SAPhA's Drug Communications Project
By Colman M. Herman, Examining Christopher A . Rodowskas Jr. and William F. McGhan the Use of Sources of Drug Information
In the summer of 1954, 167 students convened in Boston to form the Student Section of the American Pharmaceutical Association. In 1969 students participated in the greater strengthening of student activism when the Section was reorganized to become the Student American Pharmaceutical Association. Four years later, in his address as incoming APhA President, George Denmark stated, "I think the decision to create SAPhA is directly responsible for a good part of the Association 's growth. I believe that encouraging the efforts of SAPhA will insure continued strength for the entire profession. " 1 Now in its third decade, SAPhA has grown to approximately 14,000 members and is emerging as a student organization of considerable accomplishment and potential. Since the formation of its strong organization base, SAPhA has labored continuously to bring new programs to its members . In the last four years, the organization has administered over $700,000 in program funds for student projects. These activities have included Project SPEED (Student Professionals Engaged in Education on Drugs), the Health Manpower Conferences Project and the Venereal Disease-Drug Abuse Education Prevention (VD-DAEP) Project. SAPhA also has participated in the U. S. State Department's Project Ideas, the pharmaceutical industry's internship program, and Student American Medical Association projects dealing with the provision of health care services to American Indians, migrant workers and the people of Appalachia. These projects have helped to develop pharmacy students as leaders in student health activities. This article reports the results of one such activity-SAPhA 's Drug Communications Project.
Becker, et al.,6 and Coleman, Katz and MenzeL] Conversely, pharmacists have been the infrequent subjects of drug information surveys. For example, Weikel asked 72 community pharmacists to evaluate various sources of drug information. Commercial sources (e.g., journal and mail advertisements and detail men) received 1.7 times as many "good" ratings as professional sources (e.g., journal articles, colleagues and meetings). Similarly, when asked which one source provided the most complete and objective information, the pharmacists mentioned commercial sources 1.5 times as often as professional sources. Cross-tabulations of the latter responses by years of education revealed no marked differences. s The American Society of Hospital Pharmacists conducted a survey in which 25 drug information specialists listed three sources used to obtain selected types of drug information. One to three pOints were assigned to third, second and first choices, respectively. In order of decreasing value, the following were the most useful sources mentioned, along with the information most frequently sought1. American Hospital Formulary Service (indications , pharmacology, adverse reactions and cautions, contraindications and dosage); 2. Personal files of journal articles (efficacy, interactions , biopharmaceutics, investigational drugs, and compatibility and stability); 3 . Pharmacological Basis of Therapeutics (indications, pharmacology, structureactivity relationships and contraindications); 4 . Company literature, including package inserts (dosage, and compatibility and storage), and 5. Physicians!· Desk Reference (indications, dosage and dosage forms).9 In a study of 5,159 requests for drug information at the University of Michigan Hospital Pharmacy Service, the most useful sources in order of decreasing value, and the information most frequently sought, were1. American Hospital Formulary Service (indications , dosage, therapeutic compatibility and metabolism); 2. Martindale 's Extra Pharmacopeia (dosage, availability, pharmaceutical compatibility and identification); 3. Pharmacological Basis of Therapeutics (adverse reactions and contraindications, therapeutic compatibility and metabolism), and 4. de Haen's Drugs in Use (indications and adverse reactions). 10 No studies were found that examined the
Literature Review Attempts have been made to assist health professionals in their retrieval of drug information by listing the available sources of such information. Examples of these efforts include a "World List of Pharmacy Periodicals," 2 "A Manual to the Literature of Pharmacy" 3 and a " Bibliography of Pharmaceutical Reference Literature." 4 Asking physiCians about their sources of prescription drug information has been a rather common research activity. Among the many pertinent studies are those by the American Medical Association,S Stolley, Presented at the annual meeting of the Student American Pharmaceutical Association, APhA Annual Meeting. San Francisco, California, April 17, 1975. A portion of the work upon which this article is based was performed pursuant to contract FDA 72-341 between the American Pharmaceutical Association and the Food and Drug Administration, Public Health Service, Department of Health, Education, and Welfare.
