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 DOI: 10.1177/2168479013516775

2014 48: 378 originally published online 27 December 2013Therapeutic Innovation & Regulatory ScienceFantawork Samuel, Helen Dawit and Ayenew Ashenef

Ababa, Ethiopia: An AssessmentUtilization of Recently Established Drug Information Centers Located in the Public Hospitals of Addis

  

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Global Health

Utilization of Recently Established Drug

Information Centers Located in the

Public Hospitals of Addis Ababa,

Ethiopia: An Assessment

Fantawork Samuel, BPharm1, Helen Dawit, BPharm1,

and Ayenew Ashenef, MSc1

Abstract

A drug information center is a unit designed for receiving, collecting, analyzing, and providing unbiased, accurate, and up-to-date

information about drugs and their use. The drug information centers located in 4 public hospitals of Addis Ababa, Ethiopia, were

assessed in this study. They received a total of 467 drug information queries during their functional period until the time of this

study. Among these queries, only 409 were eligible to be included in the analysis. The majority of the queries were from public

hospitals (69%), mostly from health care professionals (94.9%), out of which physicians were the highest (49.7%), followed by

pharmacists (32.8%). The study found that the most frequently encountered requests were related to therapeutic use

(17.3%), followed by general product information and product availability; the highest number of queries concerned the use of

anti-infectives (29%).

Keywords

drug information center, query, hospital, Ethiopia

Introduction

Drug information is the provision of written and/or verbal

information or advice about drugs and drug therapy in response

to requests from health care providers, organizations, and

members of the public, including patients.1 With the rapid

advancement in the medical sciences, a huge amount of infor-

mation about drugs and diseases has emerged. Assessment and

authenticity of this vast information form a huge challenge.

Therefore, the rational selection and utilization of drugs have

become more complex.2

The pharmacist is in an ideal position between physician and

patient. The role of the pharmacist has changed from a com-

pounder and supplier of pharmaceutical products to a provider

of services and information and, ultimately, that of patient

care.3 Pharmacists have a fundamental responsibility and func-

tion that are unique to their profession as providers of drug

information.4 Practicing pharmacists today face challenges of

keeping up with the increasing number of new drugs and bio-

medical journals and articles available.5 In addition, other

health care professionals are currently challenged by the neces-

sity to keep up-to-date with the latest developments and

advances in therapies.6 Thus, the aspect of providing unbiased

written information for health care professionals has resulted in

an increasing demand for independent drug information

pharmacists.7

Many drug information centers (DICs) have come into exis-

tence because of the recognition by management that it is not

efficient to have practitioners review the literature and identify

solutions to all of the drug therapy problems they encounter.

Often, health care professionals in the public and private sec-

tors have little time or funds to spend on drug information

resources; thus, services in a DIC help in filling these gaps.5

As such, DICs were developed as central units, in an organized

approach, to meet these needs and help disseminate drug

1 School of Pharmacy, College of Health Sciences, Addis Ababa University,

Addis Ababa, Ethiopia

Submitted 16-Sep-2013; accepted 15-Nov-2013

Corresponding Author:

Ayenew Ashenef, School of Pharmacy, College of Health Sciences, Addis Ababa

University, PO Box 1176, Addis Ababa, Ethiopia.

Email: ayenew.ashenef@aau.edu.et

Therapeutic Innovation& Regulatory Science2014, Vol. 48(3) 378-385ª The Author(s) 2013Reprints and permission:sagepub.com/journalsPermissions.navDOI: 10.1177/2168479013516775tirs.sagepub.com

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information to medical and nursing staff.6 A drug information

service is defined as a formal unit with a series of resources and

a professional team engaged in providing information about

drugs. For one to become a DIC or for a DIC to improve its

function, it is necessary to have more pharmaceutical staff and

equipment/furniture that allow carrying out management tasks,

drug information, pharmaceutical attention, research, and

teaching.8

Disseminating drug information and establishing DICs is a

new practice in Ethiopia. This lack of experience may compro-

mise the health of the society, as drug information is not neces-

sarily available whenever access is needed. In recent years,

with the current introduction of pharmaceutical care and clini-

cal pharmacy services, DICs are available or in the process of

establishment in many hospitals in the country, especially in

university-affiliated hospitals. But lack of awareness about the

services given and lack of pharmaceutical staff and equipment/

furniture that allow carrying out tasks in the provision of drug

information could compromise the system. This study aims to

assess the overall status of the DICs as well as the query receiv-

ing and response trends performed in 4 major public hospitals

in Addis Ababa, the capital city of Ethiopia.

