Abstract
Background: Very few medical institutions are currently providing drug information center (DIC) services in low-resource countries. Objective: To assess whether academician pharmacologists of India are prepared to deliver countrywide services with regard to DICs. Methods: A cross-sectional knowledge attitude and practice study was planned in the form of an online survey. A hyperlink to the questionnaire was sent to academician pharmacologists via email, Facebook, and WhatsApp. Determinants associated with pharmacologists’ capacity and willingness in uplifting the DIC services were determined using logistic regression. Results: One hundred and thirteen academician pharmacologists responded. Participants who were working in limited functional DIC had 0.30 (95% confidence interval [CI] = 0.09-0.98) times association with answering that referring to promotional drug literature is an inappropriate practice for DIC services to that of nonfunctional DIC participants. However, the same had 5.28 (95% CI = 1.74-16.00) times association with referring to literature for establishing and running the services more as compared with participants with nonfunctional DIC. Participants from fully functional DICs in their departments had 6.31 (95% CI = 1.92-20.70) times association with identifying that adverse event reporting is not the function of DIC as compared with participants from a non-functional DIC. Participants with more academic experience had 6.7 (95% CI = 1.36 to 32.93) times association with an identification of challenges as compared with that of less experience participants. Conclusion: Academician pharmacologists need to be trained in critical appraisal of published literature and guided on how to establish and maintain the services for hospital clinicians. Senior pharmacology academicians’ advice will be crucial in strengthening the roadmap for capacity building.
Keywords: drug information center, pharmacology, evidence-based medicine, evaluation
Background
Is hetastarch (hydroxyethyl starch) indeed safe for maintaining blood pressure in postoperative or trauma patients? Questions like this remains unanswered due to the biased research findings in the literature. The past decade witnessed the retraction of several research papers from reputed journals. It is not merely an ethical violation but it also jeopardizes the quality of health care practice.1 Evidence-based medicine (EBM) is an exercise of critically appraising the published literature to arrive at the best drug information that can be utilized to improve patient care, safety, and the development of policies for continuous quality improvement of health care delivery. More than 7000 research papers of individual specialties are being published every day. This pushes clinicians with a requirement to maximize their reading hours to keep themselves up-to-date, which is nearly impossible with current health care settings in developing countries. Considering the dire necessity for drug literature–based guidance in clinical specialties, a separate service for clinicians can be provided by pharmacology departments in order to promote health care quality improvement.2 Pharmacology is a discipline that bears the moral responsibility of channelizing updated, authentic, accurate, and unbiased drug information to clinical colleagues via both proactive as well as reactive approaches. This kind of EBM on-call service has a tremendous potential not only in refining hospital-specific or region-specific disease management protocols and policies but also in strengthening the health care structure in many different ways, especially in developing countries.3 At present, the medical postgraduation discipline of pharmacology in developing countries has a relatively restricted utility, that is, primarily teaching the subject to undergraduates and training postgraduate residents.4 There are a few initiatives that are being explored for expanding the horizons of the discipline, such as cosmetovigilance, antibiotic stewardship programs, pharmacokinetically guided drug dosing, and so on, at selected medical institutions in same countries.2
Drug information center (DIC) services is a concept that originated from the University of Kentucky in the 1960s and advanced by the World Health Organization in a Nairobi conference in 1985 for rationalizing the use of medicines.5 The services of drug information in many US hospitals demonstrated a fall in monetary load by more than $50 million per hospital, along with approximately $0.4 million reduction per hospital in medicine-related expenses, and were further coupled with a significant fall in mortality rate per year.6 Though this concept is regularly practiced in Western countries, the utility and interest in these kinds of services are less in low- to middle-income countries.7 Considering the developing nature of the country and the financial stability of medical institutions, the concept of DIC has not been significantly explored by the pharmacology fraternity in the country.2 With this background information, a knowledge, attitude, and practice (KAP) study was planned to assess the background understanding of academician pharmacologists in our country along with the common hurdles to be overcome for providing DIC services by pharmacology departments.