Vol. NS 16, No. 5, May 1976
use of various sources of drug information by pharmacy students . In view of the fact that these individuals are the pharmacy practitioners of tomorrow, the conspicuous absence of any pertinent surveys presents a sizeable gap in our knowledge of the behavior of pharmacy students seeking drug information. Thus, it was decided to conduct a study to alleviate the deficiency. Such a study was thought to be of particular importance and interest because of the expanding responsibilities of pharmacists, a key component of which is the dissemination of drug information. Questionnaire Development The objectives of the portion of the research discussed in this article were to determine pharmacy students'1. Readership/consultation frequency for specific sources of drug information, 2. Opinions about various aspects of an "ideal" drug compendium and 3. Opinions about new methods by which the Food and Drug Administration could disseminate drug information . To collect the desired data, a structured, nondisguised, pretested questionnaire consisting of multiple choice questions was administered to senior students at one college of pharmacy from each of the eight districts of the American Association of Colleges of Pharmacy . These schools were the Albany College of Pharmacy (Union University); the Universities of Southern California, Connecticut, Iowa, Mississippi, and Missouri ; The Ohio State University, and Washington State University. The questionnaire was developed in collaboration with a panel of experts consisting of pharmacy and medical educators, students and practitioners; drug information speCialists; pharmacologists; and representatives of the American Association of Colleges of Pharmacy, the Association of American Medical Colleges, the Student American Pharmaceutical Association and the Food and Drug Administration . Students played an active role in the design of the questionnaire. Readership/Consultation Frequency for Drug Information Sources· In general, it appears that the pharmacy students at the University of Southern California and The Ohio State University make greater use of certain types of literature. They are more likely to read/consult the Journal of the American Medical Association, Medical Letter, AMA Drug Evaluations and American • A technical discussion of the data is available from Colman M. Herman , PhD. , Massachusetts College of Pharmacy, 179 Longwood Avenue, Boston, MA 02115 .
239
Examining the Use of Sources of Drug Information
Hospital Formulary Service. This may be a function of a greater commitment to the clinical component of the pharmacy curriculum at the two schools. Both institutions have been recognized as leaders in pharmaceutical education with USC being one of the founders of the doctor of pharmacy program, and the college of pharmacy at OSU recently being ranked as the third best pharmacy school in the nation by a panel of pharmacy deans. 11 At all the schools, students perhaps should be stimulated to do more reading of pharmacology journals such as Clinical Pharmacology and Therapeutics and Journal of Pharmacology and Experimental Therapeutics. Further, most of the schools do not possess many of the specialized drug information services, such as de Haen Drug Information Systems, Drug Products Information File, Iowa Drug Information Service and MEDLINE. Where this is so, consideration should be given to acquiring one or more such sources of drug information. APhA Publications- The readership/ consultation frequencies for four publications of the American Pharmaceutical Association were not significantly different among the schools. The majority of the students fre-
quently read/consult the Journal of the American Pharmaceutical Association (JAPhA) and Evaluations of Drug Interactions. This is to be expected, since these publications are distributed to all members of the Student American Pharmaceutical Association as part of APhA's membership services. Furthermore, both sources contain information that is relevant to the contemporary practice of pharmacy. Academy/GP (now Pharmacy Practice), a newsletter published by APhA's Academy of General Practice (now Academy of Pharmacy Practice) is read to a moderate degree. Since it also contains much relevant information, the Academy should gjve consideration to making the newsletter more widely available to students. The Journal of Pharmaceutical Sciences is read infrequently. This is probably a function of the high level of scientific sophistication necessary to comprehend the contents of this research journal . USPC Publications-The consultation frequencies for the two official compendia of The United States Pharmacopeial Convention were not significantly different among the schools. The United States Pharmacopeia and the National Formulary, which was re-
Colman M. Herman
Colman M. Herman, PhD, is assistant professor of pharmacy business administration at the Massachusetts College of Pharmacy. Herman was formerly director of APhA 's Drug Communications Project. At Ohio State, from where he earned his PhD in pharmacy administration, Herman was a Charles R. Walgreen Memorial Fellow of AFPE . His research interests include the role of demography in influencing consumer shopping habits, preferences and opinions; curriculum development and evaluation in continuing education ; attitudes toward clinical pharmacy; drug misuse , and drug communications .
Christopher A. Rodowskas Jr .
Christopher A. Rodowskas Jr., PhD, is executive director of the American Association of Colleges of Pharmacy. He has practiced community pharmacy in Maryland, hospital pharmacy in Indiana and has taught at both the University of Connecticut and Ohio State University. In addition, he has done research in the application of administrative science methodology to drug distribution with emphasis on terminal distribution.
WIlliam F. McGhan
William F. McGhan, PharmD, is executive secretary of the APhA Academy of Pharmaceutical Sciences. He received his PharmD from the University of California at San Francisco in 1970. As a student, he served as the first pharmacy student coordinator of the Appalachian Student Health Project. From 1971 - 1974 he served as executive secretary of SAPhA. In addition to serving on various national committees, McGhan is a member of APhA, AAAS, American Public Health Association and Virginia Pharmaceutical Association. In 1974 he was selected as one of the Outstanding Young Men of America.
