9 research outputs found
Clinical decision support tools: analysis of online drug information databases
BACKGROUND: Online drug information databases are used to assist in enhancing clinical decision support. However, the choice of which online database to consult, purchase or subscribe to is likely made based on subjective elements such as history of use, familiarity, or availability during professional training. The purpose of this study was to evaluate clinical decision support tools for drug information by systematically comparing the most commonly used online drug information databases. METHODS: Five commercially available and two freely available online drug information databases were evaluated according to scope (presence or absence of answer), completeness (the comprehensiveness of the answers), and ease of use. Additionally, a composite score integrating all three criteria was utilized. Fifteen weighted categories comprised of 158 questions were used to conduct the analysis. Descriptive statistics and Chi-square were used to summarize the evaluation components and make comparisons between databases. Scheffe's multiple comparison procedure was used to determine statistically different scope and completeness scores. The composite score was subjected to sensitivity analysis to investigate the effect of the choice of percentages for scope and completeness. RESULTS: The rankings for the databases from highest to lowest, based on composite scores were Clinical Pharmacology, Micromedex, Lexi-Comp Online, Facts & Comparisons 4.0, Epocrates Online Premium, RxList.com, and Epocrates Online Free. Differences in scope produced three statistical groupings with Group 1 (best) performers being: Clinical Pharmacology, Micromedex, Facts & Comparisons 4.0, Lexi-Comp Online, Group 2: Epocrates Premium and RxList.com and Group 3: Epocrates Free (p < 0.05). Completeness scores were similarly stratified. Collapsing the databases into two groups by access (subscription or free), showed the subscription databases performed better than the free databases in the measured criteria (p < 0.001). CONCLUSION: Online drug information databases, which belong to clinical decision support, vary in their ability to answer questions across a range of categories
Ability of online drug databases to assist in clinical decision-making with infectious disease therapies
<p>Abstract</p> <p>Background</p> <p>Infectious disease (ID) is a dynamic field with new guidelines being adopted at a rapid rate. Clinical decision support tools (CDSTs) have proven beneficial in selecting treatment options to improve outcomes. However, there is a dearth of information on the abilities of CDSTs, such as drug information databases. This study evaluated online drug information databases when answering infectious disease-specific queries.</p> <p>Methods</p> <p>Eight subscription drug information databases: American Hospital Formulary Service Drug Information (AHFS), Clinical Pharmacology (CP), Epocrates Online Premium (EOP), Facts & Comparisons 4.0 Online (FC), Lexi-Comp (LC), Lexi-Comp with AHFS (LC-AHFS), Micromedex (MM), and PEPID PDC (PPDC) and six freely accessible: DailyMed (DM), DIOne (DIO), Epocrates Online Free (EOF), Internet Drug Index (IDI), Johns Hopkins ABX Guide (JHAG), and Medscape Drug Reference (MDR) were evaluated for their scope (presence of an answer) and completeness (on a 3-point scale) in answering 147 infectious disease-specific questions. Questions were divided among five classifications: antibacterial, antiviral, antifungal, antiparasitic, and vaccination/immunization. Classifications were further divided into categories (e.g., dosage, administration, emerging resistance, synergy, and spectrum of activity). Databases were ranked based on scope and completeness scores. ANOVA and Chi-square were used to determine differences between individual databases and between subscription and free databases.</p> <p>Results</p> <p>Scope scores revealed three discrete tiers of database performance: Tier 1 (82-77%), Tier 2 (73-65%) and Tier 3 (56-41%) which were significantly different from each other (p < 0.05). The top tier performers: MM (82%), MDR (81%), LC-AHFS (81%), AHFS (78%), and CP (77%) answered significantly more questions compared to other databases (p < 0.05). Top databases for completeness were: MM (97%), DM (96%), IDI (95%), and MDR (95%). Subscription databases performed better than free databases in all categories (p = 0.03). Databases suffered from 37 erroneous answers for an overall error rate of 1.8%.</p> <p>Conclusion</p> <p>Drug information databases used in ID practice as CDSTs can be valuable resources. MM, MDR, LC-AHFS, AHFS, and CP were shown to be superior in their scope and completeness of information, and MM, AHFS, and MDR provided no erroneous answers. There is room for improvement in all evaluated databases.</p
Role of the pharmacist in pre-exposure chemoprophylaxis (PrEP) therapy for HIV prevention
With a global estimate of 2.5 million new infections
of HIV occurring yearly, discovering novel methods
to help stem the spread of the virus is critical. The
use of antiretroviral chemoprophylaxis for
preventing HIV after accidental or occupational
exposure and in maternal to fetal transmission has
become a widely accepted method to combat HIV.