Methods and Materials

Study Location

This study was held in the DICs of 4 of the 12 public hospitals

in Addis Ababa: Tikur Anbessa Specialized Hospital (TASH),

St Paul’s General Specialized Referral Hospital, ALERT Hos-

pital, and Amanuel Specialized Mental Hospital.

TASH is a tertiary care institute that houses the College of

Health Sciences of Addis Ababa University and is the biggest

health care institute in the country in terms of facilities and man-

power. St Paul’s is also a tertiary care hospital, which houses a

medical training institute called Millennium Medical College.

Amanuel mental hospital serves primarily as a referral center for

mental health; it also participates in the training of psychiatry

residents as well as psychiatry nurses, in collaboration with

Addis Ababa and Gondar universities. ALERT primarily serves

the needs of leprosy patients; in addition, it houses an interna-

tional research organization known as the Armaeur Hansen

Research Institute. Besides their areas of specialized expertise,

Amanuel and ALERT offer other general medical services.

Data Collection and Management

A cross-sectional descriptive study was conducted in Addis Ababa

from March 1, 2013, to June 18, 2013. A retrospective review of

drug information queries received by the DICs during this period

from inauguration till the last query was performed with a check-

list containing 9 questions; in addition, a semistructured self-

administered questionnaire with a total of 17 questions was admi-

nistered to the directors of the centers in the selected 4 hospitals.

Briefly, the questions included client identification, type of

facility (see Figure 1), type of query, mode of reply, references

used for the reply, time frame to address queries, and purpose

of the query. The self-administered questionnaire to the directors

was designed to capture about the background of the DIC, the

composition of the staff who work there, the working time, the

ways of contact, the structural organization of the DIC, the facil-

ities available in the DIC, and the operational methods. Five phar-

macists working as directors of the respective DICs responded

positively by filling the self-administered questionnaires.

Epi Info 3.5.1 (Centers for Disease Control and Prevention,

Atlanta, Georgia) was used for data entry, while SPSS 20

(IBM, Chicago, Illinois) was used to analyze the data. Analysis

described frequency and percentage based on multiple

responses by defining variable sets. Accordingly, missing data

were cleaned to ensure accuracy of the results.

Facilities and Personnel in the DICs

According to the directors of the 4 centers, each DIC had 1

employee working at a time. The employees were pharmacists

and worked at all sectors available in the units. The employees

of the DICs in TASH, St Paul’s, and ALERT worked for 8

hours a day at the DIC, while DIC employees at Amanuel

worked 4 to 6 hours per day in addition to having other

Public Hospital69%

Health Center3%

Private Hospital/Clinic

4%

Community Pharmacy

4% Pharmaceu�cal Company

9%

Other6%

Not Applicable6%

Figure 1. Organizations that sent queries to the drug informationcenters in hospitals studied, 2009-2013.

Samuel et al 379

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responsibilities (dispensing drugs, participating in drug and

therapeutics committees, etc).

According to the directors, the working area was suitably

built to carry out the work in the DICs of St Paul’s, ALERT,

and Amanuel, while TASH encountered sanitary issues and

location and communication/connectivity problems. The facil-

ities available in the 4 DICs are summarized in Table 1.

Results

Number, Distribution, and Mode of Receiving Queries bySource

The DICs received a total of 467 drug information queries from

their functional start period until the time of this study

(Table 2). Among these queries, only 409 were eligible to be

included in the analysis as the queries and responses were well

documented, containing most of the parameters used in the

analysis of this investigation. The DIC at TASH had the highest

amount of eligible queries for analysis (95.45%) and received

an average of 14 queries per month. From the 4 hospitals, all

documented queries were eligible for the analysis in this study

in the DICs of Amanuel and ALERT.

