This is the first ever survey to be conducted in KSA to measure the attitudes of physicians towards DICs. To date, no attempts have been made to investigate this issue or the physicians’ information-seeking behaviour in this part of the world. There is only little earlier research into drug information services in KSA (7-9) and Kuwait (12). All these studies were a description of activity statistics of the DICs. Other studies focused on the prescribing behaviour of primary care physicians in KSA (13-16).
In the present work, information resources currently utilized by physicians were assessed. Physicians were also surveyed concerning their information-seeking behaviour and their awareness and satisfaction with the services provided to them by DICs. They were also questioned regarding their expectations and future information needs. We tried to obtain representative sample of physicians and dentists and to obtain a good response rate to assure the validity of the study. All respondents were seeing patients regularly in their sites of practice at the time of the study. Our response rate (65.9%) was favorable and consistent with other surveys of attitudes of health professionals conducted elsewhere. Whilst this response rate cannot be representative of all physicians and dentists in KSA, all regions of the country were represented in this survey, so it is fair to say that the survey provides a sound foundation for at least some tentative conclusions about the questions raised by the study.
The information-seeking behaviours of physicians and dentists in KSA were not very different from those in the UK and USA. The results of our study revealed that textbooks, periodicals, symposia/CME and company representatives (detailmen) were the most frequently consulted sources of information about drugs. The overwhelming dependence of physicians and dentists on textbooks to answer drug related questions was almost predictable. Lack of unbiased and reliable information on drugs contributes to the inappropriate prescribing among primary care physicians (13-16). In most developing countries such as KSA, one of the major sources of information available to physicians appears to be drug company salesmen. Western physicians (USA, UK, Germany) were less likely to rely on books compared to Arab physicians. In western countries, primary care physicians use their colleagues to help them evaluate and validate the medical development about which they read. They also rely on peers who they feel are better informed about medical advances; therefore, they seek their advice and opinion regarding a multitude of issues including diagnosis and drug treatment (17,18). Our results indicated that Western physicians working in KSA were less likely to use their colleagues as information source which probably reflects a confidence crisis due to the difference between both groups in their basic medical training. This relatively high utilization of textbooks for information about new drugs reflects a lack of confidence in other information sources or reluctance from the side of the physicians to admit to being informed by others. The use of textbooks and journal articles may provide adequate information necessary to make prescribing decisions, but to be used effectively as a major information source, a large medical library or information center would be required, which is beyond the physicians’ limited resources. Ely et al. (19) recorded the titles of all medical books in the personal libraries of 103 randomly selected family physicians; they found that drug-prescribing textbooks were the most common type of books in the physicians’ offices, followed by books on general internal medicine and adult infectious diseases. Furthermore, Connelly et al. (20) reported that physicians used the Physicians’ Desk reference (PDR) on daily basis, consulted colleagues at least weekly, but rarely used electronic information-retrieval systems. This result, with the exception of the use of colleagues, is in agreement with our results since most of the surveyed physicians in our sample were affiliated with primary care institutions. The striking observation from this study was that pharmacists and colleagues were the least consulted sources.
Our sample of physicians comprised approximately 30% of physicians who are practicing in rural areas of KSA. Gorman (21) compared the self-reported information needs of rural and rural primary care physicians and found that rural physicians reported less frequent use of consultants, colleagues, librarians, and bound journals, a result in a close agreement with our findings. Generally, all results are supporting the idea of establishing specialized DICs, not only in major cities, but also in rural areas. As in the present work, where physicians were satisfied with the drug information services provided to them, other investigators concluded similar observations. In a study (22) dealing with the quality and impact of problem-oriented drug information, 79% of the surveyed physicians found that the answers provided to them by the DIC were fast enough, relevant, adequately comprehensive and with valuable references. Furthermore, the majority of these physicians thought that the answers had caused a change in their clinical practice.
Although it was not one of the aims of this study to determine the use of electronic and computerized information-retrieval systems, the use of the Internet was investigated. Our results suggested low levels of awareness and expertise in such resources especially among private sector physicians. One of the probable reasons for the low use of the Internet was the unavailability of this service for physicians in their private institution due to cost considerations. In addition, it may be worth mentioning that our results revealed that the use of electronic resources increased with recency of training. This result may be due to the fact that some medical schools in KSA just started to introduce courses of medical informatics in their curricula. Other studies also reported a relatively poor access to computers among physicians (23-25). This result does not promote using the Internet as a substitute for DICs. The quality and reliability of drug information on the Internet is still questionable. Seaboldt and Kuiper (26) compared responses to drug information questions posted on the Internet Usenet pharmacy newsgroup (sci.med.pharmacy) with responses from DICs. They found a significantly smaller proportion of accurate drug information responses from the Usenet newsgroup compared with responses from DICs.
On the other hand, the awareness of the existence of DICs was investigated. Approximately one third of the physicians were not aware of the existence of these centers in KSA. The majority of those physicians were affiliated with the private sector. This is probably due to the fact that no private sector health institution in KSA has a DIC, where all centers are governmental property. From economical point of view, DICs are not considered profit-generating projects since there are no fees-for-service in KSA as the case of some developed countries. But the striking observation is that about half of the physicians who were aware of the service had never used it, probably reflecting the low trust level in pharmacist-operated DICs, a result consistent with the low use rate of pharmacist as a drug information resource.
Similarly, although physicians attempted to find information, on their own, in excess of 17 times during the last 6 months prior to the survey, and despite the relatively high satisfaction rating with the services provided to them by these centers, they only requested information on only two occasions during the last 6 months prior to the survey. This is probably due to the ignorance of what is available at these centers or probably because they live in an information-rich environment. A contradicting observation was that physicians who had previously used these centers to request information directly and indirectly expressed their satisfaction with services provided to them. Despite their low usage figures, they almost unanimously (98.7%) stated that they would encourage their colleagues to use these centers. The majority of physicians rely heavily on their personal knowledge, accumulated over years of practice and built up through their past medical education. Our results proved that the future information needs of dentists from DICs are relatively different from the information needs of GPs and consultants. These results are in agreement with other findings (27-29). Generally, information relating to complementary/herbal medicine; cautions/contraindications/adverse effects of drugs and drug overview (drug monographs) represented the major drug information categories might be requested from DICs in the future.
The results clearly highlighted the relatively passive attitude of physicians towards drug and poison information centers in KSA. These centers are underutilized by health care professional, in part due to the lack of awareness of their existence by physicians. Physicians always deal with an ever-expanding and often overwhelming information universe, including not only reliable primary sources, but also computerized secondary sources and well-established databases. Thus, considering the cost and time of pursuing new information about drugs, and accounting for the shortcomings of medical literature, physicians should use the expertise of drug information specialists to help them in obtaining reliable, validated and well-documented information. On the other hand, DICs have to evaluate their own current processes and outcomes, to set goals and to improve the quality of their services. They also have to reach to physicians through active approaches such as drug newsletters and continuing education programs in information-retrieval and evaluation techniques to promote and publicize their existence, and declare the opportunities available to physicians in terms of the ability of these centers to satisfy their information needs.
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