Based on this success, pre-exposure
chemoprophylaxis (PrEP) is being explored in atrisk
patient populations such as injecting drug
users, female sex workers and men who have sex
with men. This off-label and unmonitored use has
created a need for education and intervention by
pharmacists and other healthcare professionals.
Pharmacists should educate themselves on PrEP
and be prepared to counsel patients about their
means of obtaining it (e.g. borrowing or sharing
medications and ordering from disreputable Internet
pharmacies). They should also be proactive about
medication therapy management in these patients
due to clinically important drug interactions with
PrEP medications. Only one trial exploring the
safety and efficacy of tenofovir as PrEP has been
completed thus far. However, five ongoing trials are
in various stages and two additional studies are
scheduled for the near future. Unfortunately, studies
in this arena have met with many challenges that
have threatened to derail progress. Ethical
controversy surrounding post-trial care of
participants who seroconvert during studies, as well
as concerns over emerging viral resistance and
logistical site problems, have already halted several
PrEP trials. Information about these early trials has
already filtered down to affected individuals who are
experimenting with this unproven therapy as an
�evening before pill�. The potential for PrEP is
promising; however, more extensive trials are
necessary to establish its safety and efficacy.
Pharmacists are well-positioned to play a key role in
helping patients make choices about PrEP managing their therapy, and developing policy with
an eye towards the future.Con una estimación global de 2,5 millones de
nuevas infecciones de VIH cada año, es crítico
descubrir nuevos métodos para ayudar a detener la
extensión del virus. El uso de quimioprofilaxis
antirretroviral para prevención del VIH después de
una exposición accidental u ocupacional y en
transmisión materno-fetal se ha convertido en un
método comúnmente aceptado para combatir el
VIH. Basando en este éxito, se está explorando la
quimioprofilaxis pre-exposición (PrEP) en
poblaciones de riesgo tales como drogadictos
intravenosos, trabajadoras sexuales, y hombres que
tiene sexo con hombres. Este uso no autorizado y
no vigilado ha creado la necesidad de educación e
intervención de farmacéuticos y otros profesionales
de la salud. Los farmacéuticos deberían formarse
sobre la PrEP y estar preparados para aconsejar a
los pacientes sobre los medios de obtenerla (p.e.
prestándose o compartiendo medicaciones y
comprándola en farmacias de confianza en
Internet). También deberían ser proactivos en el
seguimiento de estos pacientes debido a las
importantes interacciones de los medicamentos
PrEP. Solo se ha completado un ensayo que
exploró la seguridad y la eficacia del tenofovir
como PrEP. Sin embargo, están programados 5
ensayos en marcha en diversos estadios, y dos
estudios adicionales en un futuro próximo.
Desafortunadamente, los estudios en este campo se
han encontrado con muchos obstáculos que han
amenazado interrumpir su progreso. La
controversia ética sobre la atención post-ensayo de
los pacientes que se seroconvierten durante el
estudio, así como las preocupaciones sobre la
emergente resistencia viral y los problemas
logísticos, ya han interrumpido varios ensayos de
PrEP. La información de estos primeros ensayos se
ha filtrado e los individuos afectados que están
experimentando con este tratamiento no probado
como una �píldora de la tarde anterior�. El
potencial de la PrEP es prometedor, sin embargo se
necesitan ensayos más extensos para establecer su seguridad y eficacia. Los farmacéuticos están bien
posicionaos para jugar un papel importante
ayudando a los pacientes a tomar mejores
decisiones sobre la PrEP, gestionando su
tratamiento, y desarrollando políticas con un ojo en
el futur
Associations of gender and age groups on the knowledge and use of drug information resources by American pharmacists
Objectives: To explore knowledge and use of drug
information resources by pharmacists and identify
patterns influenced by gender and age-group
classification.
Methods: A survey questionnaire was mailed
nationwide to 1,000 practitioners working in
community (n = 500) and hospital (n = 500) settings
who answer drug information questions as part of
their expected job responsibilities. Responses
pertaining to drug information resource use and
knowledge of different types of drug-related queries,
resource media preferences, and perceived
adequacy of resources maintained in the pharmacy
were analyzed by gender and age group. The t
statistic was used to test for significant differences
of means and percentages between genders and
between age groups. Descriptive statistics were
used to characterize other findings.
