Drugs: The Evidence

Title of project: Drugs: the evidence

Project Team: A plus other members of the library service team

Resources Required: Brass neck to gain access to sponsored medical meetings
Ability to carry out, understand and summarise the results of a brief literature search
Ability to publicise the results of the search via intranet and/or email

Timeframe: 2010-

“The Story”: Dissatisfaction with the facility for pharmaceutical company staff sponsoring Trust medical meetings to hand out publicity materials which may not present the whole evidence about the efficacy of the products they are promoting. Library staff now infiltrate these meetings, and seize examples of the publicity materials. Advertised products are then subjected to a literature search, with a concentration on high-quality, up-to-date evidence. This results in a short summary of the findings which is posted on the Intranet. Selections of these summaries are emailed out to Trust physicians and local GPs at regular intervals inviting feedback.
Searches and summaries take no more than half an hour. The idea of the service is to encourage doctors to challenge the “evidence” presented by the drugs companies, rather than to present the “last word” on the topic.

Alignment to local, regional and national drivers: Hill Report emphasis on working outside the library comfort zone e.g. in clinical areas
Annual statistical return demand to report on search emanating from non-library areas
LQAF

Impact of this project/service for the:
• customer • organisation • library
Feedback includes:
1 Tongue in cheek comments about library staff endearing themselves to drugs reps
2 Email from doctor claiming that he had evidence that drug P was less cost-effective than the evidence I had cited suggested. I emailed him the Health Technology assessment which had reached the conclusion I quoted from and have not heard from him since.
3 Query from GP Lead prescriber at local PCT about why so many patients appear to be started on medication X by Pennine Acute doctors when the evidence appears to suggest that X is no more effective than a cheaper alternative. Passed this on to Drugs Information Pharmacist (who was happy to deal with the question) as this is obviously beyond the remit of a non-clinician

Lessons Learned: Take care to cover your back by ensuring that you quote directly from evidence (usually abstracts) so as not to give the impression that a librarian is interpreting evidence and advising on clinical decisions.
I’ve ignored this advice twice, in order to demonstrate how drugs companies misled doctors by citing relative risk rather than absolute risk but ensured that what I wrote was factual rather than interpretive.
More difficult to enthuse staff on other sites with the idea of sneaking unobtrusively into medical meeting to filch leaflets than I had originally expected. I suspect that there’s still a feeling that entry into these meetings (even during the pre-meeting lunch) is rather more difficult than entering a Masonic lodge.

Sustainability / next steps? Interest in the project appears to be growing. I’ve only just started to circulate summaries to the GPs and suspect that this may create more interest with this group than I had originally anticipated, as prescribing decisions taken by hospital doctors may have considerable long-term implications once a patient’s care returns to his GP.

Contact details: John Addison. Pennine Acute Hospitals NHS Trust. john.addison@pat.nhs.uk

Date case study completed: 8 September 2010

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