Evidence-based Drug Information Research Articles

Pharmaceutical Care in Chronic Coronary Artery Disease Management

Individuals who suffer from Acute Coronary Artery Disease (CAD) frequently experience related issues, either because of the illness itself or as a side effect. Despite the existence of established criteria, Drug-Related Problems (DRPs) are more likely to arise, which impairs therapy outcomes and overburden patients. The purpose of this study is to assess clinical pharmacist-initiated medication optimisation in ACS patients. In order to optimise pharmacotherapy and the patient care process, a comprehensive clinical pharmacy service was created and deployed for the management of acute coronary syndrome (ACS-CPS). The service activities were prototyped under four primary themes. Our research showed the proactive role of clinical chemists in starting and offering services such as transition care, medication reconciliation, medication optimisation, and evidence-based drug information and interventions

Assessment of potential drug–drug interaction knowledge, attitude, and practice among Egyptian hospital and community pharmacists: a cross-sectional multicenter study

BackgroundPharmacists have an important role in preventing prescribing errors and providing appropriate information. They can detect potential drug–drug interactions (DDIs), which are associated with a more extended hospital stay and higher medical costs that lead to substantial financial burdens on healthcare systems. This study aimed to evaluate and assess the knowledge of community and hospital pharmacists toward drug–drug interaction and their attitude and motivation to find DDI information, in addition to identifying the pharmacist factors affecting this knowledge. A cross-sectional multicenter study was conducted using a self-administered questionnaire. Nineteen drug pairs, that are common in clinical practice, were evaluated. This study aimed to evaluate and assess the knowledge of community and hospital pharmacists toward drug–drug interaction and their attitude and motivation to find DDI information, in addition to identifying the pharmacist factors affecting this knowledge.ResultsA total of 4363 pharmacists (2260 community pharmacists and 2103 hospital pharmacists) have completed the survey. The participants' knowledge of DDIs was 58.25%, and there was no significant difference in pharmacist knowledge between community and hospital pharmacists (p = 0.834). The highest correct answer was for sildenafil and isosorbide mononitrate pair 78.8%. The most used source of information was the internet or mobile applications, 47.1%. Participants who always considered PDDIs while prescribing detected more drug interactions than those who did not (p = 0.001).ConclusionAccording to the findings of this study, community and hospital pharmacists had comparable knowledge of DDIs. However, before dispensing uncommon prescriptions, they should consult evidence-based drug information resources and DDI software to identify potential drug interactions.

Impact of educational intervention in evidence-based drug information in interprofessional practice at a tertiary-level care hospital

Drug information management and interprofessional practice are essential abilities of healthcare professionals involved in prescribing, dispensing, and administering drugs. Achieving and maintaining a higher implementation of evidence-based drug information in interprofessional practice is a change management. A pre-post design was used to assess the impact of an educational intervention (online course) in the implementation of evidence-based drug information in interprofessional practice at Thumbay University Hospital, United Arab Emirates in 2021. Google Forms was used for data collection, before and after the intervention. The content of the survey form was validated by national and international experts. Statistical significance of any difference between pre- and post-course (immediate and after 6 months) surveys was calculated using the Wilcoxon Signed-Rank test. Kruskal Wallis test was used find differences among physicians, nurses, or pharmacists. The pre and post-course survey was completed by 9 doctors, 9 nurses, and 12 pharmacists. Internal consistency of the survey tool was high with Cronbach's alpha = 0.923. Based on the Wilcoxon Signed Rank test, statistically significant responses occurred after completion of the course. No statistically significant improvements or decreases were observed after 6 months. Kruskal Wallis test showed no difference in implementation of evidence-based drug information among physicians, nurses, and pharmacists (p-value >0.05). The educational intervention was found to be impactful in implementing evidence-based drug information in interprofessional practice among the study population . Improvements in practice retained even after 6 months, though refresher educational events are required maintain or further improve the best practices.

The neuron model: An educational tool for evidence-based practice and interprofessional care

Objective: The objective of the study was to assess the usefulness of the neuron model in educating how evidence-based drug information and interprofessional care interface. Methods: The Neuron model of evidence-based practice and interprofessional care was introduced in an online session to a group of healthcare professionals at a United Arab Emirates (UAE) tertiary-level care hospital in March 2021. A Google Form survey was used to assess the usefulness of the neuron model. Results: Among those who responded to the form, 90% of healthcare professionals said that the neuron model was useful. This agreement improved significantly (Wilcoxon Signed-Rank test p-value > 0.05), and persisted even after six months. Conclusion: The healthcare professionals agreed that the neuron model was beneficial in visualising how evidence-based practice and interprofessional care interface with each other, integrate into the academic health system, and help identify areas of improvement for healthcare professionals.

