/travelling_librarian_2007

ESU/CILIP Travelling Librarian 2007 13th October 2007 - 28th October 2007

Karen Poole, BA, MSc, MCLIP Assistant Librarian Royal Pharmaceutical Society of Great Britain

Acknowledgments

I am very grateful to CILIP and the ESU for the Travelling Librarian award and particularly to Gill Hale, ESU Librarian and Jill Martin, Director of Knowledge & Information, CILIP for their support in organising my trip.

Over the two weeks of my trip I was privileged to meet many dedicated health librarians and information professionals and pharmacists and am extremely appreciative for all the time that they gave to making me welcome and my visits so informative, and for their kind hospitality.

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Contents Personal Profile.....................................................................................................................4 Discussion.............................................................................................................................6 Full Report of Visits.............................................................................................................12 •

American Pharmacists Association (APhA)................................................................12

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National Library of Medicine (NLM) ............................................................................18

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Louis Stokes Health Sciences Library, Howard University.........................................21

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Snell Library, Northeastern University ........................................................................23

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Massachusetts College of Pharmacy and Health Sciences (MCPHS) .......................24

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Countway Medical Library, Harvard University...........................................................26

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Astra Zeneca Global Discovery Informatic Center (IC) ..............................................28

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Visit to Community Pharmacist, CVS Pharmacy ........................................................30

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University of Tennessee (UT) Health Science Center................................................31

Appendix 1 - Glossary.........................................................................................................36 Appendix 2 – Initial Proposal ..............................................................................................37 Appendix 3 – Expenses ......................................................................................................38

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Personal Profile As Assistant Librarian for the Royal Pharmaceutical Society of Great Britain (RPSGB) I am one of a small library team helping to support the Society’s vision to “advance health and wellbeing through promoting excellence within the pharmacy profession”1. As my job involves a mix of duties including acquisitions, cataloguing and enquiry work I was keen that during my trip I discussed a wide variety of aspects of health (and particularly) pharmacy information and library work with those that I met.

The RPSGB is the professional and regulatory body for pharmacists in England, Scotland and Wales. The primary objectives of the Society are to lead, regulate, develop and represent the profession of pharmacy. It also regulates pharmacy technicians on a voluntary basis, and the library therefore provides services to pharmacists, preregistration and MPharm students and pharmacy technicians. There are over 47,000 pharmacists and 6,500 pharmacy technicians on the RPSGB’s registers. In 2009 the regulatory role will move to a new body (the General Pharmaceutical Council (GPhC)) and pharmacy will require a new professional body which pharmacists will elect to join. The RPSGB sees itself as a firm foundation for this new professional body and is investigating what services members would want.

The RPSGB library helps members of the Society access information on pharmacy and pharmacy-related subjects such as pharmacy practice, pharmacology, drug dosage and delivery, adverse drug reactions and drug interactions and herbal medicine. It provides book loan (postal loan service available) and document supply services, a literature search service, answers to information-related enquiries and study and research facilities. The library aims to hold a comprehensive collection of key pharmacy texts, including past editions. The majority of the Library's 60,000 books are available for loan to library users. The reference collection of pharmacopoeias, formularies and proprietaries is unparalleled and includes the key drug texts from around the world. The Library is also custodian of the Society's Early Printed Collection which consists of approximately 3,500 volumes published between 1485 and 1859. The collection contains rare and unusual texts including early pharmacopoeias and herbals. Some access to electronic materials is made available in the library and access offsite for members is about to launched.

My aims for the trip were: • to identify key resources (print and electronic) currently used in the United States in pharmacy information and education, • to discuss innovations in the provision of electronic materials, • to discuss training and education opportunities provided to pharmacists (with particular focus on the areas that the RPSGB might consider in the future), and to see examples of training materials produced by librarians, • to explore the services offered to various pharmacy sectors: academic, community and industry.

• to visit a pharmacy membership organisation that was similar to the RPSGB and discuss the services they offered.

By identifying best-practice and resources that I could introduce in my own library upon my return I aimed to improve our own service.

I wished during my trip to improve my subject knowledge but also to expand my horizons, to experience a different culture and to build relationships with colleagues abroad. I was therefore very happy to share details of my library’s practice and procedure and the knowledge that I

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http://www.rpsgb.org

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have of UK and European pharmacy publications and information sources with those I met on my trip.

I made my two week trip to the United States for the Travelling Librarian Award 2007 from the 13th – 27th October 2007, visiting Washington D.C., Boston and Memphis.

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Discussion The visits I made were to a variety of organisations including academic institutions (both specific pharmacy/healthcare colleges and large multi-subject universities), as well as a pharmaceutical industry information centre, a community pharmacy, the National Library of Medicine and the American Pharmacists Association.

Washington D.C. • American Pharmacists Association • National Library of Medicine • Louis Stokes Health Sciences Library, Howard University Boston • Snell Library, Northeastern University • Health Sciences Library and Drug Information Center, Massachusetts College of Pharmacy and Health Sciences • Countway Medical Library, Center for Biomedical Informatics, Harvard University • CVS Pharmacy • Astra Zeneca, Global Discovery Informatic Center.

Memphis • University of Tennessee Health Science Center, Library and Drug Information Center Electronic resources The variety of organisations I visited provided an excellent introduction to commonly used eresources in academia, industry and the pharmacy workplace. As expected they were all investing heavily in these resources and off-site access to electronic resources was standard for university students. Centralised control of resources across campuses and in the case of Astra Zeneca across countries is a key benefit of e-resources.

A feature of e-resources for medicine (and pharmacy) has been the development of electronic platforms hosting key texts, journals and clinical and drug information which can be crosssearched by an enquirer. I now have a far greater understanding of the e-platforms and resources available, know where to locate listings of relevant e-books and have identified some potentially useful databases to be considered when considering the future development of the RPSGB library’s e-collection.

Many of the institutions have subscribed to a number of the platforms available rather than just relying on one. Often this was because there is no one single platform that can provide access to all the titles and resources required by the organisation or faculty and students, but it has led to multiple access points to some key titles but with different holdings on different platforms. It is not uncommon to have three different ways to access the same information.

A key discussion area with librarians I met was how best to allow access to the resources, and, where multiple access points existed, to facilitate transfer to the platform with the correct holdings. In many cases the library catalogue and A-Z subject listings of resources combined with a link resolver were being used to connect library users to the information they required.

Pharmacists especially those in industry, academia and hospital practice as well as those working for community pharmacy chains now expect access to e-resources as standard to support their practice. However, pharmacy colleges are still teaching Pharm.D. students who are training to be pharmacists about which print resources should be used to answer drug information enquiries. There is a danger in solely using platforms hosting multiple resources that students will not recognise which resource information is coming from, and when in practice may not have access to the same platform, or even in some community-based independent pharmacies not have access to e-resources at all.

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E-journals: As a result of the rapid increase in the number of journals available electronically and also to control the overall acquisitions costs there has been a move away from holding current print journals where this is effectively a duplication of holdings. Analysis of usage data has allowed several of the libraries I met to rationalise the collection and reduce costs whilst still meeting the needs of their users. Like many of the organisations I visited the University of Tennessee also regularly conducts a survey to ask faculty which titles they consider essential, which titles could be dropped and if there are any titles that are not currently taken which should be considered.

However, sometimes the usage statistics do not always reflect the faculty’s understanding of what resources are important. The most difficult case to resolve is where students are regularly using a resource that faculty have not rated highly and the library has to be prepared to fight to secure funding to continue to supply access to these resources.

In industry and some academic libraries historical journal collections have also often been dispensed with to increase the space available in the library for other resources, and particularly to increase the number of single and group study rooms, which are in great demand. The Louis Stokes library was built recently and epitomises this model, very few journal titles which are available electronically are taken in print and the space allocated to print journal titles is small. Priority instead has been given to study areas and to IT resources, both PC labs and wireless access for those with their own laptops, to allow all students to easily access the electronic resources.

This move away from holding older print titles not available online is made feasible as a result of either local inter-library loan networks or the NLM’s document supply service. The NLM is increasingly busy supplying libraries with older items that they might once have held in their own collection. They are also one of a number of national libraries, working with publishers to ensure that access to older issues of electronic titles are not lost once subscriptions to current information have ended or if the publisher ceases to exist.

Several libraries I visited have linked their electronic and print holdings to NLM’s PubMed services and members locating articles on PubMed who are logged in will see when their library has the item in their collection. A search for a PubMed ID (unique identifier for each article indexed on PubMed) is also supported on some e-platforms and library catalogues enabling easy and seamless access to resources.

E-textbooks/Clinical information: As with e-journals the high cost of providing e-textbooks and clinical and drug information is an issue that libraries face on a regular basis. The MCPHS library has recently moved access to Martindale: the complete drug reference (a title produced by the RPSGB’s publishing wing Pharmaceutical Press (PhP)) from one platform to the PhP’s own because of cost. As with ejournals these textbooks and cross-searchable platforms require maintenance, good linking from the library catalogue/subject web pages to facilitate access, and where a large number of e-resources are made available, a full-time manager of e-resources to improve access for users. Training of students and faculty and other library users and good marketing to promote the resources were also areas discussed at several of my visits as there is a tendency for users to rely on just one platform when in fact key resources can be spread across several which are all slightly different to use. Also, with resources frequently moving platforms users need to be made aware of how to access the full range available and to understand what each resource is useful for.

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Liaison with stakeholders All the libraries and information centres I visited were concerned with good liaison with all of their stakeholders and in meeting the needs of their users. In academic institutions building good relationships with the faculty is of huge importance to ensure funding. Librarians need to ensure good links are built in order to convince faculty of the importance of information and information handling. The liaison librarians to the pharmacy colleges varied in their level of inclusion in the course. Some taught compulsory, assessed, modules on locating drug information, database searching and evaluating the quality of information whilst others were there in a support role taking reference queries and producing guides to resources. The amount of librarian involvement on courses appears to be cyclical at a number of institutions I visited and does depend on individuals (both faculty and librarians) and also on how priorities are set on what is included in the courses for PharmD students. APhA has to provide an attractive package to ensure that US pharmacists choose to pay to become members and regularly consults both its existing membership, and crucially those pharmacists who have not chosen to join, on their views and needs. It uses the information it gathers to inform policy and developments in services.