240
cently purchased from APhA, are consulted infrequently. This is to be expected, since these publications, to date, are of relatively little value in the senior year of pharmacy school , which is usually clinical in nature. The USPC has taken steps to make the new USP (XIX) more relevant to the practice of pharmacy. The Biprofessional Subcommittee of the USP Revision Committee has prepared " dispensing information" for most monographs for dosage forms dispensed directly to patients. The USPC emphasizes that the pharmacist is free to exercise his professional judgment in determining what, if any, information is to be communicated to the patient. 12 Similar changes will be occurring in the NF.13 An example of the type of dispensing information provided by USP XIX is in the monograph for the anthelmintic, pyrvinium pamoate tablets. It is suggested that pharmacists may want to explain to patients the hygienic measures appropriate for minimizing reinfestation . Also, pharmacists are advised that a photosensitivity reaction may occur in patients exposed to ultraviolet light or sunlight. They are further cautioned that the drug will color stools red and stain clothing, and that patients should avoid chewing the tablets. 14 PDR-the consultation frequencies for Physicians' Desk Reference, a publication of "Medical Economics, " were significantly different. Of the sampled schools, PDR is consulted most often at the University of Connecticut and the Albany College of Pharmacy and least frequently at the Universities of Mississippi and Southern California. In a study of Physicians ' Attitudes Toward Drug Compendia, conducted in 1968 for the Pharmaceutical Manufacturers Association, Opinion Research Corporation (ORC) found that the PDR is the most popular source of drug information among physiCians. Doctors use the PDR primarily to obtain information on dosage, side effects and contraindications, indications and drug identification. 15 Five years later, in a follow-up survey conducted for " Medical Economics, " ORC corroborated their previous findings . In addition, they found that hospital-based physicians do not use the PDR as frequently as their office-based colleagues, and younger physiCians are less likely to be satisfied with the PDR than their older counterparts. The most frequently mentioned criticisms of the PDR were incompleteness, insufficient pharmacology and indexing problems. 16 FDA Drug Bul/etin- The readership frequencies for the FDA Drug Bulletin were not significantly different among the schools.
Journal of the American Pharmaceutical Association
Herman, Rodowskas, and McGhan
Most of the respondents at all the schools frequently read this government newsletter. This is to be expected, since the Bulletin is distributed gratuitously by FDA to all SAPhA members. In addition , the FDA Drug Bulletin provides information that has implications of a legal nature. A recent study conducted for the Food and Drug Administration by Applied Management Sciences (AMS) estimated that 85 percent of the nation's physicians had seen the FDA Drug Bulletin. Again, this is to be expected, since most U.S. physicians receive the Bulletin gratuitously. Of the 85 percent, AMS further estimated that 99 percent read or scan the Bulletin, and that it was responsible for changing the prescribing habits of 42 percent. Desired changes include more information and information of greater detail and precision, issues dealing with specific topics and documentation. Reasons for wanting the Bulletin discontinued include questionable value, unwarranted expense and lack of trust in the FDA .17 Drug Company Sources-The readership / consultation frequencies for journal advertisements and detailmen were not significantly different among the schools. The majority of the students read/consult these sources infrequently. These findings may be the result of a lack of credibility for drug company sources . Apparently the same situation exists for physicians and nurses. The American Medical Association recently gave serious consideration to eliminating advertising from the Journal of the American Medical Association. 18 In a study of nurses, detailmen were ranked 12th in frequency utilization and 13th in degree of confidence in a list of 13 drug information sources. 19
References 1. Denmark. G. D .. "Mandate to be Fu lfilled: Address of the Incom in g President (of the American Pharmaceutical Assoc iation):' JAPhA , NS13 , 47 3 (Sept. 1973) 2. Andrews, T. , Comp., from a preliminary li st by W. Sewel l, "World List of Pharmacy Periodicals, " Am. J. Hasp. Pharm., 20,4 2 (Feb 1963) 3. He llums, B. A. , "A Manual to the Literature o f Pharmacy," master's thesis. Uni versity o f Mississi ppi , University, Miss. (Aug. 1968) 4. Pasztor, M .. and Hopkins, J .. Bibliography of Pharmaceutical Reference Literature, Pharmaceutical Press, London (1968) 5. Ameri can Medical Assoc iation, Opinions of AMA Members-1973, America n Medical Assoc iation, Chicago, III. 1,3,27- 29 ( 1973) 6. Stolley, P. D., Becker, M. H. , Lasagna, L., McEv ill a, J. D ., and Sloane, l. M. , " The Relationship Between Physician Characteristics and Prescribing Appropriateness," Med. Care, 10, 17- 19,22,23,27 (Jan.-Feb. 1972) 7. Coleman, J. S., Katz, E., and Menzel, H., Medica/Innovation: A Diffusion Study, Bobbs-Merrill , Indianapolis, Ind., 58-6 4 (1966) 8. Weikel, M. K., " The Function o f the Pharmacist as a Therapeutic Consultant to Physic ians," doctoral dissertation, University of Wisconsin , Madison. Wis., 28-33, 104- 106, 108,124- 127 ( 1966)
Vol. NS 16, No.5, May 1976
Profile of an Ideal Drug Compendium A portion of the research dealt with the concept of an "ideal" therapeutic drug compendium, which was defined as a " publication that would contain accurate, comprehensive, and timely prescription drug information in one place." Based on the findings, it is recommended that an existing compendium be revised to serve as the " ideal " drug compendium . Compendia that should be given consideration are AMA Drug Evaluations, American Hospital Formulary Service, Facts and Comparisons and Physicians' Desk Reference. The revision should be accomplished under the guidance of a consortium composed of the American Pharmaceutical Association, the American Medical Association, the Food and Drug Administration, the National Academy of Sciences-National Research Council, the Pharmaceutical Manufacturers Association and the publishers of existing drug compendia. Even though PMA did not receive many endorsements for such membership by respondents in the current study, it should be represented on the consortium. The rationale is that its 110 members are responsible for "95 percent of U.S. sales of prescription and over-the-counter 'ethical' products, as well as half of the free world's supply of such medicines." 2 0 The drugs in the ideal compendium should be included on the basis of safety and efficacy, and should be categorized on a pharmacological-therapeutic basis. Information on biopharmaceutics and drug interactions should be included. Food and Drug Administration