The impact of antimicrobial use on potential major drug-drug interactions in the pediatric Intensive Care Unit patients at University Hospital in Türkiye.

Antimicrobials, especially antibiotics, are among the most widely used drugs in the pediatric intensive care unit. Pediatrics patients in intensive care unit are exposed to potential drug-drug interactions (PDDIs) and suffered from their adverse and side effects. The aim of this study is to evaluate the impact of antimicrobial use on PDDIs, as well as to examine the rate and the risk factors PDDIs, furthermore the management of PDDIs. The present retrospective cohort study included 179 patients under 18 years of age who were hospitalized in Pediatric Intensive Care Unit in Türkiye. Drug interactions were evaluated using the Lexicomp® (Macedonia, OH, USA) drug interaction tool which provides evidence-based drug information. Our study results showed that the frequency of the use of antimicrobial drugs (antibiotic, antifungal, antiviral) was found to be statistically significantly higher (P<0.05) in the group with PDDIs compared to the group without PDDIs. Especially, the use of carbapenem, cephalosporin among the antibiotic groups significantly increased the frequency of PDDIs (P<0.05). While the probability PDDIs statistically significantly increased 3.73 times (OR [odds ratio] = 3.73; 95% CI=1.47-9.50) in patients who used a single antibiotic compared to patients who did not use antibiotics (P=0.006), the probability of the occurrence of PDDIs by using more than one antibiotic was statistically significantly 8.5 times (95% CI=3.30-21.89) (P<0.001). Our study results showed that the use of antimicrobial drugs (antibiotic, antifungal, antiviral) was found to be statistically significantly higher (P<0.05) in the group with PDDIs.

To CBD or not to CBD?: What pharmacists need to know

To CBD or not to CBD?: What pharmacists need to know

Appropriateness evaluation of Drug Information Center’s Facebook page for evidence-based drug information dissemination

ObjectiveTo assess the characteristics of an unpaid Facebook page for drug information (DI) and its reachability to users. MethodsIn this retrospective observational study over a 6-month duration, a Facebook page for the DI Center was created. One drug-related clinical question recently asked in the DI Center by a hospital clinician and its evidence-based answer along with the appropriate references were framed in a scenario and posted on the Facebook page on working days. The Facebook page likes, consumption, reach, engagement, impressions, and total number of followers were obtained from Facebook insights. The monthly averages of these parameters were assessed using the augmented Dickey–Fuller (ADF) test. ResultsThe cointegration (ADF) test revealed a statistically significant time-dependent correlation trend between the mean engaged users and mean monthly reach (ADF, –4.904; P = 0.01). Similarly, a statistically significant time-dependent correlation trend was observed with mean engaged users and mean monthly impressions (ADF, –5.456; P = 0.01). ConclusionThe knowledge gap between quality DI and evidence-based medicine practice in a developing country can be bridged with a novel DI Center Facebook page initiative.

Top 20 drug - drug interactions, polypharmacy and analysis of the nature of risk factors due to QT interval prolonging drug use in elderly psychiatry outpatients.

Introduction and Objectives:Psychotropic medications extend the corrected QT (QTc) period in the ECG. Psychiatric patients exposed to ≥ 1 psychotropic medication (s) represent a group with a marked probability of drug-activated QTc-prolongation. Prolonged QTc interval in elderly patients (age > 60 years) is connected to a greater risk of all-cause and coronary heart disease deaths. We investigated the pattern of utilization of QTc-interval prolonging medications, QT-extending interactions between drugs, and prevalence of QTc-interval prolonging risk factors in elderly patients.Methods:This was a cross-sectional, prospective study at the Psychiatry OPD at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India from October 1, 2017 to December 31, 2018 employing the pertinent prescriptions.Results:A total of 208 elderly patients (age 60 years or more) visiting the Psychiatry OPD during the aforementioned study period were investigated. 105 (50.5%) patients were males whereas 103 (49.5%) were females in our study. 147 out of 208 patients (70.7%) were using interacting agents with the capacity to produce TdP. 288 interacting torsadogenic medication pairs were unraveled. As per AzCERT/CredibleMeds Classification, 254 (48.8%), 181 (34.8%), and 62 (12%) interacting medications were identified with known, possible, and conditional risk of TdP, respectively. The common interacting medications belonged to antidepressant (144), proton pump inhibitor (91), antipsychotic (85), anti-nausea (46), antimicrobial (39), and H2 receptor antagonist (15) therapeutic categories.Conclusions:Many geriatric patients were administered drugs and drug combinations with heightened proclivity towards QT-interval prolongation. Therefore, we need to exigently embrace precautionary safety interventions, to be vigilant, and forestall QT-prolongation and TdP in clinical settings. Online evidence-based drug information resources can aid clinicians in choosing drugs for psychiatric patients.