Archival role Although some organisations have greatly reduced their historical collections several of the ones I visited still maintained collections of early printed books, manuscripts and archival records of the institutions. The Countway library has taken on an archival role for documents for several of the health institutions allied to Harvard University and the NLM has an important historical collection including an Incunabula collection (books printed before 1501). Although they are operating on a much larger scale their key area of concern, as for the RPSGB library and its collection of early printed books, is to balance access to the collection with the need for preservation. The NLM online exhibition using Turning the Page (TTP) software is an excellent way of making this material available whilst restricting the amount of access and potential damage to the book. Scanning of the RPSGB’s early printed books has been discussed before but seeing the TTP software in use and the end result online was very interesting.

It was felt that a well marketed and maintained historical collection can attract a new set of users to a library. The librarians I met who dealt with this type of collection all felt that marketing of an historical collection was essential as it could be a great asset for an organisation.

However, they were also aware that it could lead to high demand on library staff’s time as items have to be fetched from the store and users have to be monitored more carefully to avoid damage to items.

Access to drug/clinical information The RPSGB’s Information Centre includes a team of Information Pharmacists who provide answers to clinical enquiries (including foreign drug identification queries) from any member of the Society. The Information Pharmacists are heavy users of the library’s collection particularly of the pharmacopoeias and proprietary books from a variety of countries. UK pharmacists also have access to Medicines Information units attached to hospitals and information provided by pharmaceutical companies as well as the resources provided by the RPSGB and other membership organisation’s information services.

In the US drug information centres are also based in hospitals but pharmacists (especially independent community pharmacists who do not have the resources that working for a company with multiple branches provides) also have access to drug information through academic institutions such as MCPHS and this is a very important and valued resource.

However, it must be remembered that these centres are primarily a training tool for students on the PharmD course and are not open year round or outside class hours. Also, both centres I visited reported that the number of queries has dropped in recent years and this is probably as a result of the increased use of electronic resources, both those that have been purchased and 8

are available in particular workplaces, but more importantly for independent pharmacists those free resources that are made available for example through the NLM. The NLM already offers a large selection of high quality databases and resources and will shortly be adding a drug identification tool for US drugs and a patient medicines management tool based on their standardised vocabulary RXNorm.

Academic pharmacists are well served by their own university’s libraries which work in concert with the NLM, and pharmacists in industry have access to a huge amount of electronic materials. APhA supports its members’ access to materials by making their publications available on an electronic platform and by offering discounts to their members on print items.

I was particularly interested to see the amount of clinical information included on electronic platforms such as Micromedex which have added content beyond simply being digitised versions of journals and books. These platforms will be well worth exploring in more detail.

Marketing of services All of the librarians I met were keen to market their services and to ensure that they were reaching all potential users. Marketing in academic institutions is particularly effective when the faculty place an importance on information and make space in their curriculum for librarians to either teach or to explain resources on offer and services supplied e.g. at the end of a compulsory lecture. In the case of APhA marketing is of particular importance as pharmacists choose to join the association and there is a very wide geographical spread of potential members to reach. The marketing team promote services that have been particularly developed to meet the needs of pharmacists and also ensure that they are marketing to all possible user groups – community, hospital, industry etc and at all stages of their career.

All the organisations I visited placed an importance on having an online presence, in many cases users may not ever visit the library but a well-organised and well-designed website/intranet can be an effective way of informing them of all of the services available.

Several of the academic organisations offer not just an email/web-form contact but also instant messaging to speak to a librarian to engage with students via technologies that they are very familiar with. APhA are relying more and more on their web presence to host the services, including continuing education programmes they provide on a secure site.

There was also some concern in certain organisations about over-promotion of the services; raising expectations about what the library can provide but not having enough staff and time to offer a high quality level of service. Therefore it was felt that the marketing must be realistic and of a level that the services could cope with.

Training Many of the librarians I met were involved in offering training to the users of their services. As discussed above some librarians teach students directly on pharmacy courses, and often had a teaching qualification as well as their library one. Other areas of training provided by librarians without extra qualifications included face-to-face basic inductions to library services and the collection and advanced training targeted at a particular group’s needs e.g. searching Medline or using Scopus. As new resources are added to the collection library staff need to quickly master how to use them and then be able to train effectively on them. In some cases the speed that new resources are added has sometimes led to library staff feeling pressurised. One successful way to combat this has been to arrange training to be given to library staff by the producers of the resource which can then be cascaded down to users. New means of delivering training are being developed, for example there are now a number of podcasts on the Snell library and UT library’s web pages which introduce students to some of the electronic resources.

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Print training resources written by librarians and targeted at particular groups of users highlighting key resources and how to use them were also common, available in the library and online to be downloaded e.g. the Louis Stokes Pathfinder series of leaflets.

Knowledge sharing One of my objectives for my trip was to share details of my library’s practice and procedure and the knowledge that I have of UK and European pharmacy publications and information sources.

On all of my visits I discussed publications that are part of the RPSGB library collection and also the bibliographic databases (including RPS ePIC) the library has access to and I was also able to give details of PhP titles which I am very familiar with. Other discussions focussed on good quality resources on herbal medicines. At APhA the people I met were very keen to hear about the kind of services that were offered not just by the library but by the RPSGB as a whole because of the similarities across the organisation. I was able to share literature produced by different sections of the RPSGB and showed the website to a number of people as a large amount of material is hosted there. I also had discussions about resources I knew of to aid foreign drug identification when visiting the two drug information centres.

I also gave a presentation on the NHS, the National Library for Health and the RPSGB to a number of library staff in University of Tennessee Health Science Center and answered a number of questions.

Sight-seeing Although my two weeks were busy with library visits and travelling I also, of course, managed to go sight-seeing. In Washington a highlight was the Smithsonian Museums particularly the display from the collection of the National Museum of American History including Kermit the Frog and Edison’s light bulb. Being in Boston in October meant that the fall foliage was spectacular and I visited one of the national parks to see some maples. In Memphis I visited the Mississippi River Museum to walk the length of the river (or at least a half-mile scale river walk!) and look at a full size replica paddle riverboat. As an end to a fantastic trip I spent the last evening with Jennifer, the librarian who had arranged my visit, in Beale Street listening to live music (Memphis blues of course!). I very much appreciated the opportunity to experience the culture of three very different cities.

Action following trip Since returning from my trip I have given an informal presentation to the RPSGB Information Centre team. I have also made example copies of APhA publications such as PharmacyWork LifeMatters to appropriate colleagues working in the Society’s journal publications team and discussed the presence of PhP publications in US universities with the marketing team. My trip to APhA highlighted a number of services offered to pharmacists that could be considered as membership benefits when the new representative body for pharmacy is formed. Discussions will be taking place on the possibility of offering an instant messenger service and also on the development of the library’s electronic collection. The library will also be considering using the NLM’s Link Out service discussed below to facilitate access to the collection from PubMed. I am writing an article for Impact the CILIP Career Development Group’s (CDG) journal and will be giving a talk about my trip for the CILIP International Library and Information Group (ILIG) in April 2008. I was also recently profiled in CILIP’s article in the Independent on Sunday on newly chartered professionals and was asked to name my career highlight which without doubt was this trip.

As a Candidate Support Officer (CSO) for the London and South East CDG division, supporting librarians wishing to charter, revalidate or achieve accreditation I am very pleased to have gained experience of an international setting. Breadth of professional knowledge and 10

understanding of the wider professional context are one of the criteria for chartership and I now feel more confident in discussing this with candidates.

Over the two weeks of my trip I was privileged to meet dedicated health librarians and information professionals and pharmacists and am extremely grateful for all the time that they gave to making me welcome and my visits so informative. Many of my initial contacts in the US had gone out of their way to plan itineraries for me to meet colleagues across the organisation and I was taken out to lunch on numerous occasions. Special thanks go to Jennifer Watson who drove me around Memphis and took me on a night out. I have learnt a great deal that will be of use within my work practice as well as benefiting personally from the chance to visit a variety of health/pharmacy information centres to gain experience of different sectors and to build contacts with other pharmacy librarians.

I have already had further discussion with a couple of the librarians I met who are undertaking a research project and wished to include a UK perspective. I also hope that through the discussions that I had with those I met about the RPSGB library, health librarianship in the UK, CILIP and the ESU as well as the presentation that I gave in Memphis that I have met my objective of sharing information and knowledge.

Karen Poole 3rd February 2008 karen.poole@rpsgb.org

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Full Report of Visits Monday 15th October • American Pharmacists Association (APhA) Washington D.C. Contact: Gwen Norheim, Knowledge Management Specialist

Photos L to R: Karen Poole and Gwen Norheim in the APhA Library; APhA’s building on the Mall (undergoing renovation); APhA.

About APha Mission Statement: “The American Pharmacists Association provides information, education, and advocacy to help all pharmacists improve medication use and to advance patient care.”2 APhA, founded in 1852, represents more than 60,000 pharmacists, pharmaceutical scientists, student pharmacists, pharmacy technicians and other individuals interested in promoting patient care. APhA work in all practice settings including community pharmacies, hospitals, long-term care facilities, managed care organisations, hospice settings and the military.

Although APhA does not have a regulatory role many of its functions are similar to those that the RPSGB fulfils in Great Britain. Both organisations are inclusive for those working in the pharmacy profession and do not focus on one particular sector e.g. community or hospital pharmacy. APhA provide information and run education programmes for all sectors and in their advocacy role can speak for and promote the whole profession. As the RPSGB is so similar (particularly as in the next few years it will lose its regulatory function) and is likely to be looking to develop its membership benefits, I was very interested to not only see the information centre but also the other sectors of APhA including publications, education and guidance departments.

I was in the US in October which is American Pharmacists Month celebrating the role of the pharmacist in medication therapy management. This year the campaign ‘Know your Medicine, Know your Pharmacist’ encouraged consumers to talk to their pharmacist. Numerous national pharmacy chains, local independent pharmacies, hospital pharmacies, and all sectors of the profession stimulate interactions between their pharmacists and consumers during this month, thus initiating long standing and positive medication outcomes.

Key areas of APhA’s work have been supporting pharmacists transition from a product-centred role to a patient-centred role and they are also very active in promoting pharmacy and putting forward pharmacists’ views to government, focussing recently on the subject of Medicaid and aiming to ensure that everyone has access to medications and pharmacy services.