novative methods by which the Food and Drug Administration could disseminate drug information. Seventy-two percent favored an FDA nationwide network of computer drug information terminals. FDA drug information specialists available by telephone interested 66 percent of the respondents. An FDA audio-visual department and an FDA speakers' bureau appealed to 48 percent and 43 percent, respectively, of the respondents. FDA certification or employment of detailmen and curriculum consultants did not receive much support. The FDA study mentioned previously found that 68 percent of the sampled physicians favored computer or telephone links to university drug consultants as a potential source of drug information. A new guide or compendium to all prescription drugs published by a nongovernmental agency interested 61 percent of the respondents. Visits from a new type of detailman, with training in clinical pharmacology and sent from a university, appealed to 54 percent of the respondents. Audio-tapes for use in an automobile and cable television received 50 percent and 36 percent, respectively, of physicians ' support. 2 1 The testing of such modes of disseminating drug information are necessary if we are to meet the charge of WaltonIf maximum effectiveness and minimum toxiCity are to be achieved in modern health care with drugs there must be developed within the biomedical community practicable, reliable communications systems for introducing new drug knowledge more rapidly and efficiently into appropriate aspects of patients care problems. 2 2 .
Students were requested to evaluate in-
9.
10.
11 .
12.
13.
14. 15.
u.s. Department of Health, Education, and Welfare, Health
16. Opinion Research Corporation, Sources o f Prescrib ing In-
Services and Mental Health Administration, National Center for Health Services Research and Development, Drug Information: Literature Review of Needs, Resources. and Services, Case Study Series Publication No. (HSM) 723013, Government Printing Office, Washington, D.C., 118-122 (March 1972) U.S. Department of Health, Education, and Welfare, Health Services and Mental Health Adm inistration , National Center for Health Services Research and Development, Drug Information Services: Two Operational Models. Case Study Series Publication No. (HSM) 72-3030, Government Printing Office. Washington, D .C., 256 (n.d .) Blau, P. M., and Margulies, R. Z., " The Reputations o f American Profess ional Schoo ls: A Research Repli cation," Change, 6, 45, (Dec. 1974-Jan. 1975) Valentino, J. G., " The USP XIX Will Inc lude Useful Dispensing Information for Pharmacists," Pharmacy Times , 40,34-3 7 (Sept. 1974) Personal communication, Robert H. Henry, director of Pro fessional Affairs , The United States Pharmacopeia I Convention (March 17, 1973) " USP Monographs Divided into Two Parts. " Quality Control Reports ( The Gold Sheet), 9, 16, 17 (Jan . 1975) Opinion Research Corporation , Physicians ' Attitudes Toward Drug Compendia. Opinion Resea rch Corporation for the Pharmace utica l Manufacturers Associ ation , Princeton, N.J ., v, 3, 6, 7, 12 (J une 1968)
formation: A Study Among a National Sample of Physicians, Opinion Research Corporation for the Physicians' Desk Reference. Princeton, N.J., 18, 19,2 4,25 (Jul y 197 3) 17. Applied Management SCiences, Survey of Drug Information Needs and Problems Associated with Communications Directed to Practicing Physicians (Part II: Drug Bulletin Survey) , Applied Management Sciences for the Food and Drug Administration, WaShington, D.C., 1.3, 1.4,3. 11,3.13, 3. 14,3. 18.3. 19,3.21,3.32,3.33,3.37,3.38 (Feb. 22, 1974) 18. " Advertising Sales Would be 1-18lted; AMA Budget Balanced; Dues Hike Asked," Am. Mad. News, 1, 12, (Nov. 4, 1974) 19. American Journal of Nursing, " The Nurse and Drugs Administered in Hospitals," Medical Marketing and Media. 9, 18 (June 1974) 20 . Pharmaceut ica l Manufacturers Association, Prescription Drug Industry Fact Book, Pharmaceutical Manufacturers Assoc iation, Washington , D .C. (1973) 21. App lied Management Sciences, Survey of Drug Information Needs and Problems Associated with Communications Directed to Practicing Physicians (Part I: Physician Information Survey), App lied Management Sciences for the Food and Drug Administration, Washington, D.C., 1.6, 3.53, 3.54, 3.71 (May 8, 1974) 22. Wa lton, C. A., " Scope and Content of a Course in Drug literature Evaluation," Am. J. Pharm. Educ., 32, 853 (Dec. 1968)
241
By Colman M. Herman, Examining Christopher A . Rodowskas Jr. and William F. McGhan the Use of Sources of Drug Information
In the summer of 1954, 167 students convened in Boston to form the Student Section of the American Pharmaceutical Association. In 1969 students participated in the greater strengthening of student activism when the Section was reorganized to become the Student American Pharmaceutical Association. Four years later, in his address as incoming APhA President, George Denmark stated, "I think the decision to create SAPhA is directly responsible for a good part of the Association 's growth. I believe that encouraging the efforts of SAPhA will insure continued strength for the entire profession. " 1 Now in its third decade, SAPhA has grown to approximately 14,000 members and is emerging as a student organization of considerable accomplishment and potential. Since the formation of its strong organization base, SAPhA has labored continuously to bring new programs to its members . In the last four years, the organization has administered over $700,000 in program funds for student projects. These activities have included Project SPEED (Student Professionals Engaged in Education on Drugs), the Health Manpower Conferences Project and the Venereal Disease-Drug Abuse Education Prevention (VD-DAEP) Project. SAPhA also has participated in the U. S. State Department's Project Ideas, the pharmaceutical industry's internship program, and Student American Medical Association projects dealing with the provision of health care services to American Indians, migrant workers and the people of Appalachia. These projects have helped to develop pharmacy students as leaders in student health activities. This article reports the results of one such activity-SAPhA 's Drug Communications Project.