Significance and Role of Academic Detailing for Optimal Medication

"Academic detailing" is used to clearly explain scientific issues. In the field of clinical practice, "academic detailing" is a form of interactive educational outreach to physicians in order to provide unbiased, non-commercial, evidence-based information about medications and other therapeutic modalities, with the goal of improving patient care. It is necessary to provide proper information about prescription drugs for their appropriate use in clinical practice. However, this requires of physicians significant time and labor to comprehensively collect and summarize all necessary information for the proper clinical application of pharmaceutical products, a task which may be both difficult and prohibitive to a busy physician. However, if clinical experience and other pharmaceutical or treatment information is derived solely from the commercial entities, this may lead to improper prescription practices. In western countries, public funds are used to support universities and other research institution programs. In Canada, clinical pharmacists act as "detailers". Their mission and role is to listen to the needs of the physician or health care professional, to provide objective, evidence-based drug information on selected drug therapy topics, to educate physicians on the optimal use of medications, to provide practical alternatives, and to extend the physician's usable knowledge base. The importance of this "academic detailing" activity is also recognized in Japan, and pharmacists can be expected to act as detailers in the future. We hope that this will lead to improvement in the quality of medical care.

Service design oriented multidisciplinary collaborative team care service model development for resolving drug related problems.

Our goal was to help prevent drug-related morbidity and mortality by developing a collaborative multidisciplinary team care (MTC) service model using a service design framework that addressed the unmet needs and perspectives of diverse stakeholders. Our service model was based on a “4D” framework that included Discover, Define, Design, and Develop phases. In the “discover” phase, we conducted desk research and field research of stakeholders to identify the unmet needs in existing patient care services. We used service design tools, including service safaris, user shadowing, and customer journey maps to identify pain and opportunity points in the current services. We also performed focus group discussions and in-depth interviews with stakeholders to explore the needs for improved services. In the “define” phase, we generated the service concept by mind mapping and brainstorming about the needs of stakeholders. The service concept was defined to be a Patient-oriented, Collaborative, Advanced, Renovated, and Excellent (P-CARE) service. We named the service “DrugTEAM” (Drug Therapy Evaluation And Management). In the “design” phase, we designed and refined four prototypes based on results from validation tests for their application towards following services: 1) medication reconciliation, 2) medication evaluation and management, 3) evidence-based drug information, and 4) pharmaceutical care transition services. During the “develop” phase, we implemented four services in a longitudinal chronic care model, considering the time spent by patients for each inpatient and outpatient setting. In conclusion, this is a study to develop a collaborative MTC service model using service design framework, focused on managing the unmet needs of patients and healthcare providers. As a result of implementing this service model, we expect to strengthen the professional relationship between pharmacists and stakeholders to ultimately create better patient outcomes.

Introducing a performance-based objective clinical examination into the pharmacy curriculum for students of Northern Cyprus

Purpose : To describe how a formative Objective Structured Clinical Examination was applied to fourth year pharmacy students at a university in Northern Cyprus. Methods : A blueprint-guided performance-based objective clinical examination was implemented. Group-prepared case scenarios based on course objectives were used to develop 12 exam stations. Scenarios were discussed in common training sessions for both assessors (faculty members) and senior students (standardized patients). Pilot testing of all stations was carried out on the day of the examination. Competencies tested included medical history taking, pharmacotherapeutic knowledge application, systemic client assessment, evidence-based drug information (DI) manipulation, drug related problems (DRP) management, patient counseling and communication skills. Results : The exam revealed that students were better in performing patient counseling (4.4 ± 0.23) and identification/resolution of DRPs (3.68 ± 0.18) than in DI tasks (2.00 ± 0.21) (p < 0.05). The students’ perceptions were positive with no significant differences in their average general performance compared to a written exam that had been previously carried out (p = 1.0). Conclusion : The evaluation revealed that undergraduate pharmacy students in a Turkish school of pharmacy were better in performing patient counseling and identification/ resolution of DRPs than in drug information manipulation tasks. Student satisfaction with OSCEs was higher compared to the written examination. The design and implementation of the formative assessment was successful with minimum cost, using only the existing available space and personnel. Keywords : Objective structured clinical examination, Formative assessment, Pharmacy students assessment, Competency, Examination

