INTRODUCTION

Professionals in clinical care experience information paradox but find it time-consuming to search and appraise scientific evidence.¹ Such professionals can take the help of Drug Information Centers (DICs) that provide unbiased and factual drug information, focusing on Patient-Oriented Evidence that Matters (POEMs).²,³,⁴ The POEMs strategy is based on the following three criteria: 1) it addresses a question that physicians encounter; 2) it measures the outcomes that physicians and their patients care about such as symptoms, morbidity, quality of life, and mortality; and 3) it has the potential to change the way physicians practice.⁵ However, self-reliance on information technology has affected the relationship between healthcare professionals and DIC personnel.

A previous study in Saudi Arabia that assessed DIC queries of a particular year at a 1400 bed setting revealed that merely 24% of physicians consulted DIC pharmacists for drug-related queries while the majority (61%) of the queries were asked by pharmacists.⁶ Likewise, a major DIC in Iran found that merely 19% queries were asked by physicians. Drug reference books, advice from colleagues, and scientific papers/journals were reported as the frequently utilized drug information resources by physicians.⁷ The brochures of pharmaceutical companies was another common source of drug information for physicians; however, brochures lacking appropriate scientific evidence can also compromise patient safety.⁸ Physicians are the first point of contact in clinical care, and their acquaintance with evidence-based drug information promotes rational prescribing behaviors that eventually lead to a better patient outcome.⁷

Although the first DIC was established in Saudi Arabia in the late 1970s, there is a dearth of empirical evidence pertinent to drug information seeking behaviors and acquaintance of practicing physicians regarding DICs in Saudi Arabia.⁶ Therefore, this study aimed to ascertain information seeking behaviors and awareness of physicians regarding DIC services. This study also aimed to calculate the average ranking of physicians’ opinions regarding the improvement of DIC services. The findings of this study will aid in the implementation of awareness and educational programs, thus, improving the DIC services, frequency of drug queries, and patient safety.

METHODS

RESULTS

A total of 500 electronic questionnaires were distributed during the study period, and only 254 physicians completed the survey, i.e., 50.8% response rate. Majority of the respondents (n=193, 76%) were male, whereas one-third of the physicians (n=83; 32.7%) had over ten years of clinical experience. Nearly half of the respondents (n=131) were residents. Of these respondents, 85 (33.5%) and 46 (18.1%) were specialists and consultants, respectively. Regarding the use of DIC services, 48% of the respondents mentioned that they had used DIC services, and more than half of the physicians never contacted the DIC for drug-related queries during their professional practice. When asked about getting orientation from DIC personnel regarding DIC services, merely 36.2% of physicians responded positively. Moreover, 96 respondents (37.8%) had contacted DIC six months before the initiation of this study. Forty-two percent of the respondents indicated that they can get the required information from drug information databases available at their institution; this was the most common reason for not contacting the DIC. Other reasons were insufficient time (86, 33.9%) and lack of knowledge regarding DIC (78, 30.7%). The majority (66.1%) of the physicians contacted DIC by telephone, followed by the submission of papers or electronic forms (18.1%). The summary of these results is listed in Table 1.

The most frequently utilized DIC service by physicians was related to drugs (Table 1). Two-thirds of the queries asked by the physicians were related to the dosage and administration of drugs, followed by drug-drug interaction (58.7%) and adverse drug reaction (37%). Table 1 also shows that UpToDate was the most preferred drug information database among physicians, followed by Lexicomp and Micromedex. Majority of the respondents were aware of the existence of DIC at the institutional and national levels. Table 2 shows that there is a statistically significant difference between the designations of the respondents, earlier use of DIC services, received an orientation from the DIC pharmacist, and awareness of both institutional and national DIC.

The respondents ranked five opinions for the improvement of DIC services. Sixty physicians (23.6%) considered the availability of the DIC contact details in all clinical wards as the most important area of improvement. Eighty-six physicians (33.9%) considered training and orientation about DIC services as the most important area of improvement. More than half of the physicians (n=137) identified the frequent dissemination of recently published scientific studies to the healthcare professionals as the least important of the suggestions (Table 3).

DISCUSSION

As per our knowledge, this is the first study in the recent 15 years that assessed information seeking behavior and awareness regarding DICs among physicians in the Saudi Arabia. There is a scarcity of literature on the studied topic as the recently published studies mainly focused on the assessment of DIC services provided to the healthcare professionals.⁶,¹² Similarly, previous studies predominantly reported the statistics of the DIC activities.

Our study shows that more than two-thirds of the respondents were male, reflecting the existing male and female proportionality among physicians.¹³,¹⁴ In addition, nearly one-third of the physicians were experienced professionals. This study also revealed that a majority of the physicians were aware of the existence of DIC at their institutions. However, these findings contradict earlier reports.³,¹⁵ Thirty-seven percent of the physicians contacted DIC six months before the initiation of this study, which accords well with the previous findings.³ In the present study, UpToDate was the most common online resource utilized by physicians for drug-related queries; this finding is comparable to the results reported in other studies.¹⁶ UpToDate is an evidence-based, peer-reviewed reference that is accessible through the web and mobile application and requires an individual and group subscription.¹⁷ It provides updated clinical information at the point of care.¹⁸ A retrospective study in the US reported that the usage of UpToDate eventually reduced the patient’s hospital stay and mortality rates.¹⁸ According to the findings of a cross-over randomized trial, healthcare professionals relatively spend less time on UpToDate for information retrieval compared to PubMed.¹⁹

In this study, two-thirds of the respondents sought information from DIC by telephone, which is in line with earlier reports.¹²,²⁰ We also found that the most frequent type of DIC query requested by physicians was related to the dosage and administration of drugs. This strengthens the findings of previous studies.⁶,¹²,²¹ Our study revealed that a significant proportion of the respondents were aware of the hospital and national DICs after receiving DIC orientation regarding their services. This finding corroborates the findings of a study conducted in Malaysia.²² Physicians identified the availability of DIC contact number in every clinical ward as the most important area of need. This will facilitate the physicians to ask queries to the DIC personnel in a timely manner, thus avoiding delay in the treatment process and improving patient safety. Training or orientation about DIC services was found to be the second most preferred choice for improving the services of DIC. It has been reported that the DIC of the largest and flagship tertiary care setting in the Saudi Arabia previously received merely 139 queries during one calendar year.⁶ However, physicians consider DIC pharmacists as a reliable source of information as they provide unbiased and factual information about drugs to the healthcare providers.²,²³

This is the first study that sought physicians’ opinions for the improvement of DIC services in the Kingdom. The diversity in the studied hospitals ensured the generalizability of our findings. However, a limitation of this study is the relatively low number of respondents. This may be because healthcare professionals constantly receive irrelevant survey requests from different sources and, thus, could have ignored important surveys pertinent to their professional field such as our survey. Likewise, the low response rate is frequently cited as a weakness of online surveys.²⁴,²⁵,²⁶ Nonetheless, our study sample is unlikely to be representative and lacks the power for statistical testing. As per earlier literature, electronic survey’s response rates may only approximate 25% to 30% with the maximum rate of 70%.²⁷ Our study response rate was well above the cited approximate range.

CONCLUSIONS

This study found that the majority of licensed physicians working in the Saudi Arabia were aware of the existence of DIC at the institutional and national levels. UpToDate was the most frequently utilized online drug information database among physicians in the Kingdom. Our findings revealed that there is a need to provide the contact details of DICs to all clinical wards. Training should also be provided to physicians regarding DIC services so as to facilitate drug consultation from DIC personnel and promote patient safety. Future studies are needed to explore the impact of DIC services on the professional performance of physicians.