Becker, et al.,6 and Coleman, Katz and MenzeL] Conversely, pharmacists have been the infrequent subjects of drug information surveys. For example, Weikel asked 72 community pharmacists to evaluate various sources of drug information. Commercial sources (e.g., journal and mail advertisements and detail men) received 1.7 times as many "good" ratings as professional sources (e.g., journal articles, colleagues and meetings). Similarly, when asked which one source provided the most complete and objective information, the pharmacists mentioned commercial sources 1.5 times as often as professional sources. Cross-tabulations of the latter responses by years of education revealed no marked differences. s The American Society of Hospital Pharmacists conducted a survey in which 25 drug information specialists listed three sources used to obtain selected types of drug information. One to three pOints were assigned to third, second and first choices, respectively. In order of decreasing value, the following were the most useful sources mentioned, along with the information most frequently sought1. American Hospital Formulary Service (indications , pharmacology, adverse reactions and cautions, contraindications and dosage); 2. Personal files of journal articles (efficacy, interactions , biopharmaceutics, investigational drugs, and compatibility and stability); 3 . Pharmacological Basis of Therapeutics (indications, pharmacology, structureactivity relationships and contraindications); 4 . Company literature, including package inserts (dosage, and compatibility and storage), and 5. Physicians!· Desk Reference (indications, dosage and dosage forms).9 In a study of 5,159 requests for drug information at the University of Michigan Hospital Pharmacy Service, the most useful sources in order of decreasing value, and the information most frequently sought, were1. American Hospital Formulary Service (indications , dosage, therapeutic compatibility and metabolism); 2. Martindale 's Extra Pharmacopeia (dosage, availability, pharmaceutical compatibility and identification); 3. Pharmacological Basis of Therapeutics (adverse reactions and contraindications, therapeutic compatibility and metabolism), and 4. de Haen's Drugs in Use (indications and adverse reactions). 10 No studies were found that examined the
Literature Review Attempts have been made to assist health professionals in their retrieval of drug information by listing the available sources of such information. Examples of these efforts include a "World List of Pharmacy Periodicals," 2 "A Manual to the Literature of Pharmacy" 3 and a " Bibliography of Pharmaceutical Reference Literature." 4 Asking physiCians about their sources of prescription drug information has been a rather common research activity. Among the many pertinent studies are those by the American Medical Association,S Stolley, Presented at the annual meeting of the Student American Pharmaceutical Association, APhA Annual Meeting. San Francisco, California, April 17, 1975. A portion of the work upon which this article is based was performed pursuant to contract FDA 72-341 between the American Pharmaceutical Association and the Food and Drug Administration, Public Health Service, Department of Health, Education, and Welfare.