Most queries were from health care professionals (94.9%),

out of which physicians were the highest (49.7%), followed

by pharmacists (32.8%) and nurses (10.2%). Requests from the

general public composed 5.9% (Table 2 and Figure 2). Mem-

bers of the general public found utilizing the services included

engineers, journalists, freelance workers, business administra-

tors, and patients from Addis Ababa as well as Adama and

Debrezeit, which are nearby towns.

Modes of Receiving Queries

The modes of receiving for most of the queries were not docu-

mented (91.2%), but 8.1% were delivered by inquirers who

walked into the center, and the rest (0.7%) were delivered

through telephone (Table 2).

Types of Queries

The majority of the purposes of query (89.2%) were not docu-

mented, whereas 10.8% were on their specific patients

(Figure 3). Most frequently encountered requests were related

to therapeutic use (17.3%), followed by general product infor-

mation (16.0%) and product availability (13.8%) (Table 3).

Table 1. Characteristics of the drug information centers in the hospitals studied.a

TASH ALERT Amanuel St Paul

Room size 12 16 24 15Computers 5 1 2 3Printers 1 1 1 1Photocopier — — 1 —Textbooks 150 41 10 100Journals — 37 — —Electronic information resources 1 Present Plentiful —Telephone — Present Present PresentInternet Present Present Present Present

Abbreviations: —, absent; TASH, Tikur Anbessa Specialized Hospital.aValues in no., with the exception of room size (m2).

Table 2. Queries, documentation period, requester characteristics,and receiving modes: Drug information centers of hospitals studied inAddis Ababa, 2009-2013.

No. of Queries

DocumentedEligible forAnalysis

DocumentationPeriod

HospitalTASH 374 357 Jul 28, 2009–Aug

29, 2011St Paul 54 13 Feb 11, 2010–Mar

14, 2011ALERT 34 34 Feb 15, 2011–Feb

26, 2013Amanuel 5 5 Sep 27, 2011–Mar

4, 2013Total 467 409 2.1 y (TASH)

No. %

Drug information requestorsRegulatory 6 1.5General public 24 5.9Health care

professionals383 94.9

Total 413 102.3Mode of receiving query

Telephone 3 0.7Walk-in 33 8.1Not documented 373 91.2Total 409 100

Abbreviation: TASH, Tikur Anbessa Specialized Hospital.

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Pharmacologic Classes of Drugs in the Queries

Most pharmacologic classes of drugs received in the queries

concerned anti-infectives (29%), which included anthel-

mintics (2.5%), antifungals (1.2%), antituberculars (3.4%),

antimalarials (1.2%), and antiretrovirals (4.4%), and the

majority were antibiotics (16.2%). This was followed by

anticancer (6.4%) and antihypertensive (6.1%) drugs,

respectively (Table 4).

References Used in the Replies

More than half (57.6%) of the resources used for responses

was Micromedex, which was available only in the DIC of

TASH. Access to other kinds of databases (Lexi-Comp,

drug facts, and comparisons) outside of Micromedex was

not available at all the centers. However, Lexi-Comp was

used in responses (Table 5) to some queries possibly

through e-mail contact with the Howard University system,

as the DIC in TASH was initially supported by them. Other

commonly used resources for answering queries were text-

books (33.3%; the most common ones included AHFS Drug

Information, Martindale, Drug Facts and Comparisons),

websites (23.8%), and UpToDate (15.2%). Guidelines

(5.9%) and phone contacts (8.3%) were used to a lesser

extent (Table 5).

Although the time frame for replies was not documented in

the majority of cases (72.9%), 24% of the replies were given

within 24 hours of receiving the queries (Figure 4).

The mode of the reply for the majority of queries was not

documented (60.8%). In 28.3% of the queries, the inquirer

received written reply, while verbal reply was given in 18.9%

of the queries. Out of the 114 written replies, 21.1% were sent

by e-mail and 4.2% were given rephrased printouts. In addition

to this, reference literature was supplied for 3.0% of queries

(Table 5).

