Analysis of Practice of Drug Information Resources by Dentists in Saudi Arabia

Phone no: +966504417712 E-mail: yalomi@gmail.com ABSTRACT Aim: This study’s objective was to analyze dentists’ practice of drug information resources in the Kingdom of Saudi Arabia. Methods: This is a 4-month cross-sectional study about the dentists’ practice of drug information resources in Saudi Arabia. It is a self-reported and electronic survey of dentists. We included dentists from interns to consultants and from all specialties in dentistry and located in Saudi Arabia. The survey consisted of two parts. The first part collected demographic information. The second part collected data about the type of drug information inquiries, aspects of dental drug information resources, and the dental drug information resources and types of dental drug information resources used in practice are responsible. We used the 5-point Likert response scale system to obtain responses to the survey questions. The data were collected through the Survey Monkey system and analyzed through the Statistical Package of Social Sciences (SPSS), Jeffery’s Amazing Statistics Program (JASP), and Microsoft Excel (version 16). Results: The average number of dental information resources was 0.84 per patient daily. The most commonly referred resource in relation to the dental drug information was biweekly (94 (36.43%)), monthly (92 (35.66%)) followed by weekly (35 (13.58%)) newsletter in addition to those published a few times per year (18 (6.98%)). The most frequently searched question was about the adverse reaction (190 (73.36%)) and drug availability (144 (55.60%)), whereas the majority of the dental prescriptions was related to the oral ulcer (83 (32.05%)) and sedation medications (74 (28.57%)). The average score for the item “implemented items for dental drug information resources” was 1.78. The highest score was obtained for the element “an annual plan of dental drug information resources” (1.88). In contrast, the lowest score was obtained for “dental drug information resources dentist’s competency” (1.7), with statistically significant differences between all responses (p<0.001). The highest scores of dental drug information resources (to authorities) the responsibility was a clinical pharmacist (4.65) and pharmacy technicians (4.34). In contrast, the lowest score was dentists (2.19), with statistical signification among all answers in each aspect (p<0.001). Conclusion: Despite the demand for resources to resolve drug-related dental care problems, the resources were seldom utilized. Targeting education and training of dental information resources is required to improve dental patient care in Saudi Arabia.


INTRODUCTION
For the past 40 years, drug information (DI) services have been well-established in Saudi Arabia and worldwide. 1,2 The DI services have several roles, including answering DI-related inquiries, managing drug formulary, and preventing drug-related problems. 3 DI is the knowledge of acquired facts through study, reading, and practical experience related to a chemical substance intended for the diagnostic uses or treatment and prevention of disease. 4 DI also provides both written and/or verbal information related to the drugs and medication therapy upon request from various committees, healthcare providing organizations, patients, and public health officers. 5 Furthermore, providing safe and effective patient care for DI requires a thorough evaluation of a specific patient or patient population. The information must be adopted as a fair, balanced, and unbiased approach when seeking DI. DI includes unlimited resources such as handbooks, mobile applications, and databases. 6 One of the significant components of DI services is references. The DI resources are of three types: primary, secondary, and tertiary resources. The tertiary resources include test books, whereas primary resources include the journal articles and secondary resources include journal indexes or abstracts of the conferences. 7 The healthcare providers used DI references during the undergraduate courses at various medical, dental, pharmacy, and nursing colleges and during their practice. The pharmacists, physicians, and lesser percentage dentists and nurses utilized the DI services, which has been reduced nowadays and switched to new online DI resources. 8 However, currently highfrequency use of the online and applications of DI resources by a healthcare professional. As a result, the number of drug inquiries decreased received by drug information centers. Other new drug information activities were implemented through DI services such as PharmacoEconomic services and medication utilization evaluation. 8 DI services help to reduce drug mobility and mortality, thereby reducing the economic burden on the healthcare system. [9][10][11][12][13] With an emphasis on dental drug information resources, various dental references included dental DI, dental surgery, orthodontics, dental materials, and other resources. Like other healthcare providers, Alomi YA, et al.: Practice of Drug Information Resources by Dentists in Saudi Arabia dentists refer to DI references that need to be used during their practice. Moreover, DI practice is considered a branch of dental informatics oriented toward dentistry. It deals with managing information, communication, and apps of new technologies in clinical practice and research concerning dentistry. 14 Dentistry has seen comparable groundbreaking advancement that has allowed it to progress based on evidence to enhance quality. The efforts have been an obligatory requisite in each field of healthcare. High-quality and sound dental practice depends not only on the wreckage of the selected evidence but also on the compilation of adequate obtainable research evidence. 15 However, there is hardly any data regarding dentists practicing DI in Saudi Arabia. Previous studies have explored the practice of usage of drug information resources worldwide. [16][17][18][19] However, to the best of our knowledge, there are no investigations conducted on the practice of DI resources by dentists in Saudi Arabia or Gulf and Arabian countries. Therefore, in this study, we aimed to evaluate the practice of utilizing DI resources by dentists in Saudi Arabia.