Material and Methods
Study Design and Population
A cross-sectional KAP study questionnaire was designed (see Supplementary Table 1, available online). The designed questionnaire was then transcribed into an online Google Survey form and circulated to pharmacologist academicians affiliated with public as well as private medical colleges. The survey was conducted within a time span of 30 days between 1 and 30 September 2018. After sending the initial form to participants via email, reminders were sent 2 weeks later via social media platforms such as WhatsApp and Facebook in order to encourage participation and improve the response rate. Considering the exploratory nature of study, the questionnaire was sent to 400 academician pharmacologists of all regions of India based on contact information available online. The study was approved by Intramural Institutional Ethics Committee vide letter No. INT/IEC/2018/001059, dated August 14, 2018.
Data Collection and the Development of Data Collection Tool
The multiple-choice questionnaire was prepared considering 4 basic sections: demographic details, knowledge, attitude, and practice based on literature and group discussions. The questionnaire was validated for face validity by a panel of experts comprising 6 pharmacologists. The questionnaire was pretested among potential participants. The items in the questionnaire that looked ambiguous were reworded based on the feedback received from the expert panel and the pretest. The introductory section of the circulated e-form consisted of a brief background information section on the objectives of the study along with the consent statement for participation in the study. The 4 sections of the questionnaire included section A, which intended to collect the demographic information of the pharmacologist and status of DIC functioning in their respective centers. Sections B, C, and D contained 6, 5, and 5 question items, respectively, for the assessment of knowledge, attitude, and practice about drug information services. All were closed-ended multiple-choice questions, with 1 correct and other incorrect options, except 3 specified questions for which more than one option was correct. The voluntary participation in this study could be registered by clicking on the shared link that directed the participants to the questionnaire.
Statistical Analysis
The statistical analysis was performed in R statistical software (version 3.5.1),8 and the packages used in addition to the base package of R were readxl,8 plyr,9 limma10, ez,10 sjPlot,11 catspec,12 and reshape2.13 The results of the logistic regression were presented as odds ratio with 95% confidence intervals (CIs). The continuous variables were represented as mean ± SD, and categorical variables as numbers with percentages.
The average score for the sum of responses for each section (knowledge, attitude, and practice) was calculated, and were labeled as K-Score, A-Score, and P-Score, respectively. Based on these scores, the participants were grouped into “less than average” (LA) and “equal to or more than average” (EMA) for knowledge, attitude, and practice individually.
Two logistic regression models were planned. The first model was to assess the factors responsible for a participant being “LA,” and “EMA” for a section, which was determined by logistic regression. The LA and EMA of knowledge was regressed against questions of attitude and practice; LA and EMA of attitude was regressed against questions of knowledge and practice; and LA and EMA of practice was regressed against questions of attitude and knowledge. Univariate regression was performed for identification of independent variables based on a P value of <.20. The selected independent variable was applied for the construction of the binomial logistic regression model. Similarly, the second model was to assess the demographic factors (city, designation, and DIC functioning) responsible for a participant selecting a particular option in knowledge, attitude, and practice MCQ. A univariate analysis was performed keeping a P value of .05. A condition was decided for further selection of a question for multivariate analysis: “For a particular question even if 1 of the 3 demographics turned significant, then that question will be regressed against all the demographics.” For questions that had 2 types of options, binomial logistic regression was applied, whereas for questions with more than 2 types of options (PQ1, PQ3, and PQ5), multinomial logistic regression was performed. The recoding of the variables is explained in the online supplementary file.
Results
KAP Survey Raw Data Acquisition
A total of 113 (28%) pharmacologists responded to the online questionnaire after persistent reminders and all were included in the analysis. The respondents were assessed for the contact information assuring representability of the respondent sample to different tier cities of various regions of the country. The descriptives of the responses for the questions by the participants based on the original questionnaire can be found in Supplementary Table 1. The frequency of the different responses of the participants, based on the recoding, is mentioned in Table 1.
