Medicines Information and the GP: are their needs being met?

Problem

Clinicians in general practice constantly balance the need to respond quickly to a wide range of clinical problems with the need to seek further information upon which to inform decisions. The potential risks of knowledge gaps related to medicines range from sub-optimal therapeutic outcome to the occurrence of preventable harm to patients, with a corresponding financial burden to health systems. The majority of medicines use occurs within primary care. Thus, optimising medicines information support for general practitioners (GPs) is vital. To date, the medicines information needs of GPs have not been investigated. Hence, the aim of this study is to explore the nature of their medicines information needs, the strategies they employ to find information, and the challenges this presents in practice.

Approach

Data will be collected from approximately twenty GPs in New Zealand using two methods. Firstly, a post-clinic structured reflection involving a face-to-face meeting where the participant is prompted to verbally reflect on each consultation during the two previous days. The focus is on medicines issues, information needs arising and actions taken as a result. Quantitative, descriptive data about information needs arising and resources used is managed in Microsoft Excel. Secondly, face-to-face semi-structured interviews will explore participant views on: (1) medicines information resources and support; (2) barriers to meeting information needs in practice and potential solutions; and (3) role of pharmacists in providing medicines information support. Interviews are digitally recorded and transcribed verbatim. Qualitative data are managed in NVivo and subjected to inductive thematic analysis. University of Otago ethical approval was obtained for this study (reference number D15/314).

Findings

Midway through data collection, the broad and unpredictable nature of GP information needs about medicines has been highlighted in both the structured reflections and interviews. GPs prefer to solve issues during a consultation using familiar, immediately available resources. When these resources fail to provide answers, rapid assistance from others such as hospital specialists, pharmacists and medicines information services is greatly valued. The issue of identifying clinically important medicine interactions and the risk of alert fatigue is a recurring theme.

Consequences

Areas for action suggested by the preliminary findings include: (1) facilitation of reliable access to support from specialists, pharmacists or medicines information services; and (2) improved presentation of medicine interaction information to reduce the risk of patient harm from unidentified clinically significant interactions caused by alert fatigue. A full data-set will enable analysis of areas where medicines information resources can be enhanced for GPs in terms of both content and format. Ensuring GPs are supported to meet their medicines information needs is an important component of optimising outcomes and reducing harm from the use of medicines.