APhA membership benefits are wide-ranging3 and include access to: • pharmacy news and developments which is provided through APhA journals such as the peer reviewed JAPhA; 2

American Pharmacists Association http://www.apha.org APhA membership benefits: http://www.pharmacist.com/AM/Template.cfm?Section=Home&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID= 14970 3

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• • • • • •

educational programmes including APhA’s Online CE Center which hosts over 100 units of programmes and online assessment; drug information resources through the DrugInfoLine publication; the Medication Therapy Management (MTM) resource centre; career development and employment resources, including a residency programme and career development publications; financial and insurance products including professional liability insurance; professional development and networking resources which allow pharmacists to communicate via e-communities and assigns them to an academy relevant to their area of practice (pharmaceutical practitioners, pharmaceutical scientists and students).

At present they do not offer off-site free access to electronic resources (full text journals or ebooks) but guidance, continuing education notes and assessment are all available online in the secure membership area.

Tour of the Library and Archives Gwen Norheim, (Knowledge Management Specialist) The APhA library consists of a large number of print journals, the full range of APhA publications and a small collection of key reference texts from other publishers. It is used by the staff working at APhA and by the one full time member of library staff to answer queries from staff and members of the association. Document supply is occasionally required from the library but in the main external requests for articles from APhA publications can be fulfilled by the NLM. One of Gwen Norheim’s key roles is to produce and disseminate to APhA staff a current awareness service consisting of a daily bulletin of health/pharmacy related news appearing in that day’s newspapers and online news services.

A part-time archivist looks after APhA’s records and archival material.

Professional Practice Jim Owen (Director) A key focus for the professional practice section is the development and promotion of Medication Therapy Management (MTM) in pharmacy practice, increasing the pharmacist’s role in improving medication use. It is not just aimed at community pharmacy practice but has a place in acute care in hospitals, in long term care and other practice settings. APhA promotes pharmacists as the most highly trained healthcare professional on medication therapy; they are ‘medication use experts’ or ‘medication therapy managers’, providing services to all patient care settings and to all patients who require it.

In 2004 a pharmacy consensus definition was reached that MTM is a distinct service or group of services that optimise therapeutic outcomes for individual patients. There has been much discussion of what MTM services will include starting with a description of the foundational core elements of MTM services that could be offered across the spectrum of community pharmacy.

By 2007 the focus was on the provision of MTM services across all pharmacy practice settings and was developed with the input of an advisory panel of pharmacy leaders representing diverse pharmacy practice settings. It is APhA’s belief that “All patients who use prescription and non-prescription medications, herbal products and other dietary supplements could potentially benefit from the core MTM elements”. MTM is not just at the point of dispensing. The MTM service could include an annual comprehensive medication therapy review/review as a result of significant event such as transition of care.

MTM in pharmacy practice includes the following five core elements: o Medication therapy review (MTR) 13

o o o o

Personal medication record (PMR) Medication action plan (MAP) Intervention and/or referral Documentation and follow-up

MTM activities include performing patient health assessments; formulating a medication treatment plan; selecting, initiating, modifying or administering medication therapy; monitoring and evaluating the patient’s response to a therapy; providing verbal education or training or written information and performing a comprehensive medication review.

There are similarities between the activities being undertaken as part of the MTM services and the work UK pharmacists undertake for the NHS pharmacy contract. Resources used to support US pharmacists in MTM may also be relevant for RPSGB members.

American Pharmacists Association Foundation4/Project Impact/Building Bill Ellis The APhA Foundation is a not-for-profit organisation affiliated with APhA that conducts research projects to improve the cost-effective and quality of consumer health outcomes that are affected by pharmacy. “As health care providers and medication experts, pharmacists have an unprecedented opportunity today to help patients manage their drug therapy. The pharmacist can play a vital role by assisting with drug therapy decision making, providing patient education, and monitoring adherence, efficacy and side effects. Studies show that patients follow the recommendations made by pharmacists in the majority of instances. As one of the nation’s premier organizations serving the profession, the APhA Foundation has consistently shown that pharmacist-based services have measurable clinical and financial impacts.”5 An example of one of the Foundation’s projects is the Diabetes Ten City Challenge which improved pharmacists’ patient-centred services available across the country. The project established a voluntary health benefit for employees and their dependents, provides incentives through waived co-pays for diabetes medications and supplies, and helps people manage their diabetes with help from a pharmacist coach in collaboration with physicians and diabetes educators. The project aimed to improve overall health, reduce absenteeism, shorten hospital stays, and reduce health care costs. Employers are keen to take part as employees in the pilot programme saved between $1,622 and $3,356 per participant annually based on reduced emergency room visits and fewer diabetes-related hospitalizations.

Another ongoing project is ImPACT: Depression. This aims to discover whether pharmacists can help improve depression treatment adherence. Traditionally 50-70% of patients stop taking their medication 3 months after the beginning of treatment without consulting a health professional and this could be an important role for pharmacists if they can improve this situation, with a direct impact on public health.

The Foundation also offers incentive grants and provides seed money to implement or support an existing patient care service within pharmacy practice. They have supported 200 pharmacybased projects since 1993.

Bill Ellis and the Foundation have also been involved in fundraising for the development of APhA’s new building and have so far been successful in securing a sponsored named space for the new library/information centre and other projects such as Bringing Your Medicines to Life campaign which will establish a Center for Pharmacist-Based Health Solutions, allowing APhA to respond quickly and decisively to emerging health care issues.

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APhA Foundation http://www.aphafoundation.org Ibid

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Publications Carlotta Richard (Managing Editor) There are numerous non-book APhA publications targeting different sectors and aspects of pharmacy practice. Some are peer-reviewed whilst others provide news and current awareness. Publications include: •

• • • • • •

•

•

•

Professional education monographs series for pharmacists. These include learning objectives and CE assessment questions and examinations. ‘Heart failure: medication therapy management services; keys to success in helping patients with heart failure’ and ‘Understanding the prevalence of migraines: diagnosis, disease, and treatment’.

Pharmacy Work Life Matters. A periodical highlighting practical ways to improve pharmacy work life. e.g. dealing with angry patients, pharmacy management tips and promotion of APhA continuing education programmes.

Drug Info Line. Drug news for APhA members. A publication that informs members of newly developed drugs, guidelines on use, regulatory information and interactions.

The One Minute Counselor. 1 page information sheets on various subjects to be copied by pharmacist and handed to patients. Titles include ‘A Pharmacist’s Guide to Travel Health and Vaccinations’.

Pharmacy Today. Magazine style publication including news articles, information on ‘hot topics’, discussion of OTCs etc.

Student Pharmacist. Publication sent to all APhA student members targeted at the needs of this particular section of the membership. Articles include discussion on careers, tips on making the most of the residency period, practice updates.

JAPhA – The Journal of the American Pharmacists Association, the official peerreviewed journal of APhA, provides members with information on pharmaceutical care, drug therapy, diseases and other health issues, trends in pharmacy practice and therapeutics, informed opinion, and original research. A subscription to the JAPhA is a benefit of APhA membership; however, members may select a subscription to either the Journal of the American Pharmacists Association or Journal of Pharmaceutical Sciences.

Journal of Pharmaceutical Sciences. This journal focuses on two major questions of importance to pharmaceutical scientists: (1) What are the physical and biological barriers that limit the access of drugs to their therapeutic targets and (2) How can drugs, dosage forms, and delivery systems be designed to maximize therapeutic efficacy?

Pharmacy Today. The monthly medication therapy management (MTM) magazine from APhA offering readers profiles of practices that employ unique MTM techniques to effectively serve their patients. Readers can use these profiles as models to develop and improve their own MTM practice, increase patient adherence and build patient loyalty.

Transitions. Published exclusively for members of the APhA New Practitioner Initiative, this quarterly electronic newsletter contains information that focuses on life outside of pharmacy practice and provides guidance in various areas of professional and practice development.

US pharmacists are regulated at state level and most states require pharmacists to complete at least 15 hours of CE every year to keep updated on new therapies and disease management information and to maintain their licenses. U.S. pharmacists usually obtain this additional education by completing self-study programmes (e.g. scientific articles in pharmacy journals, monographs, Internet-based programmes) or by attending live seminars (national, state and local conventions). Over the past decade, increasing percentages of pharmacists are choosing to pursue additional training and credentials as the pharmacist’s decision-making role in drug therapy evolves, specialization within pharmacy becomes more prevalent; and the availability and scope of certificate training programmes have increased. Further information about APhA’s Board of Pharmaceutical Specialities is below.

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APhA Books Sandy APhA publish a variety of books, one of which the Handbook of Pharmaceutical Excipients is co-published with the RPSGB. Their publications catalogue6 lists not just books published by APhA but also other key texts, practical guides and reference works from other publishers which members of APhA can obtain at discount.

APhA use Lexi-Comp as the electronic platform for the collection of e-books they publish including a drug information handbook, laboratory guide, paediatric dosing and geriatric dosing guides. Placed in an electronic environment with a search engine the publications provide clinical information on prescribing, administering and monitoring medicine.

Market Research Business Unit Deborah Ruddy (Senior Market Research Analyst) The Market Research Business Unit’s role is to conduct high quality marketing research that supports APhA’s role in providing education, information and advocacy. Their work involves developing discussion guides and questionnaires, recruiting discussion panels and focus groups, undertaking interviews and surveys (electronic, mail and telephone), managing the project work-load and generating and presenting the final report. They are also responsible for proving strategic recommendations as a result of the market research. Their work produces both quantitative and qualitative research and the Unit works with many of APhA’s departments, particularly with the association’s research departments.

Examples of their market research include surveys of attendees and exhibitors at APhA’s national meetings, education needs assessments (identifying pharmacist’s education gaps which could be filled by courses run by APhA) and attitudinal surveys. Of key importance and undertaken on a regular basis are the annual Pharmacy Today over-the-counter (OTC) products survey and the Know Your Medicine/Know Your Pharmacist Consumer Survey. They also undertake a weekly Pulse on Pharmacy survey (electronic) which allows a quick indication to be taken of member’s feelings on a particular subject.

The Unit aims to make sure that the research and recommendations that it produces are actively promoted and that APhA responds to the needs and views identified e.g. by offering a new education programme where a gap has been recognised or by putting forward the views of the pharmacy profession on a particular subject to government. An indication of the worth that is placed on the research outside of the association is shown by the fact that the OTC survey is eagerly awaited by manufacturers; winners of each category frequently amend their packaging and advertising to show their success as consumers recognise the survey and trust its results.

Pharmacy Service Support Center (PSSC) Stephanie Anderson (Director, Business Operations).