Drug information by public health and regulatory institutions: Results of an 8-country survey in Europe

PurposeTo evaluate the framework of drug information produced by public health and regulatory institutions in Europe. Materials and methodsWe carried out a short survey asking editors of ISDB bulletins of the European region to indicate the main sources of drug information provided by public health and regulatory authorities in their countries, the specific kind of information produced and their opinions about strengths and weaknesses of such information. The availability of evaluations about the added therapeutic value of drugs and of tools facilitating the implementation of such information were particularly addressed and checked on the websites of those institutions. ResultsAnswers pertaining to eight countries were available. Regulatory information and safety alerts are generally available, but just UK and Germany stand out by showing quite an advanced framework of evidence-based, comparative drug information for health professionals, decision-makers and for the general public. National plans to implement evidence-based drug information seem lacking. ConclusionMore efforts are warranted to develop sharp formats to make evidence-based drug information easier to access, understand and put in context, showing the place in therapy of medicines and their added therapeutic value. Harmonization of different sources, also at European level, would be important to favor their access and limit dispersion. Appropriate tools and specific plans are then necessary to favor implementation of information materials.

Preferences and Utilization of Drug Information Resources by Practicing Pharmacists

Objective: This study was designed to identify preferences and utilization of drug information (DI) resources, and to assess perceived level of drug information skill for pharmacists enrolled in a Non-traditional Doctor of Pharmacy (NTDP) program. Background: The ability to search for, utilize and apply drug information is an essential skill for pharmacists to fulfill their role as the primary source of drug knowledge. However, with exponential growth in the abundance of information, the increasing availability of an array DI resources and as a advocacy measures for provider status and MTM reimbursement intensify, knowing appropriate DI skills has become a challenge for pharmacists. Therefore, understanding the baseline knowledge of practicing pharmacists, such as those in NTDP programs, is crucial for determining how to design effective training measures. Methods: An 18-question survey was distributed to the participants (n=18) to assess their drug resource preferences and perceived skill level. Descriptive statistics were used and Chi-square analysis was performed using IBM SPSS 23. Results: General search engines (55.6%)was the most preferred tool for respondents’ drug information search activities, while 72% of respondents frequently used Google for drug information inquiries. However, only 17%of the respondents always cross-checked preliminary search results with other resources, and only 22 percent always verified the authenticity of the websites used. The level of confidence in drug information skills and in the accuracy of information obtained was notably high amongst NTDP students with 72% and 100%, respectively, selecting confident or very confident. Conclusion: Observation from the study suggests that pharmacists should be more aware of the possible risks to patient safety inherent in using Google or other search engines, and should be steered toward utilization of more reputable, evidence-based DI resources.

A randomized controlled trial comparing two ways of providing evidence-based drug information to GPs

Objective. To investigate whether tailored evidence-based drug information (EBDI) to general practitioners (GPs) can change the proportion of ACE inhibitor prescriptions more effectively than EBDI provided as usual three and six months after the intervention. Design. Randomized controlled trial. Setting. GPs in southern Sweden working at primary health care centres (PHCCs) in seven drug and therapeutic committee areas. Intervention. EBDI tailored to motivational interviewing (MI) technique and focused on the benefit aspect was compared with EBDI provided as usual. Subjects. There were 408 GPs in the intervention group and 583 GPs in the control group. Main outcome measures. Change in proportion of ACE inhibitor prescriptions relative to the sum of ACE inhibitors and angiotensin receptor blockers, three and six months after the intervention. Results. The GPs’ average proportions of prescribed ACE inhibitors increased in both groups. No statistically significant differences in the change of proportions were found between intervention and control groups. Information was provided to 29% of GPs in both groups. Conclusion. This study could not prove that specially tailored EBDI using MI implements guidelines more effectively than EBDI provided as usual.