Discussion

This study is the first description of activities in the DICs of the

public hospitals of Addis Ababa, Ethiopia. The demand for

drug information is observed not only in health care profession-

als but also among the general public, including patients. There

were 409 documented queries included in the study in the DICs

of 4 public hospitals of Addis Ababa from July 2009 to March

2013.

Figure 3. Reasons for submitting queries.

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

Physician Nurse Pharmacist Student Druggist Other*

49.70%

10.20%

32.80%

2.40% 1.60% 3.40%

Figure 2. Percentage of health care professionals who submittedqueries to the drug information centers in this study.

Table 3. Types of queries received.

Type No. %

Dosage recommendation 38 9.4Drug interaction 28 6.9Adverse effect 41 10.1Pregnancy and lactation 27 6.7Rate/method of administration 11 2.7Therapeutic use 70 17.3Product availability 56 13.8General product information 65 16.0Price 3 0.7Pharmacokinetics 3 0.7Pharmacology 43 10.6Toxicology information 9 2.2Contraceptives 6 1.5Serum therapeutic level 3 0.7Antimicrobial sensitivity/resistance 3 0.7Dietary supplement 18 4.4Storage 2 0.5Compatibility/stability 5 1.2Local/foreign drug equivalent 8 2.0Othera 26 6.4Total 465 114.8

aIncluded: Availability of products on the national drug list of Ethiopia, causes of

a disease, Food and Drug Administration time of approval for maraviroc and

enfuviritide, how to get narcotic and psychotropic prescription papers for a

private hospital, how to reconstitute, immunizations, list of ear/nose/throat

equipment, malaria prophylaxis, olmesartan and calcium antagonists randomized

study (OSCAR), prevalence of substance abuse among teens and epidemiology of

substance abuse in Ethiopia, test strips, restarting antiretroviral drugs after 3

years.

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The DIC found in TASH, which was established in 2009, had

the highest amount of eligible queries and received an average of

14 queries per month. This is lower than the 27 and 28 queries

received per month in Uganda and Nepal, respectively.9,10

In a previous study,9 it was assumed that the proximity of a

center partly explains the large number of queries from differ-

ent facilities. Among the queries received by the DICs during

the present study, a great percentage (69%) were from the pub-

lic hospitals of Addis Ababa. A possible explanation for the

large number of queries from these facilities could be due to the

proximity of the centers to the hospitals.

Even if the sources of queries to the DICs differ, most

receive queries from both the general public and health care

professionals. The use of the center by health care professionals

(94.9%) in the hospitals shows that evaluated drug information

is needed. Moreover, this seeking of service by physicians and

other health care workers reconfirms the acceptance of pharma-

cists as experts on drug information in the Ethiopian setting.

Even though the DICs were opened to the general public,

fewer queries (5.9%) were made by this group. This finding

was similar to those of other studies,9,11 possibly because the

public was less aware about the service compared to health care

professionals. However, this shows that patients are also in

need of a reliable source of unbiased, objective, and contextual

up-to-date drug information.

A study conducted in a South Indian teaching hospital found

that most beneficiaries of the service were health care students,

followed by nurses and doctors.7 The present study, however,

demonstrates that most beneficiaries were physicians

(49.7%), followed by pharmacists (32.8%) and nurses

(10.2%). The predominance of physicians was reported in a

study held in Uganda as well,9 perhaps because physicians are

the main prescribers and thus need to access appropriate drug

information.

The mode of receiving queries was not documented in the

majority of cases (91.2%). However, in terms of mode of

receiving queries, more inquirers delivered their queries by

walking in to the center (8.1%) than by using the telephone

(0.7%), which could be accounted by the easy accessibility of

the DICs and the services provided. This result is similar to the

one in India conducted in 2011. This mode will enable the

Table 4. Pharmacologic class of drugs in queries received.