The PSSC7 part of the Health Resources and Services Administration (HRSA) section of the U.S. Department of Health and Human Services is a programme that operates through APhA to help federally funded clinics and other health care safety net providers develop clinically and cost effective pharmacy services to those who cannot afford to pay for their own care.

Frequently these organisations contract out for pharmacy services and a partnership develops between e.g. a clinic and an outside pharmacist which provides dispensing and consulting services to the patients and is compensated for its services.

6 7

http://www.pharmacist.com/Content/NavigationMenu3/ShopAPhA/PublicationsCatalog/APhA_Publications_catalog.pdf http://pscc.aphanet.org

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One of the PSSC’s major roles in recent months has been to advise clinics and other providers to optimally use the ‘340B Drug Pricing Program’. This programme requires manufacturers to sell outpatient drugs to specific net healthcare providers including certain hospitals, community health centres and HIV/AIDS clinics at a price discounted at least as much as dictated by the 340B statute. The 340B price is at least as low as the price that state Medicaid agencies currently pay and average about 50% below the Average Wholesale Price.

With government support, PSSC provides information, education and technical assistance to increase patient access to affordable drugs and pharmacy services.

State Relations & Political Action Hrant Jamgochian (Director), Professional Practice James A. Owen (Director) and Professional Development and Research Marcie A. Bough (Senior Manager).

APhA places a high importance on its role in advocacy for the pharmacy profession and one key area of its work is with government, ensuring that it inputs into new legislation affecting pharmacists and the role they can play.

Recent position and briefing statements have included: • Delay Medicaid Tamper-resistant Prescription Pad Requirement. A sudden change in legislation could have led to patients in the most vulnerable areas of society being unable to access medication. A delay was requested to allow supplies to be ordered, pharmacists to be trained and best practice standards to be set and communicated throughout the profession. In this instance Members of Congress were also approached and APhA’s views made apparent to the relevant committee in the U.S. House of Representatives.

• The Impact of Average Manufacturer Price on Community Pharmacists. Aimed to ensure that pharmacists taking part in the Medicaid programme were not adversely financially affected and were reimbursed at a rate equal to or above acquisition costs of generic medications.

• Medicare Part D Recommendations. Encouraged Congress to enact various Acts which would have a beneficial effect on the services that pharmacists could offer patients on the Medicare scheme.

• Patients Deserve Medication Therapy Management (MTM) Services. Statement to promote understanding of the benefits (improvement of quality of patient care/reduction of health care expenditure/ increase in medication adherence) of MTM services that are offered by pharmacists and to raise the profile of the profession.

Marketing - Publications JC Zambrano (Publications Sales and Marketing Manager) The main APhA publications catalogue is split into topic areas e.g. careers and management; compounding resources; and drug reference handbooks to enable pharmacists to easily view all available publications on one topic.

As well as the main catalogue APhA produce several targeted catalogues aimed at different sections of their membership. APhA do not themselves produce enough titles to cover all aspects of information required by the members so other publisher’s titles are also included.

The specialised catalogues also allow special further discounts to be advertised to particular sectors.

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Board of Pharmaceutical Specialities (BPS) Jackie Board certification through BPS aims to provide a practical means of determining which hospital/clinical pharmacists are qualified to contribute at advanced practice levels in a particular speciality.

Current specialities include: • Nuclear Pharmacy – promotes public health through the safe and effective use of radioactive drugs.

• Nutrition Support Pharmacy – addresses the care of patients receiving specialised parenteral or enteral nutrition.

• Oncology Pharmacy – targets the needs of patients with various malignant diseases and their complications.

• Pharmacotherapy - ensures the safe, appropriate and economical use of drugs often as part of a multi disciplinary treatment team.

• Psychiatric Pharmacy – specialises in the pharmaceutical support of patients with psychiatric disorders.

In 2006 a total of 1,319 candidates took certification or recertified. The demand from non-US pharmacists worldwide to certify through BPS is increasing at a fast pace and more test sites in different countries are having to be arranged.

Visit to APhA Headquarters on the Mall.

As APhA are in temporary accommodation at the moment the visit ended with a trip to the site of the headquarters building currently undergoing major renovation on the Mall. APhA are the only non-government organisation with a presence on this important street leading up to Congress. APhA will use the extra space to expand into and will also rent out space to governmental organisations which will raise revenue. APhA believe that their location so near to Congress is an advantage in their advocacy role for the pharmacy profession with government.

Tuesday 16th October • National Library of Medicine (NLM) Washington D.C. Contact: Becky Lyon, Deputy Associate Director – Library Operations

Photos L to R: NLM Building; NLM medicinal plants garden .

Located in the campus of the National Institutes of Health the NLM is the world's largest medical library. The Library collects materials and provides information and research services in all areas of biomedicine and health care.8

8

http://www.nlm.nih.gov/

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Medical Subject Headings (MESH) Section.

Dr Stuart Nelson, (Head of Section).

This meeting with Dr Nelson and his team provided an introduction to the development and maintenance of MESH and also to other standards and services developed by the section and made public by the NLM online.

RxNorm9 is a public domain vocabulary which “provides standard names for clinical drugs (active ingredient + strength + dose form) and for dose forms as administered to a patient. It provides links from clinical drugs, both branded and generic, to their active ingredients, drug components (active ingredient + strength), and related brand names. National Drug Codes (NDCs) for specific drug products (where there are often many NDC codes for a single product) are linked to that product in RxNorm”. New developments using RxNorm include a Patient Medicines Management Record (PMMR) which will allow patients to be provided with or develop a record of their (and their family’s) medications including dosage information. Patients will be able to download a blank record and edit it and with an internet connection bring through standardised information about their medication. This record can then be printed and taken to their doctor/hospital/specialist to show their current information. This development has the potential to be used in the development of an electronic health record. As a controlled vocabulary it supports inter-operability between the electronic systems of health providers and the pharmaceutical industry.

The DailyMed10 website “provides high quality information about marketed drugs”. This information includes Food and Drug Administration (FDA) approved labels (package inserts).

This resource is similar to the UK’s electronic Medicines Compendium (eMC) which provides electronic Summaries of Product Characteristics (SPCs) and Patient Information Leaflets (PILs). DailyMed receives its information from the FDA which as the drug regulator in the US requires pharmaceutical companies to provide full details on products and therefore reflects the most current information as notified to the FDA. Although not all drugs have a targeted patient information section they have some representation on the site. Guidance given to companies on designing the way the information is provided so that it is structured and can be easily uploaded.

The Unified Medical Language System® (UMLS) was also discussed. “The purpose of NLM's UMLS is to facilitate the development of computer systems that behave as if they "understand" the meaning of the language of biomedicine and health. To that end, NLM produces and distributes the UMLS Knowledge Sources (databases) and associated software tools (programs) for use by system developers in building or enhancing electronic information systems that create, process, retrieve, integrate, and/or aggregate biomedical and health data and information, as well as in informatics research.”11 UMLS also allows different medical subject indexes to talk to each other. An example discussed was the ability of two different FDA databases to link with a database at the Department of Veteran’s Affairs. UMLS provides the language to search various databases whilst taking into account the differences in terminology.

Names of pharmaceuticals can be difficult for the system as it needs to be able to include both generic and brand name as well as coping with dosage information and the manufacturer’s details. The system needs to ensure that there is one way of looking at/providing this information in a way that can be read by all.

Dr Nelson’s team also maintain MeSH, the terminology which is used to assign topic headings to every article that is entered into Medline. This involves ensuring that new subject headings are updated and the index scheme is back-edited e.g. terms amended and added, fitting into the existing structure. There needs to have been at least 20 good quality articles on a subject 9

http://www.nlm.nih.gov/research/umls/rxnorm/index.html http://dailymed.nlm.nih.gov/dailymed/about.cfm 11 http://www.nlm.nih.gov/research/umls/about_umls.html 10

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before it can be considered as a candidate for a new subject term. However, a new drug/pharmaceutical name is added almost on first sight.

We also discussed the forthcoming Pill Image Database which will be a free comprehensive resource to visually identify US drugs by colour, shape, size, markings etc. Although this will be for US drugs I can see this being an important resource for the RPSGB’s Information Pharmacists.

Tour of the National Library of Medicine.

NLM has one of the largest collections of biomedical literature in the world. Reading rooms allow on-site access and the NLM’s interlibrary loan (ILL) and document delivery services make these resources available to the US and international libraries as part of NLM’s mission to collect, preserve and disseminate biomedical information.

Annually the NLM responds to more than 350,000 requests, averaging about 1,600 requests daily for articles, books, audiovisuals and microform materials. Requests for 1870+ journals and 1913+ monographs and 1969+ audiovisual materials are handled by the NLM, and the History of Medicine division deals with requests for earlier material. Colour copies are available.

DOCLINE® is the National Library of Medicine's automated interlibrary loan (ILL) request routing and referral system.12 It works with a number of other systems to enable the NLM to meet the high level of demand for document delivery. These include Relais the imaging and delivery system used to scan and send documents through various means such as Ariel (electronic document delivery) and Post-to-Web (scanned article posted on secure NLM website can be retrieved by requesting library).

History of Medicine Division – Early Printed Collection, Incunabula and Manuscripts.

My visit to the NLM’s early printed collection was an excellent opportunity to see some items selected from the collection by the librarian I met as having particular relevance to pharmacy and drugs. I was shown the illustrated 1737 Histoire generale des drogues by Pomet, (3rd edition, with engraved plates), that includes “a catalogue of the seeds of several scarce and curious plants lately brought from the American islands by Joseph Donatus of Surian”. Other items I was shown included Gerard du Barry, Flosule viatici, a manuscript on parchment in Latin from 13th century Germany on medicine. Finally, I was shown the Pharmacopoeia universalis, a new universal English dispensatory by Robert James. 3rd ed. 1764. The reading room also has a display area showing highlights of the collection.

A major achievement in recent years which has greatly increased access to some works in the NLM’s early printed, incunabula and manuscripts collection has been the Turning The Page (TTP) project online13, part of the NLM’s Digital Collection. This TTP software was originally developed by the British Library and has since been further developed by the NLM. Now a number of rare items can be viewed in full, in colour, online meaning that access is granted to the maximum number of people with minimal handling to the item itself. More books are to be digitised in this fashion but it is a fairly expensive process and at present only very select and important titles are being chosen.