Vol. NS 16, No. 5, May 1976
use of various sources of drug information by pharmacy students . In view of the fact that these individuals are the pharmacy practitioners of tomorrow, the conspicuous absence of any pertinent surveys presents a sizeable gap in our knowledge of the behavior of pharmacy students seeking drug information. Thus, it was decided to conduct a study to alleviate the deficiency. Such a study was thought to be of particular importance and interest because of the expanding responsibilities of pharmacists, a key component of which is the dissemination of drug information. Questionnaire Development The objectives of the portion of the research discussed in this article were to determine pharmacy students'1. Readership/consultation frequency for specific sources of drug information, 2. Opinions about various aspects of an "ideal" drug compendium and 3. Opinions about new methods by which the Food and Drug Administration could disseminate drug information . To collect the desired data, a structured, nondisguised, pretested questionnaire consisting of multiple choice questions was administered to senior students at one college of pharmacy from each of the eight districts of the American Association of Colleges of Pharmacy . These schools were the Albany College of Pharmacy (Union University); the Universities of Southern California, Connecticut, Iowa, Mississippi, and Missouri ; The Ohio State University, and Washington State University. The questionnaire was developed in collaboration with a panel of experts consisting of pharmacy and medical educators, students and practitioners; drug information speCialists; pharmacologists; and representatives of the American Association of Colleges of Pharmacy, the Association of American Medical Colleges, the Student American Pharmaceutical Association and the Food and Drug Administration . Students played an active role in the design of the questionnaire. Readership/Consultation Frequency for Drug Information Sources· In general, it appears that the pharmacy students at the University of Southern California and The Ohio State University make greater use of certain types of literature. They are more likely to read/consult the Journal of the American Medical Association, Medical Letter, AMA Drug Evaluations and American • A technical discussion of the data is available from Colman M. Herman , PhD. , Massachusetts College of Pharmacy, 179 Longwood Avenue, Boston, MA 02115 .
239
Examining the Use of Sources of Drug Information
Hospital Formulary Service. This may be a function of a greater commitment to the clinical component of the pharmacy curriculum at the two schools. Both institutions have been recognized as leaders in pharmaceutical education with USC being one of the founders of the doctor of pharmacy program, and the college of pharmacy at OSU recently being ranked as the third best pharmacy school in the nation by a panel of pharmacy deans. 11 At all the schools, students perhaps should be stimulated to do more reading of pharmacology journals such as Clinical Pharmacology and Therapeutics and Journal of Pharmacology and Experimental Therapeutics. Further, most of the schools do not possess many of the specialized drug information services, such as de Haen Drug Information Systems, Drug Products Information File, Iowa Drug Information Service and MEDLINE. Where this is so, consideration should be given to acquiring one or more such sources of drug information. APhA Publications- The readership/ consultation frequencies for four publications of the American Pharmaceutical Association were not significantly different among the schools. The majority of the students fre-
quently read/consult the Journal of the American Pharmaceutical Association (JAPhA) and Evaluations of Drug Interactions. This is to be expected, since these publications are distributed to all members of the Student American Pharmaceutical Association as part of APhA's membership services. Furthermore, both sources contain information that is relevant to the contemporary practice of pharmacy. Academy/GP (now Pharmacy Practice), a newsletter published by APhA's Academy of General Practice (now Academy of Pharmacy Practice) is read to a moderate degree. Since it also contains much relevant information, the Academy should gjve consideration to making the newsletter more widely available to students. The Journal of Pharmaceutical Sciences is read infrequently. This is probably a function of the high level of scientific sophistication necessary to comprehend the contents of this research journal . USPC Publications-The consultation frequencies for the two official compendia of The United States Pharmacopeial Convention were not significantly different among the schools. The United States Pharmacopeia and the National Formulary, which was re-
Colman M. Herman
Colman M. Herman, PhD, is assistant professor of pharmacy business administration at the Massachusetts College of Pharmacy. Herman was formerly director of APhA 's Drug Communications Project. At Ohio State, from where he earned his PhD in pharmacy administration, Herman was a Charles R. Walgreen Memorial Fellow of AFPE . His research interests include the role of demography in influencing consumer shopping habits, preferences and opinions; curriculum development and evaluation in continuing education ; attitudes toward clinical pharmacy; drug misuse , and drug communications .
Christopher A. Rodowskas Jr .
Christopher A. Rodowskas Jr., PhD, is executive director of the American Association of Colleges of Pharmacy. He has practiced community pharmacy in Maryland, hospital pharmacy in Indiana and has taught at both the University of Connecticut and Ohio State University. In addition, he has done research in the application of administrative science methodology to drug distribution with emphasis on terminal distribution.
WIlliam F. McGhan
William F. McGhan, PharmD, is executive secretary of the APhA Academy of Pharmaceutical Sciences. He received his PharmD from the University of California at San Francisco in 1970. As a student, he served as the first pharmacy student coordinator of the Appalachian Student Health Project. From 1971 - 1974 he served as executive secretary of SAPhA. In addition to serving on various national committees, McGhan is a member of APhA, AAAS, American Public Health Association and Virginia Pharmaceutical Association. In 1974 he was selected as one of the Outstanding Young Men of America.