Class of Drugs No. %

Antihypertensive 25 6.1Anticonvulsant 23 5.6Anthelminthics 10 2.5Anticancer 26 6.4Antifungal 5 1.2Anticholesterol 7 1.7Antituberculars 14 3.4Antimalarial 5 1.2Antidepressant 5 1.2Antiallergy 2 0.5Antipain 19 4.7Antiretroviral 18 4.4Antibiotics 66 16.2Othera 136 33.3Not applicable 67 16.4Total 428 104.9

aAntacid, antiarrythmic, antiasthmatic, anticoagulant, antidiabetic, antiemetic,

anti-Parkinson, antiplatelet, antipsychotic, antispamodics, benign prostatic

hyperplasia agents, cardiovascular system agent, contraceptives, local anes-

thetics, maintenance fluids, natural remedy, steroids, vaccines, laxatives,

radiological contrast media, hormonal therapy (infertility treatment).

Table 5. References used and mode of reply to queries.

No. %

ReferenceTextbook 136 33.3Micromedex 235 57.6Websites 97 23.8Journals 37 9.1UpToDate 62 15.2Guidelines 24 5.9Telephone contacts 34 8.3Othera 13 3.2Not documented 9 2.2Total 647 158.6

Mode of replyWritten

Literature supplied 12 3.0E-mail 85 21.1Rephrased print out 17 4.2Total 114 28.3

VerbalPhone 53 13.2In person 23 5.7Total 76 18.9

Not documented 245 60.8Total 435 107.9

aIncludes information from the Food, Medicine, and Health Care

Administration and Control Authority of Ethiopia, Pharmaceutical Fund and

Supply Agency of Ethiopia, Lexi-Comp, other drug information centers, other

importers/wholesellers/distributors, package inserts, pharmacy department of

Tikur Anbessa Specialized Hospital.

0.00%

50.00%

100.00%

Within 1 day Within 2 days Other* Not documented

24.00%0.70% 2.20%

72.90%

Perc

enta

ge

Time frame

Figure 4. Time frame for responding to the queries to drug infor-mation centers during the study period. *3, 5, 6, 10, 14 days, and 3months.

382 Therapeutic Innovation & Regulatory Science 48(3)

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inquirer to get more information about the functioning of

the center and thus provide another form of publicity. This

assumption could be a possibility for the present study as well.

In addition, it was noted that the same clients were frequently

asking, which could indicate that the inquirers were satisfied by

the services provided.9,12 The possible explanation for the low

percentage of telephone use could be that most of it was not

documented; 2 drug information officers have mentioned that

cell phone enquiries were not documented. According to the

results obtained from the directors, some of the units

lacked some of the basic standards on receiving requestor

demographics.

Basically, types of queries are mainly on issues directly con-

cerned with improving the quality of patient care: 10.8% of the

queries were found to be on a specific patient or on better

patient care, while the rest were not documented. This is much

lower than the result obtained from the study carried out in

India in 2012, where more queries were asked for the purpose

of updating knowledge (56.55%) than for better patient care

(31.14%) and educational/academic reasons (1.65%).4 How-

ever, if it is inferred that the health care professionals (exclud-

ing health care students) are using it for this purpose as well,

then 92.5% of the queries were on a specific patient. The low

percentage of queries on specific patients could account for the

very high value (89.2%) of undocumented purpose of queries.

Another explanation for this could be most likely that the

inquirers had met a challenge before and therefore wanted to

be equipped with the appropriate knowledge, in case a similar

situation arose.9 In this study, 2.4% of the delivered queries

were by health care students. This number of queries received

could be an indication of the role of the center as an academic

resource, which could be comparable to the 1.65% of queries

received in India.4

The most important areas of information identified were

therapeutic use (17.3%), general product information (16%),

product availability (13.8%), pharmacology (10.6%), and

adverse effect (10.1%). In most studies, including the one in

Uganda, queries on therapy were reported to be the most com-

mon. In the current study, similar results were observed

(17.3%). Therefore, this emphasizes the likely role of the DICs

in improving the quality of patient care.9 Queries grouped

under others were on certain diseases, reconstitution, immuni-

zation, and availability of products on the national drug list of

Ethiopia. FDA time approval for maraviroc and enfuviritide

and how to restart antiretrovirals were some of the questions

regarding antiretrovirals. There were queries also on medical

equipment and supplies, such as test strips and list of ear/

nose/throat equipment, and about the previously conducted

OSCAR study. Furthermore, the prevalence and epidemiology

of substance abuse among teens in Ethiopia and how to get

narcotic and psychotropic prescriptions for private hospitals

were the types of queries classified as other.

