National Survey of Drug Information Centers’ practice: Evidence-Based Medicine-Therapeutics Guidelines (EBM-TG) System at Ministry of Health hospitals in Saudi Arabia

Objective: To explore the practice at the National Survey of Drug Information Centers in Saudi Arabia with an emphasis on Evidence-Based Medicine-Therapeutics Guidelines (EBM-TGs) System at Ministry of Health hospitals. Methods: This is a 4-month crosssectional national survey of the Drug Information Services at MOH. The survey contains 10 domains with a total of 181 questions designed by the authors. The questions were derived from the International Pharmaceutical Federation, American Society of HealthSystem Pharmacists best practice guidelines. The survey was distributed to 40 hospital pharmacies that run drug information services. In this study, the domain MedicationUse Evaluation System was explored and analyzed. It consisted of seven questions about the written policies and procedures and application methods for EBM-TG in the drug information centers. The data were analyzed through the Survey Monkey system. Results: The response rate was found to be around 88.88%. According to the results, written policies and procedures for EBM-TGs existed only in 18 (45%) hospitals and approximately 25–100% of the elements implementations. EBM-TG monitoring system is available live in only 17 (42.5%) hospitals applying approximately 25–100% of the elements. According to our results, in only 18 (45%) hospitals, the patients receive appropriate care due to EBM-TGs. There is evidence that the EBM-TG Indicators existed in only 19 (45.5%) hospitals applying approximately 25–100% of the elements. Process for improving EBM-TG system exists in 20 (50%) hospitals applying approximately 25–100% of the elements. Conclusion: There a poor application of EBM-TGs in the practice of drug information centers. Implementation of EBM-TG system improves patient outcomes which avoids unnecessary additional costs in the healthcare system.


INTRODUCTION
The primary activity of the drug information center (DICs) is to answer drug information queries from the healthcare professionals and the public. 1 During answering the question, the pharmacist needs to revise tertiary and then secondary references. If they do not find the answer, they switch to primary references. At each step, the pharmacist must read the reference carefully with critical appraisal of the topic and evaluate the literature. The new concept is more than the socalled evidence-based medicine. It can be used at each step of search to critically evaluate the topic before Access this article online www.ijpcs.net delivering the answer of the question. Furthermore, it can be used to set up therapeutic guidelines or management protocols for various diseases. The EBM concept implemented in the Kingdom of Saudi Arabia (KSA) through medicines and physician while in pharmacy field not existed. [2][3][4][5][6] Several studies on DICs have been performed locally and they did not study the utilization of evidence-based reference or tool while answering queries or while designing guidelines. 7,8 Other studies performed on a group of DICs have surveyed the network of DICs but have not mentioned anything related to the evidence-based medicine. [9][10][11][12] The authors are unfamiliar with any investigations discussed with respect to the utilization of evidencebased medicine with DICs in Saudi Arabia or Gulf and Middle East countries. Moreover, it hard to find the studies worldwide in practice. Therefore, the goal of this survey is to explore EBM-TG system used in the drug information practice in Saudi Arabia.  1,[13][14][15][16] This survey was distributed to 40 hospital pharmacies that run drug information services. The basic information regarding the DICs services offered by the hospitals from the extensive records of General Administration of pharmaceutical care. This study was conducted in the year 2015. In this study, we explored and analyzed the EBM-TGs System. Table 2 shows the seven questions as per this domain. The data were analyzed by the Survey Monkey system.

RESULTS
The survey was distributed to 45 MOH hospitals. Of them 40 (88.88%) hospitals responded to the questions. Among the total responders, 35% were large, 37.5% were medium size, and 17.5% were small size hospitals as well as 10% were National and Regional Drug Information Centers. Approximately 15 hospitals were accredited by CIBAHI and 8 hospitals were only accredited by Joint commission, whereas none of them were accredited by ASHP or Canada. Most responders were Saudi (38 (95%)) nationals. There were 28 (70%) male and 12 (30%) female responders (

DISCUSSION
The MOH started the strategic plan of healthcare system in 2010 and has shown several significant achievements. 17 One of best achievement is the establishment of the evidence-based healthcare center. This project was founded with the collaboration of McMaster University, Canada. The center collaborates with the medical administrator and the assistant medical administrator at the MOH. In addition, the center collaborates with non-MOH government organizations including universities, national guard institutions, military health organizations, and scientific societies. The primary goal of the center is to establish and distribute concepts of evidence-based medicines and national guidelines and protocol for diagnosis, management, and prevention of acute and chronic diseases among all healthcare professionals. 18, 19 The center also collaborates with Gulf's evidence-based medical center, the first center founded in Gulf area which is located at King Abdul-Aziz medical city. The MOH and Gulf center provides educational courses on evidence-based medicine. Till date, the MOH has released and published almost 20 diagnostics, management, and prevention of disease guidelines. 19 17.5 % 6 (15%) 1 (2.5%) 5 (12.5%) 2 (5%) 6 (30%) 4 (20%) 0 (0%) 0 (0%) More than or equal 600 0 0% 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)

Very Large
Medical Cities 0 0% 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) National and Regional Drug Information Centers  The General Administration of pharmaceutical care collaborated with the center and participated with several clinical pharmacists during the establishment of the guidelines for evidence-based medicines. [20][21] The pharmacy administration established evidence-based pharmacy based on the guidelines provided by the MOH center and on international literature as part of the DICs activities. The authors surveyed to explore EBM-TGs via DICs. Our results showed poor application and implementation of EBM-TGs among the investigated hospitals' DICs. Most of the literature did not mention anything in detail about the evidence-based medicine and may be one respondent stated the references of evidence-based medicine only. 10 It is hard to compare our results with those of other studies. The drug information pharmacist needs education and training for evidence-based medicine and internal policy and policy for implementing the system at MOH hospital pharmacies in Saudi Arabia.

CONCLUSION
EBM-TGs are a new concept in the pharmacy field of DICs practice. Systemic implementation of EBM-TGs with education and training, close monitoring, and repeating the survey of the application of such new system improves DICs services and may prevent economic burden in the healthcare system at MOH hospitals in KSA.

ACKNOWLEDGEMENT
I want to thank all drug information pharmacist at all regions for their cooperation.