-42.
- Brennan PF, Aronson AR. Towards linking patients and clinical information: detecting UMLS concepts in e-mail. J Biomed Inform. 2003 Aug-Oct;36(4-5):334-41.
- Anderson S, Wittwer W. Using bar-code point-of-care technology for patient safety. J Healthc Qual. 2004 Nov-Dec;26(6):5-11.
- Santoro E, Garattini S. A model for integrating biomedical research information. Recenti Prog Med. 2004 Apr;95(4):207-9.
- Rosenberg JM, Koumis T, Nathan JP, Cicero LA, McGuire H.
Current status of pharmacist-operated drug information centers in the United States. Am J Health Syst Pharm. 2004 Oct 1;61(19):2023-32.
- Mangino PD. Role of the pharmacist in reducing medication errors. J Surg Oncol. 2004 Dec 1;88(3):189-94.
- Kupferberg N, Jones Hartel L. Evaluation of five full-text drug databases by pharmacy students, faculty, and librarians: do the groups agree? J Med Libr Assoc. 2004 Jan;92(1):66-71.
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