Division of Specialized Information Services (SIS)14 Florence Chang (Branch Chief, SIS) In the afternoon of my visit I listened to a number of presentations on the specialised information services being developed by this division of the NLM and made available on their 12 13 14

http://www.nlm.nih.gov/docline/ http://archive.nlm.nih.gov/proj/ttp/intro.htm http://sis.nlm.nih.gov/

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website. SIS is responsible for information resources and services in toxicology, environmental health, chemistry, HIV/AIDS, and specialized topics in minority health.

TOXNET15 is cluster of databases providing access to toxicology and environmental health information resources. AIDSInfo16 allows targeted searches of AIDS and HIV related drugs, this is information aimed at both health professionals and patients. ChemIDplus17 is a database of over 380,000 chemicals, synonyms, structures, regulatory list information, and links to other databases. The advanced service allows enquirers to search and display registry number, chemical name, molecular formula, structure, physical and toxicological properties plus locator and classification data. The NLM Drug Information Portal provides information on over 12,000 selected drugs, and the Dietary Supplements Labels database and Household Products database provide consumer information but are also useful as resources for health professionals.

A project the SIS team are currently working on is the online Pill Image Database which will include in-depth and detailed photos and allow searching by size, shape and colour. Not yet live this will be a free resource, comprehensive for US drugs, and an excellent tool for drug identification by US pharmacists (currently this type of identification tool requires a subscription to be paid for).

Wednesday 17th October • Louis Stokes Health Sciences Library, Howard University Washington D.C. Contact: Mr Donald Monroe, Associate Librarian. Reference. Pharmacy library liaison

Photo: Louis Stokes Health Sciences Library

Howard University offers a 4 year professional programme that leads to the Doctor of Pharmacy degree. The Louis Stokes library is a health information resource for the University’s medical, dental, pharmacy, nursing and allied health science faculty and students and also a resource for individual patients, healthcare providers, members of the local Washington D.C. community and professionals and researchers around the globe.

Upon arrival at the Louis Stokes library18 I had a short meeting with Ellis Beteck, Interim Director of the library, where we discussed the university and library services and also talked about my trip.

Tour of the library and conversation with Mr Monroe.

The library is a relatively new building sited in a central campus location close to the Health Science buildings, allowing easy access by students from their faculty to the library. It is also just around the corner from the local hospital. This was my first opportunity to see the print and electronic resources made available in a US academic setting which was extremely interesting but I was particularly also interested by the design and facilities of this modern library. With more use of electronic resources rather than print, space was freed from the start of the design process for many small group study rooms and problem-based learning rooms which are in 15 16 17 18

http://tox.nlm.nih.gov http://www.aidsinfo.nih.gov/ http://sis.nlm.nih.gov/chemical.html http://hsl.howard.edu/

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high demand. The current emphasis on problem/evidence-based education demands more group learning. Reservations for the rooms have to be taken to manage demand.

Although the library now has capacity for 400,000 volumes of books and an estimated space provision for a 20-year growth, the collection had to be greatly reduced to fit into the new building. In the main this was achieved by removing older editions of books and moving to electronic journals and books over print. The library therefore relies on other libraries such as the NLM to provide documents and texts through inter-library services.

Interestingly no publicly accessible printing is available in the library. Students must download or electronically transfer documents or files and print elsewhere if they need a hard copy. There is an assumption that all students will have access either to their own PC or laptop or make use of the library’s large computer labs. Distance learning labs allow interaction with the wider medical community and there is also a telemedicine centre in the library to facilitate discussion of clinical matters at a distance.

The collection consists of circulating books (NLM classification is used), reference, and AV collections, printed journals and microfilm as well as electronic materials. There is a special collections room providing a secure and controlled environment for the display and use of special collections held by the library including collections devoted to health issues and the contributions of African American health practitioners to the history of medicine. This room is not yet used to its full potential and this is one area that the library is keen to develop further.

The Library catalogue is available online and lists all print resources. It is also a portal to online resources and contains links to full-text, online journals which are subscribed to as well as other electronic resources. Wireless and offsite access is available.

The electronic resources provided by the library include full text Science Direct, OVID including access to JAMA and NEJM, MDConsult for journals and full text of many standard reference books like Harrison’s, EBSCO databases including IPA and CINAHL and other subscription databases e.g. HerbMed19 an interactive, electronic herbal database. They also link to some free bibliographic databases such as PubMed and journal indexes e.g. Agricola, the US National Agriculture Library.

Library users have several pathways to access online resources, they can use the catalogue, but searching is also available on Science Direct and OVID and through various other open access sources.

Mr Monroe recommended the VERA – Virtual Electronic Resource Access web pages20 produced by the MIT libraries as a good place to see what types of electronic resources are available for a particular subject and through which platforms.

The library runs various classes including in-person library inductions as well as on-line tutorials. Database searching and how to access full text are examples of courses run.

The library produce a number of Pathfinder documents aimed at students on particular courses or looking for particular types of information. The Pathfinder on drug information resources lists key print publications and links to high quality evaluated online resources. It also highlights key journal indexes. They also produce a list of journals relevant to particular subjects e.g. pharmacy and pharmaceutical sciences to guide students to useful titles.

19 http://www.herbmed.org/ 20 http://river.mit.edu/mitlibweb/free.html

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Thursday 18th October • Snell Library, Northeastern University Boston Contact: Kathy Herrlich, Research and Instruction Librarian

Photo: Snell Library, Northeastern University

Snell Library the primary library for Northeastern University opened in the autumn of 1990. It holds resources across multiple subjects including pharmacy, has shelving for 1.2 million volumes and seats 2,800 users. The library houses three microcomputer labs and has over 300 computer workstations for students.

In its collection it has: 968,000 2,291,913 7.636 160,542 21,957 18,089

printed volumes microforms serials subscriptions government documents audio, video and software items licensed-access digital information resources (including e-journals).

Electronic resources targeted at pharmacy students include McGraw-Hill’s Access Pharmacy resource21 which provides access to e-textbooks, case studies and self-assessment and an integrated drug database (allows cross searching across the resources). Northeastern students also have access to the R2 Digital Library platform22 from Rittenhouse Book Distributors. It offers “fully integrated and searchable medical, nursing and allied health secondary source book content from key health science publishers, on a web based platform”. STAT!Ref23 is also available, an “online, healthcare reference that integrates core titles with evidence-based resources” Librarians are also available by appointment for one-on-one consultations with student and faculty who require assistance with a research project.

New innovations that library staff are implementing include using new Web 2.0 technologies such as video tutorials on effective searching and on how to use specific packages like EndNote, as well as producing podcasts for library tours which are hosted on the library’s website and can be downloaded to an mp3 player for use as the student walks around the library.24 As the RPSGB library makes more electronic resources available training will be essential for users and this type of video tutorial could be one way of providing it.

Training materials have been developed by the research and instruction librarian for students on the pharmacy course highlighting key resources and databases. She also runs assessed sessions for students on particular courses on using the research databases.

21

http://www.accesspharmacy.com/ http://www.r2library.com/public/Default.aspx 23 http://www.statref.com/ 24 http://www.lib.neu.edu/online_research/help/online_tutorials/ 22

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Friday 19th October • Massachusetts College of Pharmacy and Health Sciences (MCPHS) Boston

Photos L to R: MCPHS building; Pat McNary, Karen Poole and MCPHS staff in the MCPHS library; MCPHS building.

MCPHS Drug Information Center Contact: Maria Kostka-Rokosz, (Assistant Professor of Pharmacy Practice) The Drug Information Center provides a free service to community and hospital pharmacists normally in the Boston/Massachusetts area. The centre is staffed by pharmacy students, taking the Drug Literature Evaluation compulsory module, who are supervised by faculty. The centre currently receives 30-50 calls a month and the majority of these enquiries require 60-120 minutes worth of research to be completed. The centre is closed when the college is closed which means that pharmacists cannot rely on the service as their only source of external information. Analysis of the users indicates that most enquiries come from pharmacists in the Boston area and that many come from MCPHS alumni. Since January 2006 over 1500 queries have been entered but it has been noticed that there has been a drop in the use of the service.

The resources that are heavily used to answer enquiries and which are maintained and provided by the library for all staff and students in the faculty include: • Micromedex25: a drug information system. Includes “”solutions for drug reference and interactive tools, alternative medicine references, formulary management, clinical workflow, IV Compatibility, regulatory compliance, and continuing education”.

• PDR; Index Nominum; Martindale; Red Book (most of these are available in both print and electronic form).

• Lexi-Comp’s Clinical Reference Library26, an e-resource allowing access to the collection of books offered by APhA (see above). Cross searching is allowed across these resources. Similarities exist between this and the RPS Publishing’s ‘Medicines Complete’ which is available for use across the Society and to walk in users of the library.

• Natural Medicines Comprehensive Database27 provides “evidence-based monographs on individual natural ingredients including safety and effectiveness information as well as allowing a search of brand names and access to information about which products have been tested to clinical trial standard”.

Literature searches for relevant journal articles are also undertaken on bibliographic databases such as MEDLINE and EMBASE if the answer is not readily apparent on the resources listed above.

The response is often given in writing by email or fax but frequently there is a need for an immediate answer. Hospital Pharmacists occasionally wish to have full details of the research undertaken but normally citing the source and the answer is sufficient.

Extensive questions are rare and most are answered in 24 hours, the average falls within the 12 hour range. As this is a learning experience for the students and they are regularly rotated this does not always reflect the length of time that a more experienced practitioner could 25 26 27

http://www.micromedex.com/products/index.html http://www.lexi.com/ http://www.naturaldatabase.com

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answer the question in. All answers are checked with faculty and the student can then be asked to further research the answer before the enquirer is informed of the results.

Common enquiries include identification of foreign drugs and as with the RPSGB’s Information Pharmacists the most common resources used include Martindale, Index Nominum and the European Drug Index (an older title). If this does not provide an answer then EMBASE is searched and as a final result Google is used to see if any mention is made online. The enquirer is always informed of the quality of the research.

The centre does receive a small percentage of consumer calls but there is serious concern over whether the centre is the best place to deal with patients and normally these callers are referred to the patient information websites/help-lines which are provided by the drug companies or referred to their health professional.

As students may not have access to all or any of these electronic resources when they enter the workplace they are encouraged as a first point of call to use print resources, using the index and developing knowledge of what each individual resource can provide. Most of the electronic resources such as Micromedex facilitate cross-searching across the resources, which is a strength of the product but can lead to a student not really understanding exactly where the information is coming from and becoming too reliant on one particular product that may well not be available to them later.