Table 1.
Frequency Distribution of Responses According to Recoded Variables of the Questionnaire.
| No. | Abbreviated Questions | Recoded Variable | ||
|---|---|---|---|---|
| 0 | 1 | 2 | ||
| DQ1 | City | 55 (48.67%) | 29 (25.66%) | 29 (25.66%) |
| DQ2 | Academic experience | 82 (72.57%) | 31 (27.43%) | — |
| DQ3 | DIU functioning | 78 (69.03%) | 19 (16.81%) | 16 (14.16%) |
| KQ1 | What is the important purpose of DIC? | 17 (15.04%) | 96 (84.96%) | — |
| KQ2 | Is patient privacy important in a case of inquiring drug-related information from DIC? | 44 (38.94%) | 69 (61.06%) | — |
| KQ3 | Can the promotional literature of a drug be used as a source for drug information? | 61 (53.98%) | 52 (46.02%) | — |
| KQ4 | Do DICs have the responsibility of ADR reporting (pharmacovigilance)? | 90 (79.65%) | 23 (20.35%) | — |
| KQ5 | Do you think DICs can serve by providing authentic individualized, accurate, relevant, and unbiased drug information? | 8 (7.08%) | 105 (92.92%) | — |
| AQ1 | Do you think the DICs bring awareness of rational drug use to various health care professionals? | 13 (11.50%) | 100 (88.50%) | — |
| AQ2 | Do you think the DIC should be taught in detail to budding pharmacology professionals? | 5 (4.42%) | 108 (95.58%) | — |
| AQ3 | Do you think an effective DIC can control the irrational use of medicines by proactive outreach activities? | 16 (14.16%) | 97 (85.84%) | — |
| AQ4 | What is your opinion about establishing and running DIC in every hospital? | 36 (31.86%) | 77 (68.14%) | — |
| AQ5 | Have you ever referred to literature on how to establish DIC in department of pharmacology? | 74 (65.49%) | 39 (34.51%) | — |
| PQ1 | If you are given an opportunity to serve as a drug information practitioner in a DIC, what do you think would be the common challenge? (Mark more than one if needed) | 21 (18.58%) | 42 (37.17%) | 50 (44.25%) |
| PQ2 | Do you think services of DIC can affect health care in terms of cost, morbidity, and mortality reduction? | 19 (16.81%) | 94 (83.19%) | — |
| PQ3 | Which modes of communication you would like to use for DIC service? | 43 (38.05%) | 70 (61.95%) | — |
| PQ4 | Should DIC be allowed to generate funds on account of the information obtained? | 73 (64.60%) | 40 (35.40%) | — |
| PQ5 | How to generate your own funds for the establishment and maintenance of DIC service? | 79 (69.91%) | 34 (30.09%) | — |
Abbreviations: DQ, demographics question; KQ, knowledge question; AQ, attitude question; PQ, practice question; DIC, drug information centre; ADR, adverse drug reaction.
The average of the sum of responses along with standard deviation of knowledge, attitude, and practice among the participants was 3.06 ± 0.96, 3.73 ± 0.98, and 3.36 ± 1.36, respectively. The K-Score, A-Score, and P-Score for the study were fixed at 3.06, 3.73, and 3.36, respectively, as per the planned methodology. Out of total 113 participants, 10.62% were having EMA in all 3 domains, 13.27% were having LA in all 3 domains, 33.63% were having EMA in 2 domains, and 42.48% of the participants were having LA in 2 domains. Taking individual domain, in knowledge, 68.14% were LA and 31.86% were EMA; in Attitude, 32.74% were LA and 67.26% were EMA; and in practice, 57.52% were LA and 42.48% were EMA. The possible combinations of domains are represented in the Venn diagram in Figure 1.