GPs' opinions of public and industrial information regarding drugs: a cross-sectional study

BackgroundGeneral Practitioners {GP} in Sweden prescribe more than 50% of all prescriptions. Scientific knowledge on the opinions of GPs regarding drug information has been sparse. Such knowledge could be valuable when designing evidence-based drug information to GPs. GPs' opinions on public- and industry-provided drug information are presented in this article.MethodsA cross-sectional study using a questionnaire was answered by 368 GPs at 97 primary-health care centres {PHCC}. The centres were invited to participate by eight out of 29 drug and therapeutic committees {DTCs}. A multilevel model was used to analyse associations between opinions of GPs regarding drug information and whether the GPs worked in public sector or in a private enterprise, their age, sex, and work experience. PHCC and geographical area were included as random effects.ResultsAbout 85% of the GPs perceived they received too much information from the industry, that the quality of public information was high and useful, and that the main task of public authorities was to increase the GPs' knowledge of drugs. Female GPs valued information from public authorities to a much greater extent than male GPs. Out of the GPs, 93% considered the main task of the industry was to promote sales. Differences between the GPs' opinions between PHCCs were generally more visible than differences between areas.ConclusionsSome kind of incentives could be considered for PHCCs that actively reduce drug promotion from the industry. That female GPs valued information from public authorities to a much greater extent than male GPs should be taken into consideration when designing evidence-based drug information from public authorities to make implementation easier.

Problem-oriented drug information: physicians’ expectations and impact on clinical practice

Problem-oriented drug information (POD) is a service in which health professionals provide evidence-based answers to clinical questions posed by physicians. The objective of this study was to evaluate the user satisfaction and clinical impact of POD, to investigate predictors for use and to examine the kind of sources physicians search before applying for POD. To evaluate POD, a questionnaire was distributed with problem-oriented answers sent from a drug information centre to physicians during the period of April 2006 to March 2007. Of 197 questionnaires, 183 (93%) were returned. The information from the POD service was highly valued by the physicians, and 90% of the answers led to reported impact on clinical practice in the specific clinical situation. Furthermore, 74% of the answers were intended to be used in a wider context either for future patients (67%) or for dissemination to colleagues (51%). Secondary-care physicians more often than general practitioners (GPs) used the information for dissemination to colleagues (63 vs. 39%, P = 0.0008), while GPs more often used the answer to support patient information (88 vs. 70%, P = 0.0029). The most prominent motive for applying for POD was a request for evidence-based information (78%), and the service was used to overcome barriers to practicing evidence-based medicine such as lack of time (36%), skills for searching (26%), and appraising the literature (13%). Before inquiring, 74% of the physicians had tried other information sources; the most frequent sources used were a drug reference (68%) and consulting a colleague (24%). Secondary-care physicians reported fewer barriers than GPs when seeking information, and secondary-care physicians searched other sources more often than GPs before contacting the service (81 vs. 67%, P = 0.031). POD represents a useful source for acquiring evidence-based drug information by physicians. POD is highly valued by the users. It was reported to have an impact on clinical practice for the specific patient but is also intended to be used in a wider context for future patients or for dissemination to colleagues. GPs' and secondary-care physicians' use of POD differs with GPs having more focus on patient information and secondary-care physicians having more focus on dissemination of the information to colleagues.

Prioritizing Future Research on Off‐Label Prescribing: Results of a Quantitative Evaluation

To develop a prioritized list of individual drugs for which future research regarding off-label uses is warranted. Retrospective, cross-sectional study. Commercial database that provides ongoing estimates of drug prescribing practices of office-based physicians in the United States and an Internet database of comprehensive evidence-based drug information. The base analyses incorporated three key factors based on the theory of value of information: volume of off-label use with inadequate evidence, drug safety, and cost and market considerations. Nationally representative prescribing data were used to estimate the number of off-label drug uses by indication from January 1, 2005-June 30, 2007, in the United States, and these indications were then categorized according to the adequacy of scientific support. Black-box warnings and safety alerts, drug cost, date of market entry, and marketing expenditures were also incorporated into the final model to produce a priority score. Sensitivity analyses were conducted by varying key model parameters. Our findings identified a high volume of off-label prescribing in the absence of good evidence for a substantial number of drugs, particularly antidepressants, antipsychotics, and anxiolytic-sedatives. Drugs that consistently ranked high in both our base model and sensitivity analyses were quetiapine, warfarin, escitalopram, risperidone, montelukast, bupropion, sertraline, venlafaxine, celecoxib, lisinopril, duloxetine, trazodone, olanzapine, and epoetin alfa. Future research into off-label drug use should focus on drugs used frequently with inadequate supporting evidence, particularly if further concerns are raised by known safety issues, high drug cost, recent market entry, and extensive marketing. Our quantitative analysis identified particular concerns with the off-label use of antipsychotic and antidepressant drugs. Targeted research and policy activities on our list of prioritized drugs have high potential value.