The students record all queries including the resources checked, normally on paper in the first place, and this information is then entered on to an electronic system the DocPharm ID28 database which was purchased rather than created in-house. This database allows the faculty to maintain control over the enquiries that are being answer by the students, to assign priority, to evaluate the student’s answers and either request further clarification or approve the answer.

The database also allows statistics to be produced on who the enquirers are, what types of enquiries are being asked and what resources have been most effective is providing an answer. At present it is not often searched to see whether a question has been answered before because it is unlikely that the student assigned the query will have dealt with the previous one and they need to learn from scratch. This enquiry database may be of interest to the RPSGB’s Information Pharmacists.

Queries on poisons are referred to the local Poison Control Centre.

The Drug Literature Evaluation course’s goals and objectives include gaining an understanding of information sources (print and electronic), using databases, developing search strategies and skills, interpreting and evaluating literature and gaining critical appraisal skills, and being able to communicate well when responding to information requests.

Mariana Lapidus, Assistant Professor of Instructional Resources, who is based in the library is directly involved with the course in the lectures on internet searching for secondary drug information using indexing and abstracting systems: Ovid-Medline, IPA, Embase, Pub-Med and EBM. She also discusses VIPPS – the Verified Internet Pharmacy Practice Sites program and the Health on the Net (HON) Foundation Code of Conduct.

Health Sciences Library – Massachusetts College of Pharmacy and Health Sciences Pat McNary, (Library and Learning Resources, Electronic Services Librarian) A link resolver Ex-Libris SFX29 is used to facilitate access to the various different electronic resources that the college subscribes to. JDNet, produced by a small company, is used as the e-journals manager.

28 29

http://www.ultimatemotionsoftware.com/docupharm_di_brochure.htm http://www.exlibrisgroup.com/category/SFXOverview

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In addition to the resources discussed above, and as at Northeastern, MCPHS staff and students have access to McGraw-Hill’s Access Pharmacy and its parent Access Medicine as well as Wolters Kluwer’s Cliniguide30 and Facts and Comparison E-Facts31 which is point of care focussed and particularly aimed at hospital professionals.

Monday 22nd October • Countway Medical Library, Harvard University – Center for Biomedical Informatics, Boston Contact: Julie Whelan, Countway Reference Librarian

Photos L to R: Harvard University – Center for Biomedical Informatics; Julie Whelan and Karen Poole; Countway Medical Library.

One of the largest medical libraries in the world, Countway serves the Harvard Medical School, Harvard School of Public Health, Harvard School of Dental Medicine, and holds collections from the Boston Medical Library and the Massachusetts Medical Society. The Countway Library holds more than 630,000 volumes, subscribes to 3,500 current journal titles and houses over 10,000 non-current biomedical journal titles. The library also houses one of the world’s leading medical history collections and provides access to many electronic information resources. Countway also hosts the Archives and Records Management Program for the schools of the Harvard medical area and the collections of the Warren Anatomical Museum.

Countway currently has 771 medical students, 136 dental students, 1039 students in public health, 463 PhD science programme students as well as all faculty. There are also 18 affiliated hospitals and all these staff of are also welcome to use the library. The public health students are not only in the majority but are in general the heaviest users of the library resources and more likely to ask more complicated questions and require access to resources that include an international focus. The requirements of these users have a direct effect on the acquisitions policy of the library.

At present the library does not have an active role in the teaching element of any of the student’s courses as although research/information skills are included in some degree in one of the modules this is not carried out by library staff. The library has identified this lack of taught presence on the courses as a major issue and it is a top priority to tackle this. At present the level of liaison varies between individual faculty members and library staff, and a recent success has been an increased library presence on the human biology class. This was a direct result of library staff approaching students at their student council promoting the services that the library could provide. Students alerted to these services could then demand that faculty make time for a library induction etc. Library staff have now been involved in creating information pathfinders for this course to help students with the clinical case studies aspect of the course, six of which need to be completed on top of the traditional lecture and tutorial element. The aim is to promote scholarship and enquiry through the pathfinders which are tied to the subjects of the case studies and to aid students in locating useful resources.

One useful resource recommended by the librarian was the American Association of Medical Colleges – MedEdPORTAL guide to good resources32. “MedEdPORTAL is a new approach to online publication that offers peer review for teaching resources. Examples of MedEdPORTAL 30

http://www.cliniguideplus.com http://www.factsandcomparisons.com/ 32 http://services.aamc.org/jsp/mededportal/goLinkPage.do?link=home 31

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publications include tutorials, virtual patients, cases, lab manuals, assessment instruments, faculty development materials, etc. MedEdPORTAL is available free to the general public and covers the continuum of medical education (i.e. undergraduate, graduate, and continuing medical education). MedEdPORTAL contains descriptive information about published resources and indicates how these materials may be accessed or obtained.” I will be adding details of this website to the CE section of the library’s Finding Pharmacy Information on the Internet web pages.

Countway library staff offer teaching classes and sessions at lunchtime as well as one on one drop-in sessions. Topics include End Note, Pub Med, Effective Web Searching and sessions aimed at particular topics e.g. resources for herbal medicines and dietary supplements, resources for clinical pharmacology etc.

They also have a member of staff with a clinical background who offers seminars on bioinformatics including topics such as genome browsing. These sessions have been very successful and have in the past been requested to fill a guest lecturer spot in some of the courses.

Countway also offers on-site drop-in access to its resources to non-students and faculty of Countway if they belong to one of the linked hospitals. However, health professionals such as pharmacists and nurses normally go to their own hospital library where the librarians can log in to some Countway e-resources on their behalf.

Harvard operates a citation linker using SFX technology. It allows keyword searches to be undertaken and provides the best match to the resource, showing holdings for print and electronic collections; it also allows searches to be undertaken by PMID. Publication details/abstracts of journal articles that can be searched on the interface can come from PubMed, Science Direct, Web of Science or the publisher’s own information.

Other resources available include DynaMed33 a point of care clinical database with over 2000 topics hosted by EBSCO which focuses on primary care and has over 40 people helping to produce it and keep it current.

EMBASE is also available to search along with a number of other medical databases.

Center for the History of Medicine - Rare Books and Special Collections The Countway Library was created in 1960 as a result of an alliance between the Boston Medical Library and the Harvard Medical Library. Its historical collections comprise more than 250,000 books and journals (including early printed material); 20 million manuscripts; the archives of the Harvard Medical School, Harvard School of Dental Medicine, and Harvard School of Public Health; 100,000 photographs and prints; and the collections of the Warren Anatomical Museum. The Countway’s collections are particularly rich in the diverse subject areas of anatomy, gynaecology and obstetrics, radiology, medical jurisprudence, neurology, surgery, psychology, phrenology, physicians' travel narratives, medical botany, pharmacy and pharmacology, and internal medicine. There are particular strengths in medical incunabula— with over 800 books printed before 1501—European books printed from the sixteenth through the nineteenth century, and English publications before 1800. The Countway also holds a comprehensive collection of American, particularly New England, medical imprints of the eighteenth and nineteenth centuries.

The Center for the History of Medicine34 includes the rare books and special collections and it mounts displays of items from its collections, but the majority of items are kept in an environmentally controlled special store. Researchers can request to access these items and 33 34

http://ebscohost.com/dynamed/ https://www.countway.harvard.edu/lenya/countway/live/menuNavigation/historicalResources/collectionsChm.html

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then use them in the specialist reading room rather than the main library area. The centre has to balance the need to preserve its collections with allowing access to make them available to readers and researchers.

The collection includes books previously owned by the Cambridge physician Benjamin Waterhouse (1754-1846), one of the three members of the first Harvard Medical School faculty.

Waterhouse was one of the foremost proponents in the US of Edward Jenner's belief that cowpox matter, transmitted from one person to another, could confer immunity to smallpox.

Waterhouse vaccinated his children and servants when the vaccinations was still at a very experimental stage and the front page of the Waterhouse family Bible (held in the collection) records the vaccinations of the children in 1800. I had the opportunity to see this book and to look at and discuss other items in the early printed and manuscript collection.

I was also given a tour of the Anatomical Museum which has in its collection the skull of Phineas Gage. Gage’s skull was impaled by a railroad spike in 1848 and although he survived he had undergone a major personality change. This event heralded the start of understanding about personality being linked to a particular area of the brain, physiology, rather than phrenology.

Tuesday 23rd October • Astra Zeneca Global Discovery Informatic Center (IC) Boston The Boston site of AstraZeneca is home to one of its Global Discovery Informatic Centers. The site focuses on two areas of research, oncology which is shared with the UK and infection which is Boston only.

Whilst there is no longer a large traditional print library (the space that was previously the library is now a cafeteria area) information professionals are still required in the role of information scientists who work directly with the research teams and frequently have a science/research background. Information Science in the pharmaceutical industry is becoming more specialised. Domain knowledge is extremely important and working as a generalist is becoming more difficult. In the experience of the Information Scientist I met in most cases it is no longer enough to be solely an information professional if your role involves directly supporting scientists involved in drug development. There is little time for scientists to scroll through 200 abstracts and they now require a specific answer to a specific question from an information professional who is qualified to make that judgement.

The work of the information scientists includes patent searches and answering enquiries from scientists. They are also involved in web design, archiving, and micro-filming of archival material. The Boston site is rapidly expanding, going from 100 people in 2001 to 400 currently and demand on the informatics centre is growing. Expansion is taking place at the site to add more laboratory space and to re-integrate those staff who are having to work off-site. The informatics staff are currently not housed in the main building and do feel that returning there will increase their use further as at present they are rather out of the way and do not get the informal approaches of people just walking by and asking their question.

Resources are sourced by Astra Zeneca at a national and international level as it was felt that arranging them at site level was inefficient. Resources are accessed at desk top through the company’s intranet. These include STN35 (an online database service that provides global access to published research, journal literature, patents, structures, sequences, properties, and other data), CAB Abstracts36 (a life-science database) and also the in-house drug pipeline database. Most information is now available electronically – e-books, journals and other database resources. Astra Zeneca’s print collection has recently been reduced dramatically 35 36

http://www.cas.org/products/stnfamily/index.html http://www.cabi.org/datapage.asp?iDocID=165

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and there is now a reliance on inter-library loan when e-resources cannot answer the query.

This trend of moving away from a physical library space has been seen across the industry.

Astra Zeneca Boston do still obtain certain reports in print format as well as a key select collection of journals that are used in print. New resources and databases are evaluated to see if they add any value to what is already available. Internally some blogs are produced but as yet Web 2.0 technology has not made a huge impact.