Figure 1.
Venn diagram depicting the frequency of participants having possible combinations of knowledge, attitude, and practice regarding DIC services.
Note: The shaded areas indicate the “equal to or more than average” in the KAP individually The number in figure represents frequencies.
First Model
The results of the univariate analysis of the first model are provided in Supplementary Table 2.
Evaluation of Association of Knowledge With the Other 2 Domains
Though the participant who felt that DIC should be established in every hospital had 2.50 (95% confidence interval [CI] = 0.97-6.44) times association with EMA in “K-Score” as compared with a participant who felt that DIC did not bring awareness, the odds did not turn significant (Figure 2).
Figure 2.
Pictorial representation of the odds of the binomial logistic regression of “Classified based on K-Score,” “Classified based on A-Score,” and “Classified based on P-Score” against study questions selected by univariate regression.
*P < .05. **P < .01.
Evaluation of Association of Attitude With the Other 2 Domains
The participant who felt that the DIC would reduce health care cost, morbidity, mortality and who had the knowledge that the prime purpose of DIC services is to provide unbiased drug information, train postgraduates, and control irrational drug use had 7.87 (95% CI = 2.14-28.91) and 7.35 (95% CI = 1.93-27.99) times association with EMA in “A-Score,” respectively. The participant who opted for more than one way of generating funds for establishment of DIC services had 0.24 (95% CI = 0.08–0.70) times association with EMA in “A-Score” (Figure 2).
Evaluation of Association of Practice With the Other 2 Domains
The participant who believed that the DIC can control irrational drug use by proactive outreach had 6.09 (95% CI = 1.30-128.55) times association with EMA in “P-Score” (Figure 2).
Second Model
The results of the univariate analysis of individual question of KAP against the demographics are provided in Supplementary Table 3. Based on the univariate analysis, questions KQ3, KQ4, AQ3, AQ5, and PQ1 were selected and binomial logistic regression was conducted for all except question PQ1, for which multinomial logistic regression was applied.
Binomial Logistic Regression of KQ3, KQ4, AQ3, and AQ5 Against Demographics
The participants who were working in a limited functional DIC had 0.30 (95% CI = 0.09-0.98) times association for correctly answering that referring to promotional drug literature is not an appropriate practice for DIC services as compared with non-functional DIC. There was no statistically significant difference in participants from different tier cities and academic experience with regard to identifying promotional drug literature as an inappropriate reference for answering any clinical query. Similarly, the participants who were serving with a fully functional DIC in their department had 6.31 (95% CI = 1.92-20.70) times association for identifying that adverse drug reaction (ADR) reporting is not the function of a DIC. The odds of correctly answering the question on responsibility of adverse event reporting and controlling irrational drug use did not turn significant for any demographic variable. Participants with limited extent DIC functioning in their respective departments had 5.28 (95% CI = 1.74-16.00) times association with referring to literature for establishing and running the services (Figure 3).
Figure 3.
Pictorial representation of the odds of the binomial logistic regression for KQ3, KQ4, AQ3, and AQ5 questions against demographics.
*P < .05. **P < .01.
Multinomial Logistic Regression of PQ1 Against Demographics
The participants with academic experience of more than 6 years had 6.7 (95% CI = 1.36-32.93) times association with identifying more challenges compared with a participants with academic experience of less than 6 years. Neither the city nor the extent of DIC functioning had any statistically significant bearing on identifying higher number of challenges in establishing and running the DIC services (Figure 4).
Figure 4.
Pictorial representation of the odds of the multinomial logistic regression for PQ1 question against demographics.
*P < .05.