Developing the role of pharmacists as members of community mental health teams: Perspectives of pharmacists and mental health professionals

Background People living with bipolar mood disorder and psychotic illnesses in Australia primarily access public-sector mental health care through community mental health teams (CMHTs). Adverse drug events are common among clients of CMHTs taking psychotropic medications. Objective The study aimed to investigate and describe a potential role for pharmacists as members of CMHTs. Methods Five study pharmacists were employed 1 day per week to work with 5 mental health teams over a 24-week period. The pharmacists conducted both client and team specific activities designed to optimize the use of medications. The pharmacists recorded their professional activities in diaries. Audiotaped focus groups were conducted with the pharmacists (n = 1) and mental health team staff (n = 3) at the conclusion of the study. Pharmacists' diaries and the transcripts of focus groups were thematically content analyzed. Results Study pharmacists were perceived as valuable sources of unbiased and evidence-based drug information for both mental health team staff and their clients and caregivers. Mental health team staff particularly appreciated the provision of information about nonpsychotropic medications. Pharmacists' participation in clinical team meetings was used as an opportunity to present medication review findings and recommendations. Liaising between medication prescribers and dispensers working in primary and secondary care settings was deemed an important additional role; however, participating only 1 day per week was considered to delay rapport building and the establishment of collaborative working relationships with mental health team staff. Conclusions Including pharmacists as members of CMHTs addressed an unmet need for pharmaceutical services among clients and staff of CMHTs. Pharmacists' contributions were welcomed by mental health team staff. The study raised the issue of whether pharmacists should be considered as essential and legitimate members of interdisciplinary CMHTs.

Status of Drug Use/Abuse in Africa: A Review

The history of psychoactive substance use in Africa is relatively short except for the reports on the use of traditional substances such as alcohol, cannabis and khat. The introduction of prescription drugs to Africa drastically increased the availability and use of psychoactive substances. This notwithstanding, alcohol, cannabis and khat still remain the most common substances of abuse in Africa. More recently, trafficking in heroin and cocaine has made narcotic drugs easily available across Africa despite the existing legal control measures. Complications arising from the use/abuse of psychoactive substances often draw public attention to their deleterious effects, which culminate in drug control policy formulation. This paper highlights the contribution of poverty, political instability, social unrest and refugee problems to the rapid spread of psychoactive substance use/abuse in Africa particularly among the youth. The review also points to a possible linkage between psychoactive drug use and HIV infection. At present in Africa, systematic evidence-based drug information is sparse. Also, drug policies are skewed towards formal control measures that may not encourage community participation. Poor funding, insufficient skilled health personnel, poor laboratory facilities, inadequate treatment facilities, and lack of political will are some of the impediments to controlling substance use/abuse in Africa. The paper argues that well-coordinated civil society participation is necessary in the control of drug problems in Africa in order to achieve a balance between supply and demand reduction efforts.

Gabexate mesilate and acute pancreatitis: an experience of evidence based drug information for improving rational drug use

Gabexate mesylate is a drug marketed only in Italy and Japan and it is considered an essential drug in the treatment of acute pancreatitis. A periodic revision and evaluation of drug utilization in our hospital demonstrated that the dosages and indications of Gabexate mesilate (GM) did not follow those settled by the National Health System and by our Hospital Formulary. We therefore promoted and conducted a program of drug information and meetings with the physicians in order to improve the correct utilisation of GM and identify potential problems. GM prescriptions in 1999 were analysed for indications and dosages. Scheduled meetings with the medical staff were successively started in order to debate current therapies and treatments of acute pancreatitis using the criteria of evidence-based medicine (EBM). Follow-up was done in 2000, 2001 and 2002 to evaluate the efficacy of our intervention. The hospital board and 20 physicians were involved in this program of evidence-based drug information. The follow-up and the monitoring of GM prescriptions showed a reduction in the utilisation of GM in the subsequent period. GM is one of the most expensive drugs in our hospital, but its benefits are not very evident. Moreover, the international guidelines and literature ascribe to GM only a marginal role in the treatment of acute pancreatitis. Evidence-based medicine strengthens clinical experience with the evidence from the literature and underlines that essential drugs are used worldwide.