More traditional e-resources are available and include OVID core science database, CITELINE, Clinical Trials Intelligence, ISO Database, Planet Product Lite (internal product information).

ADIS Research and Development Insight (a pharma pipeline allowing searches to be undertaken).

The site is a base for scientific research (although off-site there are people involved in the marketing and administration of clinical trials) and the IC exists to support the drug development process. Information staff undertake research in publications but also look at other sources including conference reports and proceedings. They aim to regularly inform scientists of relevant new research and any information about competitor data. Current awareness services provided by the information team include daily alerts automatically generated by keyword searches which are emailed to researchers and released as internal press releases. There is a specialised database for conference proceedings as well as extensive information on patents and the ability to see the chemical structure of drugs. It is also possible to check what stage a new drug is at in pre-clinical trials.

Thomson Pharma37 is used to capture compound names, the structure and results of studies which are used as the starting point of research of a new compound.

Emerging fields of research include stem-cell research in haematological diseases e.g. leukaemia and research is no longer solely based around the development of compounds. This means that resources to record and study the research also have needed to develop. Areas of development in areas such as the growing field of protein drugs which has sped up the drug discovery process has resulted in high information needs.

STN is command based and does not allow free text searching therefore scientists are encouraged to ask the information scientists to undertake the searches for them.

Regulatory enquiries include obtaining information from the FDA about INDs (Investigational New Drugs, excludes confidential information but still important for development) and NDAs (New Drug Applications, all IND information then available).

Science projects are reviewed every 6 months and as new projects are sanctioned so the information needs of the scientists increases. Information enquiries vary from ad-hoc requests to more long-term projects or use of current awareness services.

There is no compulsory central place for storage of information generated by a project.

Scientists are responsible for the records of their research and they are encouraged to store this on a central system that is globally accessible. This is not enforced and the level of communication and information sharing is sometimes not as good as it should be.

There is an animal facility where animal experimentation takes place. It is a regulatory requirement that research has to be undertaken to ensure that unnecessary experimentation does not take place. Therefore a literature search must be undertaken to check for previous details of experimentation but also to evaluate the possibility of using in-vitro cells are not an alternative.

37

http://www.thomsonscientific.com/thomsonpharma/aboutpharma/ataglance/

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Also a patent search for Intellectual Property (IP) around a compound has to be carried out.

The information scientists need to be able to search by compound (exact and related) to be able to ensure IP rights are cleared.

AstraZeneca’s Informatic Centre’s US headquarters is in Manchester. Larger than the Boston IC there are 12 staff in the Information Center, supporting the various specialised topic areas.

Staff can provide more extensive services than are currently possible in Boston which has limited staff and high demand. The Manchester team produces monthly reports and summarises key articles and reports. There is a monthly all ICs team meeting to encourage knowledge sharing and understanding throughout the team of new resources and key initiatives.

Information services are vital to the company as it takes 200 million dollars to produce a new drug. Scientists must be able to justify the financial investment and research can aid in this.

Wednesday 24th October • Visit to Community Pharmacist, CVS Pharmacy Boston

Photo: CVS Pharmacy

CVS is America's largest retail pharmacy, operating more than 6000 retail and specialty pharmacy stores in 38 states and the District of Columbia. It is also a pharmacy services provider and has an online store and information presence. The company fills or manages more than one billion prescriptions per year, more than any other pharmacy services provider.

Expansion is expected as “The retail pharmacy industry is expected to more than double by the year 2012. An aging population and the increased utilization of prescription drugs is fueling the demand for more pharmacy services. Several markets in the U.S. with high-growth population rates are relatively under-stored and need more pharmacies”.38 The CVS intranet ‘CVS Learn net’ is a resource to allow CVS employees to communicate, learn, collaborate, and teach by making online training available and spaces for knowledge sharing to take place. The intranet also provides access to articles (e.g. “look-alike/sound-alike” drugs) and to the CVS quality assurance intranet.

In-store patient education initiatives are frequently run and have included one to better inform and educate seniors about the Medicare Part D program. The company's 20,000 pharmacists all underwent training to help them explain the new Medicare prescription drug benefit to their patients. Medicare Information Centers are available in all CVS pharmacy stores, which offer guides to explain how Medicare drug plans will work and to assist individuals select a plan that best meets their needs. The centres also have materials from a number of managed care and insurance companies that are offering Medicare prescription drug plans.

CVS provides online resources for patients including articles written by pharmacists on a variety of health issues such as information on high blood pressure, guidance on smoking cessation etc. They also provide an ‘Ask a Pharmacist’ online service. CVS pharmacists are involved in all areas of patient counselling/education, quality assurance and dispensing.

Pharmacists in larger chains such as CVS and Walgreens tend to have access to electronic resources including Clinical Pharmacology39. Paper references tend to only be purchased 38 39

http://phx.corporate-ir.net/phoenix.zhtml?c=183405&p=irol-faq http://www.clinicalpharmacology.com/

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where they are required by state law and are not yet available electronically. Other required resources such as the USP DI can now be accessed through the intranets.

Smaller chains and independent pharmacies often have far less information available online. In the pharmacist’s experience the majority of pharmacies will at least have access to some online information for example Facts and Comparisons40 online which provides drug information to support therapeutic decision making. Free online resources from the NLM are also heavily used. Specialist stores may purchase relevant resources on e.g. compounding or natural medicine but these would not normally be required.

Regulation of pharmacists takes place at state level. The Massachusetts Board of Registration in Pharmacy41 provides a code of professional regulations for ensuring the highest degree of ethical and moral practice by pharmacists, pharmacy interns and pharmacy technicians. They also monitor pharmacists to ensure they meet requisite continuing educational requirements. In 2007 the Massachusetts Board of Registration in Pharmacy licensed 10,465 pharmacists, 54 nuclear pharmacists, 3,343 pharmacy interns, 5,823 pharmacy technicians, 1,115 community/chain pharmacies, 7 nuclear pharmacies and 52 wholesale distributors in the Commonwealth.

The pharmacist has also had experience of hospital pharmacy and told me that hospitals also vary in the amount and type of information they make available to staff. In-house drug information centres are sometimes present or there is an agreement with an off-site drug information centre at a university which provides some support.

There has been a dramatic increase in the use of PDAs to access information particularly in hospital settings, not just pharmacists but doctors, nurses and other healthcare professionals accessing databases and resources through hand-held devices to support evidence-based practice. In some states the texts AHFS42 and PDR43 have to be made available at every nurses station in order for the hospital to be accredited.

A discussion about the roles of pharmacists in the US shows that some supplementary prescribing roles for pharmacists are being developed and there is an aim for clinical pharmacists to be integral to patient care. Pharmacists are now offering targeted services e.g. for diabetes, hypertension, HIV, and are also checking and amending where required regular doses/refills and providing general advice and counselling.

Friday 26th October • University of Tennessee (UT) Health Science Center Memphis

Photos L to R: Karen Poole, Jennifer Watson and UT staff in the UT Health Science Center Library; UT DIC.

University of Tennessee (UT) Health Science Center Library44 Jennifer Watson, (Assistant Professor/Head, Electronic & Collection) Jennifer Watson who had organised my visit to UT had arranged a tour around the library and a number of short meetings with various staff members. I also gave a presentation on the NHS, the National Library for Health and the RPSGB to a number of library staff.

40

http://www.factsandcomparisons.com/ http://www.mass.gov 42 http://www.ashp.org/ahfs/index.cfm 43 http://www.pdr.net 44 http://library.utmem.edu 41

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Collection The Health Sciences Library supports the university’s instructional and research programmes through a collection of journals, books, audiovisuals, CD-ROM and online databases, and multimedia. The library holds 2300 current print and electronic periodical titles, 300 e-book titles, 52,000 book volumes, and 196,000 volumes. The library employs 12.4 faculty and 19 fulltime staff employees UT’s electronic resources include e-journal and e-books with access provided to BioMed Central; Books@Ovid; MD Consult; NCBI Bookshelf; NetLibrary; Pharmacy & Pharmacology EJournals@UTHSC; PubMed Central; ScienceDirect Journals; STAT!Ref Medicine and the Merck Manual Online. Bibliographic databases available via the library include MEDLINE, EMBASE, IPA, HaPI, and PsychINFO. The library also has an historical collection which contains rare books, manuscripts, and artefacts pertaining to the history of the health sciences.

Training UT’s accreditation process has determined that students must be exposed to literature and lifelong learning skills as well as subject-specific information on their courses. As a result of this 80% of students at UT are required to take a library/information course to pass their course.

Often these sessions are scheduled at a time when faculty are away at conferences and the library staff take the lecture and set and mark the relevant assessment.

Preparation takes up a relatively large amount of time for staff involved in teaching although some material for sessions can be reused. Most courses have information such as course notes and announcements added to Blackboard, an e-education platform, as well as online evaluations and links to outside resources. Material produced by the liaison librarians can also be hosted on this platform. Library staff who are involved in course teaching do find that the marking of the assessments can be time consuming.

The library also offers library orientations and workshops which provide access to library resources. In addition to these and the curriculum-related sessions, library staff also run sessions that deal with practical skills such as how to use particular programmes e.g. EndNote reference software.

Podcast technology is being explored and some podcasts have already been produced to provide a library orientation and to give guidance on using resources such as Scopus, and to answer frequently asked questions such as how to get help and how to connect off campus.

Plans are in place to use podcasts to provide information targeted at particular students e.g. 1st year pharmacists, 4th year dentists.45 It is felt that being able to directly target a particular group with specific information can only increase the understanding of important resources made available by the library.

In the past UT has also brought in experts from the NLM e.g. expert trainers on PubMed and also on clinical information. These sessions were open to faculty, students and also librarians.

Frequently when new databases are launched the vendor’s trainers are invited to visit to visit UT to offer training sessions or to run virtual training sessions. There is also often web-based training available e.g. for Scopus.

45

http://library.utmem.edu/media/podcasting/Podcast/Podcast.html

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Scientific Editing.

David Armbruster.

Mr Armbuster’s role is to use his scientific editorial skills to improve the quality of UT publications and increase the likelihood of them being accepted by peer-reviewed journals. He works with faculty, post doctorate students and occasionally graduate students (often overseas students who do not have English as a first language) who have been referred by their research advisors. Approximately 12% of his time is spent directly on scientific editing.