Discussion
In the present study, efforts were made to decode the strategy for capacity building of academician pharmacologists, in order to provide DIC services for hospital clinicians. This is a first-of-its-kind KAP study that discusses not only the willingness and hurdles but also the possible measures to overcome the same from the viewpoint of the academician pharmacologist fraternity. The study demonstrated the significant association of higher knowledge score with 4 independent DIC service determinants, namely, the duty to spread awareness of rational drug use, willingness to establish DIC in every hospital, identification of practical challenges, and ways to generate funds in providing such a service. This implies that academician pharmacologists have a sound medication knowledge pool to help hospital clinicians in many ways, such as curbing the growing antimicrobial resistance, performing critical appraisal of published literature for safety efficacy evaluation, and so on. Fully functioning DICs exist around the globe, and they are the guiding force for hospital clinicians in various ways, such as timely newsletter circulation; maintaining dedicated websites for updated, unbiased, accurate, and authentic information update; issuing safety alerts; and so on. One of the well-known example of “EBM on the call helpline services” is the joint venture formed by 200 UK Medicine Information (UKMI) centers with the funding support of the National Health Service. It showed remarkable user satisfaction among hospital clinicians and further demonstrated that almost all of them immediately acted on the advice given by the medicine information center.14 Clinicians in Bhatinda, India, have shown only little knowledge about rational drug use in the form of identifying P drug, the use of essential drugs, and ADR awareness of prescribed drugs in daily practice as per the study by Mahajan et al.15 Thus, there is a dire need for EBM on-call service in developing nations, similar to the UKMI service. The present study also indirectly signifies that the participants with good knowledge are in agreement about the establishment of DIC services in every hospital. The DIC catering EBM on-call service has the potential to be translated into a national health program, if it gets established in every teaching medical institution, similar to pharmacovigilance program. DIC services are not only meant for hospital doctors but also for supporting staff members such as nurses and even for the patient population in the form of treatment counseling and patient education. The need for establishing these DICs in major teaching hospitals was stressed on as the first step toward health care quality improvement according to Chauhan et al7 Similarly, the association between good knowledge and identification of possible hurdles suggests that pharmacologist academicians are not only prepared to establish the services but also for predicting obstacles and counteracting them for smooth uninterrupted functioning. The study is the first one to establish the preparedness level before launching a countywide outreach program.16 Institutional support in the form of funding and infrastructure are only present in a very few institutions in developing nations.2 It took almost 13 years of dedicated pharmacovigilance service from 6 medical colleges of our country for it to become a national health program and spreading to each and every medical institution across the country.17
The willingness or the attitude is an essential component for developing a successful algorithm that provides EBM on-call service from DICs for clinicians. The present study found a significant association between a good attitude score and 4 determinants, namely, identification of apt purpose of DIC services, importance of maintaining patient confidentiality, capacity of DIC service in terms of health care cost reduction, and ways to generate our own funds for sustainable growth in catering to health care service. In majority of developing countries, treatment cost has become a considerably big issue, especially when the majority of the population is not covered by any health insurance and have to spend significant amounts from their own pockets during the treatment process.18 The services of drug information in more than 200 hospitals of the United States have shown a significant fall in health care cost, morbidity, and mortality rates per year.6 The utilities of the DIC needs to be understood in depth before establishing the services. The medical literature available in various databases needs thorough evaluation before any recommendation or answer can be provided to the clinicians with regard to the clinical query faced during the treatment course. Disproportionate doctor-patient ratio leaves doctors of low- to middle-income countries to practice beyond the recommended daily limit. Therefore, there exists a gap between update on drug information and the clinical practice that can be addressed if the DIC services are established countrywide.2 The rightful identification of ways of generating funds in catering to EBM on-call service from the present study suggests that capacity building has been ascertained.