Results: Gender and age group classification
influenced patterns of knowledge and use of drug
information resources by pharmacists. They also
affected pharmacists´ perceptions of the most
common types of questions prompting them to
consult a drug information reference, as well as the
resources consulted. Micromedex, exclusively
available in electronic format, was the most
commonly consulted resource overall by
pharmacists. Lexi-Comp Online was the leading
choice by women, preferred over Micromedex, but
was not one of the top two resources selected by
men.
Conclusion: This study successfully identified the
influence of gender and age-group classification in
assessing drug information resource knowledge and
use of general and specific types of drug-related
queries.Objetivos: Explorar el conocimiento y el uso de
fuentes de información por farmacéuticos e
identificar los patrones afectados por género y
grupo etario.
Métodos: Se envió un cuestionario por correo a
1000 facultativos de todo el país cuyas funciones en
farmacias comunitarias (n=500) y de hospital
incluían responder preguntas sobre información de
medicamentos. Se analizaron por género y grupo
etario las respuestas relativas al uso de fuentes de
información y al conocimiento de los diferentes
tipos de áreas, preferencias de fuentes e idoneidad
percibida de las fuentes. Se utilizó el test t para
probar las diferencias de medias y porcentajes entre
géneros y grupos etarios. Se usó estadística
descriptiva para caracterizar otros hallazgos.
Resultados: El género y los grupos etarios
afectaron los patrones de conocimiento y uso de
fuentes de información sobre medicamentos por
farmacéuticos. También afectaron las percepciones
de los farmacéuticos sobre los tipos de preguntas
más frecuentemente formuladas que les llevaban a
consultar fuentes de información sobre
medicamentos, así como las fuentes consultadas.
Micromedex, sólo disponible en formato
electrónico, fue la fuente más consultada por el
conjunto de los farmacéuticos. Lexi-Comp Online
fue la fuente preferida por las mujeres, seguida de
Micromedex, pero no estaba entre las dos fuentes
más populares entre los hombres.
Conclusión: Este estudio identificó con éxito la
influencia del género y del grupo etario en la
evaluación de las fuentes de información sobre
medicamentos y el uso en general y específico de
búsquedas relativas a medicamentos
Self-reported influence of television-based direct-to-consumer advertising on patient seasonal allergy and asthma medication use: An internet survey
Background: Direct-to-consumer advertising (DDTCA) of medications, a marketing tool used by the pharmaceutical industry to increase patient awareness of products, affects both consumer behavior and, ultimately, physician prescribing practices. Billions of dollars are budgeted each year for DTCA, and its influence is far-reaching. However, little information is available about patient-initiated physician interactions in which television-bbased DTCA has played a role in consumer behavior.
Objective: The objective of this study was to explore the influence of television-based DTCA on treatment changes in patient-initiated medication use.
Methods: A 68-item survey instrument consisting of dichotomous, multiple-choice, and open-ended questions was constructed and sent to a convenience sample of US residents during 3 consecutive months ending in February 2005. The survey, which was accessed through an Internet link provided in the e-mail, was designed to capture data about patient perceptions and behaviors regarding television-based DTCA of prescription medications used for seasonal allergy and asthma as well as demographic information. Inferential and descriptive analyses were performed. Key tests included Crosstabs analysis and normal approximation to the binomial test with the z score.
Results: Surveys were sent to 2500 individuals. A total of 427 valid surveys were returned for a 17.1% response rate. Of the 402 respondents (94.1%) who stated that they had seen DTCA for seasonal allergy medication, 50 (12.4%) said they had discussed the advertised medication with their physician and 22 of those discussions (44.0%) resulted in a change in treatment. Three hundred forty-two respondents (80.1%) stated that they had viewed DTCA for prescription asthma medications, and 23 of those respondents (6.7%) said that they had discussed the brand of asthma medication viewed on television with their physician. Those discussions resulted in a change in treatment for 9 respondents (39.1%).
Conclusion: Within this limited, self-reported, survey sample, patient-initiated discussions with physicians regarding television-based DTCA of allergy and asthma medications resulted in a change of treatment in 44.0% and 39.1% of respondents, respectively