240
cently purchased from APhA, are consulted infrequently. This is to be expected, since these publications, to date, are of relatively little value in the senior year of pharmacy school , which is usually clinical in nature. The USPC has taken steps to make the new USP (XIX) more relevant to the practice of pharmacy. The Biprofessional Subcommittee of the USP Revision Committee has prepared " dispensing information" for most monographs for dosage forms dispensed directly to patients. The USPC emphasizes that the pharmacist is free to exercise his professional judgment in determining what, if any, information is to be communicated to the patient. 12 Similar changes will be occurring in the NF.13 An example of the type of dispensing information provided by USP XIX is in the monograph for the anthelmintic, pyrvinium pamoate tablets. It is suggested that pharmacists may want to explain to patients the hygienic measures appropriate for minimizing reinfestation . Also, pharmacists are advised that a photosensitivity reaction may occur in patients exposed to ultraviolet light or sunlight. They are further cautioned that the drug will color stools red and stain clothing, and that patients should avoid chewing the tablets. 14 PDR-the consultation frequencies for Physicians' Desk Reference, a publication of "Medical Economics, " were significantly different. Of the sampled schools, PDR is consulted most often at the University of Connecticut and the Albany College of Pharmacy and least frequently at the Universities of Mississippi and Southern California. In a study of Physicians ' Attitudes Toward Drug Compendia, conducted in 1968 for the Pharmaceutical Manufacturers Association, Opinion Research Corporation (ORC) found that the PDR is the most popular source of drug information among physiCians. Doctors use the PDR primarily to obtain information on dosage, side effects and contraindications, indications and drug identification. 15 Five years later, in a follow-up survey conducted for " Medical Economics, " ORC corroborated their previous findings . In addition, they found that hospital-based physicians do not use the PDR as frequently as their office-based colleagues, and younger physiCians are less likely to be satisfied with the PDR than their older counterparts. The most frequently mentioned criticisms of the PDR were incompleteness, insufficient pharmacology and indexing problems. 16 FDA Drug Bul/etin- The readership frequencies for the FDA Drug Bulletin were not significantly different among the schools.
Journal of the American Pharmaceutical Association
Herman, Rodowskas, and McGhan
Most of the respondents at all the schools frequently read this government newsletter. This is to be expected, since the Bulletin is distributed gratuitously by FDA to all SAPhA members. In addition , the FDA Drug Bulletin provides information that has implications of a legal nature. A recent study conducted for the Food and Drug Administration by Applied Management Sciences (AMS) estimated that 85 percent of the nation's physicians had seen the FDA Drug Bulletin. Again, this is to be expected, since most U.S. physicians receive the Bulletin gratuitously. Of the 85 percent, AMS further estimated that 99 percent read or scan the Bulletin, and that it was responsible for changing the prescribing habits of 42 percent. Desired changes include more information and information of greater detail and precision, issues dealing with specific topics and documentation. Reasons for wanting the Bulletin discontinued include questionable value, unwarranted expense and lack of trust in the FDA .17 Drug Company Sources-The readership / consultation frequencies for journal advertisements and detailmen were not significantly different among the schools. The majority of the students read/consult these sources infrequently. These findings may be the result of a lack of credibility for drug company sources . Apparently the same situation exists for physicians and nurses. The American Medical Association recently gave serious consideration to eliminating advertising from the Journal of the American Medical Association. 18 In a study of nurses, detailmen were ranked 12th in frequency utilization and 13th in degree of confidence in a list of 13 drug information sources. 19
References 1. Denmark. G. D .. "Mandate to be Fu lfilled: Address of the Incom in g President (of the American Pharmaceutical Assoc iation):' JAPhA , NS13 , 47 3 (Sept. 1973) 2. Andrews, T. , Comp., from a preliminary li st by W. Sewel l, "World List of Pharmacy Periodicals, " Am. J. Hasp. Pharm., 20,4 2 (Feb 1963) 3. He llums, B. A. , "A Manual to the Literature o f Pharmacy," master's thesis. Uni versity o f Mississi ppi , University, Miss. (Aug. 1968) 4. Pasztor, M .. and Hopkins, J .. Bibliography of Pharmaceutical Reference Literature, Pharmaceutical Press, London (1968) 5. Ameri can Medical Assoc iation, Opinions of AMA Members-1973, America n Medical Assoc iation, Chicago, III. 1,3,27- 29 ( 1973) 6. Stolley, P. D., Becker, M. H. , Lasagna, L., McEv ill a, J. D ., and Sloane, l. M. , " The Relationship Between Physician Characteristics and Prescribing Appropriateness," Med. Care, 10, 17- 19,22,23,27 (Jan.-Feb. 1972) 7. Coleman, J. S., Katz, E., and Menzel, H., Medica/Innovation: A Diffusion Study, Bobbs-Merrill , Indianapolis, Ind., 58-6 4 (1966) 8. Weikel, M. K., " The Function o f the Pharmacist as a Therapeutic Consultant to Physic ians," doctoral dissertation, University of Wisconsin , Madison. Wis., 28-33, 104- 106, 108,124- 127 ( 1966)
Vol. NS 16, No.5, May 1976