The study observed significant association of higher practice score with the positive attitude that DIC would help in controlling irrational drug use. Mahajan et al clearly showed that the practitioners from Bhatinda heavily relied on information supplied by medical representatives and were not fully aware of the adverse effects of drugs while prescribing medicines.15 DICs have a capacity to devise region-specific hospital treatment protocols for the rational use of drugs. The World Health Organization in its Nairobi 1985 conference had stressed on flow of medication information from pharmacy and pharmacology divisions to clinicians for rational drug use.5
In current study, participants in only fully functional DIC could identify that pharmacovigilance or adverse event reporting is not the DIC’s duty in India. Participants need to be made aware that pharmacovigilance and DIC are 2 different patient-oriented services in India offered by the department of pharmacology. The pharmacovigilance program of India has taken a giant leap in the last decade. ADR reporting from pharmacovigilance units of almost all medical colleges is currently happening and reports are sent to the National Coordination Center (NCC).17
The academic pharmacologists affiliated to limited functional DICs were having very little awareness over referring to promotional literature in the DIC’s services was a wrong practice. This is the one of the most important findings of the study, implying that the quality of DIC service heavily relies on the reference quoted while answering clinical queries, which may be the reason for discrepancy in the extent of DIC functioning across the country. Though rational drug promotion is taught in pharmacy and pharmacology graduation, the quality of promotional literature tends to deviate due to marketing pressures, ultimately culminating in poor quality and costlier health care practice.19 In the current study, the participants from limited functioning DICs incorrectly identified promotional drug literature as a means of reference while answering a clinical query, while the same also reported having referred to the literature regarding the ways to establish and deliver the service sustainably. Another negative association observed in the study was between the attitude score and ways of generating funds. This signifies the need for guidance from already developed DICs to the ones that are not fully developed, which was the aim of the study, that is, capacity-building exercise of DICs. In the present study, the experience of senior pharmacology academicians who were able to identify the hurdles more may be connected with participants from limited functional DICs on the way the service quality can be improved. This can be achieved by organizing seminars, workshops, and continuing medical education programs for guiding the critical appraisal of published literature.2 In addition, incentives can be given to DICs to publish, disseminate, and encourage other medical institutions for DIC services.
Limitations
The current study is not without limitations. The first one is that it is survey research from single developing nation assessing the opinions and not quantifying the knowledge capacity on actual patient scenarios. Second, the small sample size of the study population cannot guarantee the omission of selection bias.
Conclusion
There is significant interest in the pharmacology fraternity for the uplift of DIC services. The quality of references used while answering clinical queries and expertise of senior academician pharmacologists in administration of DIC services can play a crucial role in developing EBM on-call service in each DIC if utilized judiciously. Hence, the roadmap for capacity building of pharmacology academicians in delivery of DIC services has been laid down in India.
Supplemental Material
Supplemental material, Supplementary_file for Decoding the Roadmap for Capacity Building of Pharmacology Academicians in Catering to Drug Information Center Services in a Developing Country by M Praveen Kumar, Amol Patil, Ashish Kumar Kakkar and Harmanjit Singh in Journal of Pharmacy Technology
Acknowledgments
Authors would like to thank the academician pharmacologists who participated in this study.
Footnotes
Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
Supplemental Material: Supplemental material for this article is available online.
ORCID iD: Amol Patil 
https://orcid.org/0000-0001-8552-2796
References
- 1. Brainard J, You J. What a massive database of retracted papers reveals about science publishing’s “death penalty. ” https://www.sciencemag.org/news/2018/10/what-massive-database-retracted-papers-reveals-about-science-publishing-s-death-penalty. Published October 18, 2018. Accessed March 15, 2019. doi: 10.1126/science.aav8384 [DOI]
- 2. Patil A, Padhy B, Prasanthi SK, Rohilla R. Drug information center in India: overview, challenges, and future prospects. Int J Pharma Investig. 2018;8:1-6. doi: 10.4103/jphi.JPHI_103_17 [DOI] [Google Scholar]
- 3. Kshirsagar NA, Bachhav SS, Kulkarni LA, Vijaykumar Clinical pharmacology training in India: status and need. Indian J Pharmacol. 2013;45:429-433. doi: 10.4103/0253-7613.117718 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Badyal DK. Pharmacology education in India: challenges ahead. Indian J Pharmacol. 2016;48(suppl 1):S3-S4. doi: 10.4103/0253-7613.193327 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. World Health Organization. The Rational Use of Drugs: Report of the Conference of Experts, Nairobi, 25-29 November 1985. Geneva, Switzerland: World Health Organization; 1987. [Google Scholar]
- 6. Bond CA, Raehl CL, Franke T. Clinical pharmacy services, pharmacy staffing, and the total cost of care in United States hospitals. Pharmacotherapy. 2000;20:609-621. doi: 10.1592/phco.20.7.609.35169 [DOI] [PubMed] [Google Scholar]
- 7. Chauhan N, Moin S, Pandey A, Mittal A, Bajaj U. Indian aspects of drug information resources and impact of drug information center on community. J Adv Pharm Technol Res. 2013;4:84-93. doi: 10.4103/2231-4040.111524 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Wickham H, Bryan J, Kalicinski M, et al. Readxl: read excel files. https://CRAN.R-project.org/package=readxl. Accessed March 20, 2019.