METHOD
This is a 4-month cross-sectional study conducted to analyze the utilization of dental DI resources in dental practice by dentists in Saudi Arabia. It is a self-reported electronic survey of dentists, including all dentists from interns to consultants and those from across all specialties in dentistry and located in Saudi Arabia. All nondentists or students and those who did complete the surveys will be excluded from the study. The survey consisted of demographic information and dental DI resources used for dental and non-dental medications. Aspects of dental DI resources (to authorities) are the responsibility and types of dental drug information resources used most frequently in practice. We used 5-point Likert response scale system to obtain the responses of participants. We calculated the sample in this cross-sectional study based on the previous literature: population percentage of 50%, the confidence level of 95% with a z score of 1.96 and margin of error of 5-6.5%, and a drop-out rate of 10%. With these parameters, the sample size was calculated as 251 to 432 with a power of study of 80%. [20][21][22] The response rate required for the estimated sample size is at least 60-70% and above. 22,23 The survey was distributed through social media such as WhatsApp and Telegram groups of dentists. A reminder message was sent once every two weeks. The survey was validated through the revision of expert reviewers and pilot testing. Moreover, the test of reliability was tested with Cronbach's alpha value. The data were is collected through the Survey Monkey system and analyzed with the Statistical Package of Social Sciences (SPSS), Jeffery's Amazing Statistics Program (JASP), and Microsoft Excel sheet version 16 software. The STROBE (Strengthening the reporting of observational studies in epidemiology statement: guidelines for reporting observational studies) guided the reporting of this study. 24,25

RESULTS
A total of 260 dentists responded to this survey, with most of them coming from the north are (75 (28.85%)) and central region (64 (24.62%)), with statistically significant differences between all analyzed regions (p<0.001). Out of 260 responders, 153 (59.30%) were male, and 105 (40.7%) were female, with statistically significant differences between them (p<0.003). The majority of the responders (257 (98.85%)) were in the age group of 24-35 years, with statistically significant differences among all age groups (p<0.001). Almost half of the responders were interns (135 (51.92%)) followed by residents (63 (24.23%)) and General Practitioner 62(23.85%), with statistically significant differences among them (p<0.001). Most of the responders belonged to the dental staff (222 (85.38%)), with statistically significant differences between the type of positions (p<0.001). The majority of the responders had approximately three years of experience(230 (88.46%)), and more than half of them were nonspecialized dentists (217 (84.44%)) with statistically significant differences between all periods of work experience (p<0.001) (Tables 1  and 2). A substantial number of patients needed DI resources, which was unknown by dentists (163 (62.69%)) followed by (1-5) questions daily 59 (22.69%). The number of dental drug information resources used daily was unknown 166 (63.85%) followed by (1-5) references daily was 61 (23.46%). The average number of DI resources accessed was 0.84 per patient daily. The most dental DI resources used to answer drug information inquires about adults 172 (66.41%) and adolescents 124 (47.88%). The most frequently used dental DI resource was biweekly (94 (36.43%)) or monthly (92 (35.66%)) followed by weekly (35 (13.58%)) and few times per year (18 (6.98%)). The most frequently searched questions were about dental medications: adverse reaction (190 (73.36%)) and drug availability (144 (55.60%)). The most frequently mentioned dental medications in DI resources were for an oral ulcer (83 (32.05%)) and sedation medications (74 (28.57%)), and the most frequently mentioned nondental medications in dental DI resources were anticoagulants (95 (36.96%)) and gastrointestinal tract medications (87 (33.85%)) (Tables 3-5). The average score was recorded for the item "implemented items for dental drug information resources" (1.78), with a high score recorded for the element "annual plan of dental drug information resources" (1.88). The lowest score was recorded for the item "dental drug information resources dentist's competency" (1.7) with statistical signification between all answers in each aspect (p<0.001) ( Table 6). The average score of frequently used dental drug information resources used was (3.63), with a high score recorded for the element "online evidence-based dental drug information resources" (3.93). In contrast, the lowest scores were recorded for "applications of dental drug information resources" (3.19), with statistically significant differences between all answers in each item (p<0.001) ( Table 7). The highest score concerning dental drug information resources (to authorities) in terms of the responsibility of types of healthcare professionals was a clinical pharmacist (4.65) and pharmacy technicians (4.34). In contrast, the lowest score was recorded for dentists (2.19), with statistically significant differences among all answers in each aspect (p<0.001) (