In this study, the highest proportion of inquiries were from

the pharmacologic class anti-infective (29%), with most

queries regarding antibiotics (16.2%). Similar findings, though

with higher figures (22%-56%), were reported in previous stud-

ies.9,11 The use of these drugs could imply the presence of

infectious diseases. The second-highest class of drugs was

found to be anticancer (6.4%). It was also observed that the

higher proportion of inquirers were from TASH, probably

because it is the nation’s sole cancer referral center.13 The pre-

dominance of pharmacologic classes categorized under other

(33%) is due to the high variety of drugs with a very low (insig-

nificant) frequency.

Results of a study from India showed that to answer

the received queries, primary, secondary, and tertiary sources

were used. Among them, more than 50% of the queries were

answered through Micromedex (52.45%), followed by text-

books (22.38%) and websites (10.49%). The present study indi-

cates similar results. For providing answers to the queries

received, the most commonly used resources were Microme-

dex (57.6%), textbooks (33.3%), and websites (23.8%). Micro-

medex was the most preferred drug information reference in

other studies as well.7,11 It was used only in TASH, and it pro-

vides updated, unbiased, and quick information compared to

textbooks. However, the use of Micromedex is limited to the

other centers, which may be due to its subscription cost, as is

the reason in other countries as well.14 Ease of retrieval of

information from textbooks, ease of use of computers and the

Internet, and availability of recent and relevant information

from them might explain the results obtained. Previous studies

assumed that the less frequent use of primary sources could

indicate that almost all necessary information presents a low

complexity level or is answered by tertiary sources. It could

even indicate unfamiliarity or difficulty of access to primary

information.15 It was observed that on some queries of product

availability, some references were documented, such as Micro-

medex and AHFS textbooks.

The goal of response to the queries for all the DICs is within

3 business days. Although 72.9% of the time frame to reply was

not documented, out of the 409 queries, 24% of them were

replied within a day. This is lower than 30.15% and 68.03%

replied in 24 hours from 335 and 122 queries, respectively.3,4

The type of literature search was the individual factor best pre-

dicting the time consumption. Easily accessible tertiary

sources, such as handbooks or databases, significantly reduce

the complexity of a query.16 A study carried out to evaluate

electronic resources showed that databases such as Lexi-

Drugs and Drugdex answered questions in a faster and easier

manner when judged against an Internet search. Drugdex is the

main drug information database from Micromedex, the highest

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used reference in the present study—perhaps because the data-

bases contain a main index that allows search by drug name

(generic or trade) and directs to a monograph for each drug.

Moreover, each monograph is divided into subsections addres-

sing different areas of information. This organization reduces

the time of the search, as all monographs are arranged in the

same way.17 However, the low percentage of reply within 24

hours could be a result of poor documentation.

It was observed that the mode of replies was mostly by the

enquirer’s preference. Of the 409 queries, most of the informa-

tion was provided in written form (28.3%). This is comparable

to the finding of the study held in India in 2012, which was

27.87%. Literature supplied in the present study was 3%. This

is very low compared to another study (63.11%).4 The possible

explanation for a low percentage of supplying literature could

be the poor documentation or the fact that journals were used to

a lesser extent. Yet, it was found that verbal reply was 18.9%,

which is higher than the 9.02% observed in India. Although

most of the purposes of queries were not documented, since

health care professionals were the highest inquirers, inferring

that majority of the queries were asked for better patient care,

the requirement for an immediate answer could explain the

higher percentage of verbal reply. This can be supported by the

findings from studies conducted in India.7,12 In the present

study, the percentage of replies by phone is 13.2%. In a city

of a wide telephone network, communication using telephones

is thought to be a practical way of utilizing DICs, where they

would participate in providing drug information to health care

professionals through telephone. Such a center has been

reported to be successful in Nepal.17 Drug information person-

nel have mentioned that rephrased printouts were supplied after

quick replies through the phone.

