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["\"Dr. Douglas Ball\" <dball@hsc.kuniv.edu.kw> Subject": dball@hsc.kuniv.edu.kw (1)]

Indices: Indicators for DICs/MICs (1)

 For those INDICES members interested in developing indicators to
monitor/evaluate drug/medicine information services -  a follow-up to
earlier messages in November/December last year. The message is a bit
 lengthy (apologies).

 Background:
 Faced with poor growth at the Drug & Toxicology Information Service in
 Zimbabwe, I have been working with Dexter Tagwireyi to develop simple
 indicators (yes/no questions) which would help to monitor the function
 of a MIC over time and could also be used to "compare" MICs in different
 countries. I had asked about previous work in this area and was directed
 to a report from 1997.

 "The Report"
 It took some time due to postal glitches but I finally received the
 report from Lee Baker which was from a DSE/WHO sponsored workshop on
 DICs entitled "Evaluating the quality and effectiveness of a drug
 information centre". The report identifies structures, processes and
 outcomes in providing a MI service but concentrates on providing tools
 for evaluating the quality of the service provided e.g. were the
 responses given researched appropriately and contained accurate
 information and served the needs of the enquirer. Some indicators were
 provided but were not always complete e.g. the "minimum" number of staff
 to be present, key reference books to be on hand, appropriate hours of
 service were not defined. In summary, there is still scope for further
 work on indicators which will give a rapid assessment tool for MI
 services. These can be used alongside the recommendations of the report
 which works in greater detail and would require more input.

 e.g. The indicators would identify whether the centre has suitable
 funding, facilties, operating procedures and is being productive and
 growing. These could "indicate" a problem in particular areas which
 could then hopefully be addressed or be used to set goals in planning.
 The report would be of more use to study the activities of the centre in
 more detail and to implement quality assurance measures (the indicators
 ask if these are being used).

 [I have scanned the report in as a PDF file but it is 2.2Mb which is too
 large for e-mailing (even when zipped). If someone would like a copy
 please contact me directly for it to be made available over the WWW or
 posted]

 Note that the indicators and report are mostly directed at "reactive"
 DICs which respond to enquiries from outside. Those which are largely
 "proactive" in producing bulletins, developing guidelines will not find
 their situation addressed directly - however, we have included some
 measures of these functions and additional ones could be derived
 locally. The indicators also try to take account of the varied nature of
 DICs in Africa with their funding constraints and do not try to measure
 ideals.

 What We Have Done
 Using the report we have modified the draft indicators we had developed
 with the assistance of some MICs in Africa. We have tried to make the
 indicators and report agree in content but there are still are some
 technical differences whether some activities should be considered as
 processes or outcomes of a MI service. We don't see this as critical. We
 tend towards a wider approach where markers of the service provision are
 outcomes regardless of their quality or impact (so that they can be used
 as targets for planning purposes) whereas the report considers user
 satisfaction and impact of the service as the outcomes. The true
 outcomes of MI are very difficult to measure (especially impact on
 health outcomes) which is why we are willing to use surrogate markers.
 There is the danger that efforts then focus on these surrogates (which
 are really processes such as producing bulletins, providing responses)
 without thinking about the real intended outcome. This can be modified
 if a wider consensus is reached.

 Where We Are Headed
 The indicator list is available for anyone who wants a copy by e-mail
 (contact me directly, not through INDICES, so that I can send it as an
 attachment of about 153Kb). I will be presenting what we have com up
 with so far as a poster at the ICIUM meeting in Thailand later this> month.
The presentation will be made available electronically and I will
 feedback with the comments and suggestions received (Let me know if you
 would like a copy of the abstract sent to you). We hope to then produce
 a document/report on the indicators explaining why and how to measure
 them and will try to have it placed with the 1997 report on the WHO EDM
 website for wider dissemination and availability for the future.

 What Is Asked Of You
 If you would like to contribute further to this work, please read
 through the indicators (sent as a separate message since some mail
 programmes cut off long messages; available as e-mail attachment as
 described above) and make any comments as to modifications, additions,
 deletions. We are interested in the indicators:
 *being easy to understand (so as to measure the same thing at different
 centres)
 *being easy to measure from routine data or observation
 *providing information which reflects on the strengths/weaknesses of the
 service to help monitor it growth, sustainability and/or aid in planning
 if conducted once off or annually/serially.
 If you have any comments at all these will be welcomed and acknowledged.

 Regards

 Douglas Ball

 ==========================
 Dr. Douglas Ball PhD
 Dept. of Pharmacy Practice
 Faculty of Pharmacy, Health Sciences Center
 University of Kuwait, PO Box 24923 Safat 13110
 Kuwait
 Tel: (965)531-2300 ext. 6073
 Fax (work): (965)534-2807
 Fax (private): (1) 775-860-0325
 E-mail: dball@hsc.kuniv.edu.kw

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