DISCUSSION
All healthcare professionals, including dentists, deal with medications daily. The medication process starts from procurement, preparation, and dispensing by the pharmacists and is prescribed by dentists and physicians, followed by pharmacists. 26 The medications, including dental types, need complete information among all stages of medication management. The dentists need to know the right dose for geriatric, adult, and pediatric populations. The status of the patient's condition     Skipped 0  with either regular or non-normal liver or kidney function required answering the drug dosing adjustment. 27,28 All DI was related to the drug storage and administration and medications for patients counseling (27) (28). All previous inquires need full detail of the dental DI resources. 29 The dentist needs to refer to the database information and dental drug information resources. 7,30,31 They also need to know the frequency of drug inquiries to answer their dental medications questions with full patient information. 29,32 Moreover, the dentist needs unique dental drug information resources, vision or mission, and policy and procedures of dental drug information resources program. 32 This study was conducted to declare the dentist practice of DI resources during daily dental operations or during clinic practice. This survey has high reliability and an almost equal number of both male and female which reflected the reality population. In this study, the majority of the responders were new interns or new graduates and had less experience when compared with general practitioners, which shows that the younger generation more frequently use electronic survey. The study should have more than half of the dentists' had unknown documentation of patients' number of DI inquiries followed by 1-5 of DI references, similar to the previous study. 16 In comparison, the number of DI inquiries per patient higher than in aother study reflected an increased number of DI inquiries per patient locally. 33 However, the dentists used one and less resource per patient. They referred to biweekly or monthly dental DI resources. The dentists did not frequently use the dental DI resources; therefore, they were not familiar. The majority of responders used dental DI resources for adverse drug reactions or drug availability. Thus, the dentist's high frequency used DI inquires to answer side effects of patients during dental care or get information about the drug availability for such dental disease. According to our hypothesis, dentists did not frequently use DI resources in practice. The dentist search for drug information for medications therapy of the oral ulcer and sedation medication. Simultaneously, the Alomi YA, et al.: Practice of Drug Information Resources by Dentists in Saudi Arabia dentist often searches about side effect medication used for sedation or local anesthetic used for oral ulcers. 34 Both oral cancer and sedation medications are considered a high-risk group of drugs, which requires excellent attention to prevent drug-related problems. 35 Dentists most frequently search for anticoagulant therapy, which shows various adverse effects and is regarded as high alert drugs. 36 Many practice elements of dental DI resources were not implemented. Comprehensive effort to improve the practice elements for dental drug information resources implementations. Most dentists frequently use evidence-based dental DI resources. However, dental DI apps have been less commonly used in practice. Some dentists were either not familiar with the digital applications of dental DI resources or few resources available in the market. The dentist declared their thoughts the responsibilities of dental drug information resources are the clinical pharmacist, while the dentist least one responsible for drug information resources. This shows that clinical pharmacists have more knowledge with regard to dental DI resources and dentist have less knowledge. Therefore, the clinical pharmacist takes care of the availability of dental DI resource for the dentist or provides education and training to them. 37

Limitations and Strengths
This study has some limitations. This survey was conducted through an electronic format, and there was an inadequate number of participants, as only people with internet access could participate. However, this study also had some strengths. For example, this is the first study conducted on a large population in Saudi Arabia concerning DI resources' dentist practice.

CONCLUSION
So far, studies conducted on information-seeking behaviors of dental practitioners are scarce. Knowledge of dentists' information-seeking actions should advance the translational gap between drug information resources and dental practice.