Profile of an Ideal Drug Compendium A portion of the research dealt with the concept of an "ideal" therapeutic drug compendium, which was defined as a " publication that would contain accurate, comprehensive, and timely prescription drug information in one place." Based on the findings, it is recommended that an existing compendium be revised to serve as the " ideal " drug compendium . Compendia that should be given consideration are AMA Drug Evaluations, American Hospital Formulary Service, Facts and Comparisons and Physicians' Desk Reference. The revision should be accomplished under the guidance of a consortium composed of the American Pharmaceutical Association, the American Medical Association, the Food and Drug Administration, the National Academy of Sciences-National Research Council, the Pharmaceutical Manufacturers Association and the publishers of existing drug compendia. Even though PMA did not receive many endorsements for such membership by respondents in the current study, it should be represented on the consortium. The rationale is that its 110 members are responsible for "95 percent of U.S. sales of prescription and over-the-counter 'ethical' products, as well as half of the free world's supply of such medicines." 2 0 The drugs in the ideal compendium should be included on the basis of safety and efficacy, and should be categorized on a pharmacological-therapeutic basis. Information on biopharmaceutics and drug interactions should be included. Food and Drug Administration
novative methods by which the Food and Drug Administration could disseminate drug information. Seventy-two percent favored an FDA nationwide network of computer drug information terminals. FDA drug information specialists available by telephone interested 66 percent of the respondents. An FDA audio-visual department and an FDA speakers' bureau appealed to 48 percent and 43 percent, respectively, of the respondents. FDA certification or employment of detailmen and curriculum consultants did not receive much support. The FDA study mentioned previously found that 68 percent of the sampled physicians favored computer or telephone links to university drug consultants as a potential source of drug information. A new guide or compendium to all prescription drugs published by a nongovernmental agency interested 61 percent of the respondents. Visits from a new type of detailman, with training in clinical pharmacology and sent from a university, appealed to 54 percent of the respondents. Audio-tapes for use in an automobile and cable television received 50 percent and 36 percent, respectively, of physicians ' support. 2 1 The testing of such modes of disseminating drug information are necessary if we are to meet the charge of WaltonIf maximum effectiveness and minimum toxiCity are to be achieved in modern health care with drugs there must be developed within the biomedical community practicable, reliable communications systems for introducing new drug knowledge more rapidly and efficiently into appropriate aspects of patients care problems. 2 2 .
Students were requested to evaluate in-
9.
10.
11 .
12.
13.
14. 15.
u.s. Department of Health, Education, and Welfare, Health
16. Opinion Research Corporation, Sources o f Prescrib ing In-
Services and Mental Health Administration, National Center for Health Services Research and Development, Drug Information: Literature Review of Needs, Resources. and Services, Case Study Series Publication No. (HSM) 723013, Government Printing Office, Washington, D.C., 118-122 (March 1972) U.S. Department of Health, Education, and Welfare, Health Services and Mental Health Adm inistration , National Center for Health Services Research and Development, Drug Information Services: Two Operational Models. Case Study Series Publication No. (HSM) 72-3030, Government Printing Office. Washington, D .C., 256 (n.d .) Blau, P. M., and Margulies, R. Z., " The Reputations o f American Profess ional Schoo ls: A Research Repli cation," Change, 6, 45, (Dec. 1974-Jan. 1975) Valentino, J. G., " The USP XIX Will Inc lude Useful Dispensing Information for Pharmacists," Pharmacy Times , 40,34-3 7 (Sept. 1974) Personal communication, Robert H. Henry, director of Pro fessional Affairs , The United States Pharmacopeia I Convention (March 17, 1973) " USP Monographs Divided into Two Parts. " Quality Control Reports ( The Gold Sheet), 9, 16, 17 (Jan . 1975) Opinion Research Corporation , Physicians ' Attitudes Toward Drug Compendia. Opinion Resea rch Corporation for the Pharmace utica l Manufacturers Associ ation , Princeton, N.J ., v, 3, 6, 7, 12 (J une 1968)
formation: A Study Among a National Sample of Physicians, Opinion Research Corporation for the Physicians' Desk Reference. Princeton, N.J., 18, 19,2 4,25 (Jul y 197 3) 17. Applied Management SCiences, Survey of Drug Information Needs and Problems Associated with Communications Directed to Practicing Physicians (Part II: Drug Bulletin Survey) , Applied Management Sciences for the Food and Drug Administration, WaShington, D.C., 1.3, 1.4,3. 11,3.13, 3. 14,3. 18.3. 19,3.21,3.32,3.33,3.37,3.38 (Feb. 22, 1974) 18. " Advertising Sales Would be 1-18lted; AMA Budget Balanced; Dues Hike Asked," Am. Mad. News, 1, 12, (Nov. 4, 1974) 19. American Journal of Nursing, " The Nurse and Drugs Administered in Hospitals," Medical Marketing and Media. 9, 18 (June 1974) 20 . Pharmaceut ica l Manufacturers Association, Prescription Drug Industry Fact Book, Pharmaceutical Manufacturers Assoc iation, Washington , D .C. (1973) 21. App lied Management Sciences, Survey of Drug Information Needs and Problems Associated with Communications Directed to Practicing Physicians (Part I: Physician Information Survey), App lied Management Sciences for the Food and Drug Administration, Washington, D.C., 1.6, 3.53, 3.54, 3.71 (May 8, 1974) 22. Wa lton, C. A., " Scope and Content of a Course in Drug literature Evaluation," Am. J. Pharm. Educ., 32, 853 (Dec. 1968)
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