Pharmacoepidemiological concepts and methods are frequently applied
in pharmacy practice. Perhaps the most common application of pharmacoepidemiology
is the use of information obtained from pharmacoepidemiological
studies to make drug therapy decisions. The best clinical decisions
are based on solid evidence. This chapter discusses the incorporation
of evidence-based medicine into clinical practice.
Other areas to which pharmacists apply pharmacoepidemiological
methods include adverse drug reaction surveillance, drug utilization
evaluations (DUEs), and pharmacoeconomical analyses. All of these
functions provide pharmacists with excellent sources of data to
conduct more formalized pharmacoepidemiological research. This chapter
also discusses how to apply the pharmacoepidemiological methods
discussed throughout this book to the practice of pharmacy. Resources
available to pharmacists who wish to practice in the area of pharmacoepidemiology
are discussed as well.
The best drug therapy decisions are decisions based on sound
evidence. Evidence that a drug is safe and effective is obtained
from pharmacoepidemiological studies and disseminated via the medical
literature. Medical literature can be classified as primary, secondary,
Primary medical literature provides
new information to the field of medicine and consists of descriptive,
observational, and interventional studies. All of these study designs
are used to provide new information about the use or effect of a
particular drug in a specific population. These studies are then
published in pharmacy and medical journals.
Hundreds of medical journals are published every week. These
journals fall into either general or specialty categories. General
medical journals publish information on topics of interest to general practitioners,
whereas specialty medical journals publish in specific areas of
medical practice (e.g., dermatology, cardiology). To remain current
in the field of practice, practitioners typically subscribe to a
few medical journals within their scope of practice.
Secondary medical literature consists
of indexing systems. It is impractical to search one by one through
the thousands of editions of medical journals to find clinical information.
The secondary systems allow practitioners to search through the
vast array of medical journals to find information about a particular
subject. Search terms are entered into a database, and the database
then reveals when and where information has been published on the
topic of interest. Some databases provide access to complete article(s),
and others provide information only on where to locate the article(s).
The most commonly used indexing system is the Medline database,
which was created in 1966 and indexes more than 1600 medical journals.
Tertiary medical literature consists
of literature reviews, which can be in the form of textbooks, reference
books, or review articles in medical journals. Before a review is
written, a literature search is conducted using the secondary systems
to identify all of the articles published on a particular subject.
The information is then collated and presented in a manner that
is easily used by practitioners. Tertiary resources are quick, efficient
resources that are used to answer questions about the most common