He is also heavily involved in the development of library communications including writing newsletters, factsheets and other communications e.g. announcements to campus about new services etc and the student handbook and telephone directory. He has recently worked on developing library policies including collection management and the computer use policy which needed updating (plan to annually review this policy). These policies are being added to the library intranet and website.

Electronic & Collection Services.

Jennifer Watson, (Head of Service).

The UT Health Sciences library aims to make access to electronic resources seamlessly available to students no matter whether they have started their search from the library catalogue, the lists of resources on the website or sites such as PubMed. Jennifer has set up an account for the library with My NCBI and registered both the library’s electronic and print holdings using Link Out46, a free service provided by the NCBI at the National Library of Medicine. Students are encouraged to log-in when using PubMed as results will be flagged when an article is available from the library be it in print or electronic. Students can also order inter-library loans from a PubMed search for items they wish to source but which are not held by the library. These are provided by the NLM’s DocLine.

Other resources include access to the Tennessee Electronic Library (TEL) provided by the state government which hosts a collection of databases that provide information on a widerange of topics for all ages that can be accessed over the Internet by all citizens of Tennessee.

University of Tennessee Health Science – Drug Information Center (DIC) Dr. Katie Suda, (DIC Director) Lin Wu, (Reference Librarian and library liaison to the College of Pharmacy) The DIC is manned by three final year pharmacy students on month long rotations. The spring semester also sees 3rd year students working in the centre which means that UT Pharm.D students have over a year and a half of exposure to therapeutics and drug information services which is more than most other US pharmacy courses. The UT DIC is also always staffed by a licensed pharmacist faculty member who supervises the students. There are three additional faculty members who serve as backup in supervising and running the centre. “At any one time a minimum of 3.5 full time employees are dedicated to direct provision of drug information services.”47 The drug information centre is only open when the university is open.

As well as the electronic resources made available via the library, additional items have been purchased by the department to support the DIC. These electronic resources which are currently only available in the department include NDA Pipeline, a “database [that] contains information on over 6,600 drug development projects. Updated weekly, The NDA Pipeline tracks drug and biological product research and approvals. It includes a comprehensive listing of products in research, descriptions of phases of development, indication, and licensing information and linked articles to other F-D-C Reports publications”48. Also limited to the 46 47

48

http://www.ncbi.nlm.nih.gov/projects/linkout/ http://dcp.utmem.edu/dic/about.htm

http://www.elsevier.com/wps/find/newsletterdescription.cws_home/622209/description#description

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department is Micromedex although this is soon going to be available to all the University of Tennessee health science students.

Questions to the centre can take from 10 minutes to 20 hours to answer depending on the complexity of the enquiry, the level of experience and knowledge of the student assigned to the enquiry, how involved the supervising staff have to become in guiding the student to the answer and the number of sources that need to be searched. Queries are received via email, phone and fax.

The students manning the centre also have weekly question and answer sessions where they work through questions for previous weeks to learn the best way to tackle them and what resources are useful for which questions.

There is a great emphasis on documentation and recording what answers have been provided as the centre can be held liable for the information that they give. Records are kept for seven years and to date the centre has been subpoenaed once to provide evidence on the advice it provided. References are often supplied in the form of full text articles or monographs from reference works to enquirers who are affiliated to UT and where copyright is not an issue.

When answering a query the students will always send the enquirer full evidence for their answer but they do try to limit the amount of information if they are faxing the evidence and often post the remainder.

Although when dealing with an enquiry the student will take on board particulars such as age, race, current medications or known allergies they do not give patient specific answers as this needs to be the responsibility of the health professional who is directly responsible for the patient.

The enquirer is asked to state when they need their answer by so that the enquiries can be organised in order of urgency. A File Maker Pro (FMP) system is used to record the enquiries and show the order that they need to be answered in so that students can be assigned the most urgent questions. The FMP system also allows faculty to see when a student has finished a question and it is ready to be checked.

UT has contracts with Group Purchasing Networks (GPNs) which consist of hospitals that have linked with others to combine the purchasing power of the individual organizations in order to obtain lower prices for equipment and supplies. As part of UT’s service the centre provides drug information to 700 hospitals and these contracts are nationwide.

The DIC also provides a free service to healthcare professionals in Tennessee. This includes not only pharmacists but also nurses, dieticians and social workers. Pharmacists are the main user of this service and especially community pharmacists because they are less likely to have access to the range of resources that the drug information centre can search.

The centre also offers a free service to any UT faculty member.

The centre processes approximately 1200 questions per year but the usage is decreasing. At one stage the centre used to deal with 3000 queries per year. In recent months usage has dropped further to less than 100 questions per month.

In recent years the UT’s pharmacy faculty and DIC have been expanding their services and transitioning towards outcomes research. One reason for this in that in the US there has been a trend for drug information centres to close, probably as a result of the increase of information online, and so a successful centre will need to do more than simply provide a basic drug information service. UT has recognised that there is a need to evolve to survive. Although the DIC is a revenue centre and brings money into the university principally through its work for the GPNs it does cost more to run than it brings in. However, it also provides invaluable training for the students. Some faculty members are not trained in drug identification and have more of a 34

focus on policy or research so there is always a need to promote the DIC even across the university.

The pharmacy faculty of which the DIC is part has recently faced a new challenge with the opening of a campus in Knoxville and the need to provide teaching through distance learning.

Currently there are 130 pharmacy students in Memphis and 40 in Knoxville although the total will soon be expanding to 200 across the two campuses. Knoxville students watch lectures given in Memphis live via video conferencing and have the opportunity to ask questions of lecturers in then same way as Memphis students. Blackboard is an extremely useful tool both for posting lecture notes and accompanying material online but also for students across the campuses to access discussion boards. The online resources provided by the library are an essential tool in meeting the information needs of the students undertaking distance learning.

As well as staffing the DIC the UT pharmacy course also requires that students undertake medical literature reviews e.g. how to read journal articles and interpret statistics and can undertake critical appraisal and evaluation. The library liaison is involved in helping students develop these skills.

Following these discussions I was also invited to sit in for some of a lecture on understanding medical statistics in the pharmacy literature, a key skill for successful critical appraisal of a resource.

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Appendix 1 - Glossary CE

Continuing Education

CPD

Continuing Professional Development

Independent Pharmacy

A community pharmacy which is not part of a multiple chain of pharmacies (see below).

MPharm

Professional degree that prepares the graduate for UK pharmacy practice.

Multiple

A pharmacy chain with multiple pharmacy branches e.g. CVS in the US.

NCBI

National Center for Biotechnology Information (division of the National Library of Medicine).

OTC

A medicine or food supplement available over-the-counter from the pharmacist.

PharmD

Professional degree that prepares the graduate for US pharmacy practice.

Pharmacopoeia

Collection of standards for medicinal substances and pharmaceutical quality standards for a particular country.

Preregistration training

The period of employment that a person must undertake and successfully complete before they can register as a pharmacist in Great Britain.

Proprietary Book

Collection of information provided by drug companies in a particular country on individual medications either aimed at patients or health professionals. For example one of the UK proprietary books the Medicines Compendium provides access to both Summaries of Product Characteristics (SPCs) and Patient Information Leaflets (PILs).

PubMed

Free online service provided by the NLM which includes 17 million citations from MEDLINE and other life science journals for biomedical articles back to the 1950s. PubMed includes links to full text articles and other related resources.

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Appendix 2 – Initial Proposal Application for Travelling Librarian Award 2007 Karen Poole My job as Assistant Librarian at the Royal Pharmaceutical Society of Great Britain involves a mix of duties including acquisitions, cataloguing and enquiry work. I am inquisitive and enthusiastic, committed to developing my professional and personal development and am currently undertaking the chartership process with CILIP. In applying for the Travelling Librarian Award I hope to show how the study tour would develop my professional skills and enable me to improve the service offered by my library; and therefore help the organisation I work for meet its overall aims to improve the education and professional practice of pharmacists. Committed to knowledge sharing I would also take the opportunity to engage and share experiences with those I meet on the trip and on my return.

The main focus of my trip would be to discover more about pharmacy/health information from colleagues working in a similar membership organisation as the one I work for (although my preliminary investigations have shown that this is likely to be at state rather than country level) and I would also wish to visit a university school of pharmacy department. This would allow me to identify key resources currently used in the United States in pharmacy information and education, to discuss innovations in the provision of electronic materials and to explore the services they offer.

The Society’s library collection is not solely focussed on publications from the UK as American publications are an important source of material for us. I have been developing my knowledge of relevant US sources through courses and discussions with UK colleagues, but the opportunity to build relationships with those in the US with whom I could share information about what they consider to be key resources and who the relevant publishers are would be greatly welcomed.

My research has shown that the American Pharmacists’ Association has branches in the majority of US states. These branches offer a variety of electronic resources and support to the pharmacists in their area, principally focussed on Continuing Education via distance learning. I would like in particular to visit one or more of these branches to discuss their resources but I am also very interested in how they market their information service to maximise use and overcome geographical limitations, an issue which my library also faces in supporting pharmacists based through a large area. In visiting a university’s school of pharmacy I would be able to see a more traditional academic library-based service and again discuss key resources as well as developments in supporting pharmacy education. Medicines information is often provided within hospital staff libraries and I feel I would gain a great deal from visiting a hospital in the US that offers a clinical information service to pharmacists as well as other support through its library. Finally, I would like to visit a community pharmacist to discuss their practice and the kind of information support that they require in their day-to-day role and where they turn for help, especially what online sites they use. I hope that the knowledge I would gain would allow me to identify best-practice and resources that I could introduce in my own library upon my return to improve our own service.

Having travelled and worked for a short time abroad after my MSc I found that I gained a far better understanding of people and their culture when living and working together and so feel that staying with people participating in the home hospitality scheme would be a very interesting and rewarding experience. In return I would be happy to share details of my library’s practice and procedure and the knowledge that I have of UK and European pharmacy publications and information sources with those I meet on my trip. Upon my return I would of course be available to the ESU and CILIP to give feedback on and talk about my experiences.

In conclusion this opportunity is one that I would value both as a chance to improve my subject knowledge but also to expand my horizons, to experience a different culture and to build relationships with colleagues abroad. I enclose my CV and would welcome the opportunity to discuss this application further.

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Appendix 3 – Expenses

Cost (£)

Items

950.00

Flights

1025.00

Accommodation

245.00

Travel (including metro, airport shuttles, taxis etc)

355.00

Food and drinks

97.00

Insurance

40.00

Postage and phone cards

50.00

Printing and binding costs

Total: £2762.00 Expenditure is approximate

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