- 9. Wickham H. The split-apply-combine strategy for data analysis. J Stat Software. 2011;40(1). doi: 10.18637/jss.v040.i01 [DOI] [Google Scholar]
- 10. Ritchie ME, Phipson B, Wu D, et al. limma powers differential expression analyses for RNA-sequencing and microarray studies. Nucleic Acids Res. 2015;43:e47. doi: 10.1093/nar/gkv007 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11. Lüdecke D. sjPlot—data visualization for statistics in social science. https://zenodo.org/record/1308158#.XIyQTyIzbIU. Published July 9, 2018. Accessed March 20, 2019. doi: 10.5281/zenodo.2400856 [DOI]
- 12. Hendrickx J. Catspec: special models for categorical variables. https://CRAN.R-project.org/package=catspec. Published April 17, 2013. Accessed March 16, 2019.
- 13. Wickham H. Reshaping data with the reshape package. J Stat Software. 2007;21(12). doi: 10.18637/jss.v021.i12 [DOI] [Google Scholar]
- 14. Rutter J, Fitzpatrick R, Rutter P. What effect does medicine advice provided by UK Medicines Information pharmacists have on prescriber practice and patient care: a qualitative primary care study. J Eval Clin Pract. 2015;21:307-312. doi: 10.1111/jep.12310 [DOI] [PubMed] [Google Scholar]
- 15. Mahajan R, Singh NR, Singh J, Dixit A, Jain A, Gupta A. Current scenario of attitude and knowledge of physicians about rational prescription: a novel cross-sectional study. J Pharm Bioallied Sci. 2010;2:132-136. doi: 10.4103/0975-7406.67008 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16. Peiris D, Prabhakaran D. Developing cardiovascular disease risk programs in India—why location and wealth matter. PLoS Med. 2018;15:e1002582. doi: 10.1371/journal.pmed.1002582 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17. Kalaiselvan V, Thota P, Singh GN. Pharmacovigilance programme of India: recent developments and future perspectives. Indian J Pharmacol. 2016;48:624-628. doi: 10.4103/0253-7613.194855 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18. Balarajan Y, Selvaraj S, Subramanian SV. Health care and equity in India. Lancet. 2011;377:505-515. doi: 10.1016/S0140-6736(10)61894-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19. Mali SN, Dudhgaonkar S, Bachewar NP. Evaluation of rationality of promotional drug literature using World Health Organization guidelines. Indian J Pharmacol. 2010;42:267-272. doi: 10.4103/0253-7613.70020 [DOI] [PMC free article] [PubMed] [Google Scholar]
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Supplementary Materials
Supplemental material, Supplementary_file for Decoding the Roadmap for Capacity Building of Pharmacology Academicians in Catering to Drug Information Center Services in a Developing Country by M Praveen Kumar, Amol Patil, Ashish Kumar Kakkar and Harmanjit Singh in Journal of Pharmacy Technology