Documentation in 3 DICs was through log books and

file folders, where 2 used computer databases. For most of the

results obtained above, poor documentation was an issue. The

basic elements listed by the Pan African Health Organization

and other additional elements are the consecutive number of

inquiry, demographics of inquirer, type of inquiry, question and

answer, references used, the type of answer (oral or written),

contact information, institution of origin, and person answering

the inquiry. Date and time of inquiry and response, key words,

purpose of query, data on the patient, and mode of receiving

queries were the least documented ones in the DICs of the pub-

lic hospitals.1,8 This problem with documentation could be due

to the lack of a professional attitude toward the job since there

is no permanent staff and a lack of incentives or training. Poor

documentation and dissemination of the little available infor-

mation may lead to the lack of adequate drug information.10

Introducing standardized documentation processes such as

databases and/or forms in a national manner may help to rem-

edy this problem.

The challenges and drawbacks of the centers mostly

included the ones faced in developing countries.18 These can

be viewed in 3 aspects: inquirers, reference, and staff mem-

bers. In this study, one of the challenges mentioned by the

directors of the DICs was lack of awareness by the inquirers.

From a study conducted in Malaysia, the increase in the num-

ber of utilizations of drug information services was not con-

sistent, as the number dropped 3 months after an awareness

program was carried out to promote the units. It was believed

that the awareness program could attract users to utilize the

unit but only within a short period; the awareness program

could not retain users’ interest in using the service. Probably

by carrying out the program more frequently, users’ interest to

use the centers could be sustained. Results presented in previ-

ous studies suggest that physicians and pharmacists could

come into play to promote the service of drug information

to patients.9

Lack of up-to-date textbooks and unavailability of databases

were the major challenges with regard to reference materials.

One of the directors works 4 to 6 hours in addition to having

other responsibilities in the hospitals (dispensing, Drug and

Therapeutics Committee member, and other managerial

works). It was mentioned that in developing countries, there are

few drug information officers employed, and besides their daily

work at the DICs, they are also involved in other activities,

such as teaching.18 It was observed that there were no means

of contacting the drug information officers when the DICs were

closed (ie, address, phone, and e-mail), and working hours were

not posted on the doors.

Other than receiving and replying to drug information

queries, drug information services from the DICs of the public

hospitals of Addis Ababa also include preparing and distribut-

ing educational and informational materials with brochures and

newsletters. When these activities carried out were compared

to those of other countries, some similarities were observed.8

In addition, development of courses and lectures, training of

students, and stronger participation in hospital committees are

the activities shared by the DICs of Italy, Costa Rica, Iran, and

Argentina. However, these are yet to be fulfilled in some of the

public hospitals of Addis Ababa.

Limitations of the Study

The study was dependent on the documented data. The overall

poor or lack of documentation practices in DICs limited the

interpretation of many parameters included in this research.

Moreover, the variation in the documentation practice among

the 4 centers and the individual pharmacist variations within

the single DIC were high. Absence of using standardized for-

mats for the DIC practices was the challenge.

384 Therapeutic Innovation & Regulatory Science 48(3)

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Conclusion

This study shows that the most important areas of drug informa-

tion are therapeutic use, general product information, product

availability, pharmacology, and adverse effect, mainly about the

use of antibiotics. The majority of inquirers were physicians

from public hospitals. The main sources of drug information

used by the respondents were Micromedex and textbooks. There

were no permanent staff for the DIC services in most of the

hospitals; the drug information officers were engaged in other

activities too. With regard to the premises, all the DICs had suf-

ficient space and facilities for the provision of the services.

Acknowledgments

We are very grateful to all the drug information center directors and

staff pharmacists for their willingness to participate in the study and

allowing us to access all the available information regarding queries

and facilities in their centers. Deepest appreciation also goes to

Dawit Teshome and Teshale Mekonnen from the School of Phar-

macy, College of Health Sciences, Addis Ababa University, for the

constructive comments and valuable suggestions they offered to

improve this study.

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, author-

ship, and/or publication of this article.

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