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

Evaluation of State Schedule II Controlled Substance Laws

Background. States have the authority to mandate laws that are more stringent than federal law, which often results in important differences in prescribing and dispensing patterns throughout the country. Objective. The objective of this study was to evaluate schedule II controlled substance laws in all 50 states, the District of Columbia, and Puerto Rico to identify important differences. Methods. The current state laws and regulations regarding controlled substances were evaluated using the following criteria: whether prescription expiration dates are mandated, whether partial fills are permitted, whether changes can be made to prescriptions after consulting with a physician, whether maximum days’ supplies are mandated, and whether pharmacists can dispense emergency oral prescriptions. Results. Thirty-nine states and Puerto Rico (77%) mandate prescription expiration dates. Partial filling is permitted in all states, the District of Columbia, and Puerto Rico (100%). All 50 states and the District of Columbia (98%) permit pharmacists to make prescription changes after consulting with the physician. Nine states (17%) have mandated maximum days’ supplies that a physician may prescribe. All 50 states, the District of Columbia, and Puerto Rico (100%) permit pharmacists to dispense drugs in an emergency situation with verbal prescription. Conclusion. Pharmacists should be aware that differences exist among the states, the District of Columbia, and Puerto Rico regarding schedule II controlled substance laws. Understanding these differences is fundamental to the profession. Acknowledgement. This research is accepted for publication in the journal of Pharmacy Technology

Evaluation of State Drug Information Resource Requirements

Background. Requirements for drug information (DI) resources can differ by state, practice setting or specialty. Objective. To determine each State’s requirements for the type and format of DI resources that must be kept in a pharmacy according to general or specialty practice. Methods. All States were targeted to identify mandated DI resources. Criteria were: 1) whether a range or specified references are permitted, 2) if general resources or specialty practices require additional references, 3) whether format (i.e. print or electronic) is specified, and 4) if law resources are mandated. Information was culled from each State’s Board of Pharmacy. Results. All Boards of Pharmacy listed reference requirements. Sixty-five percent of States specified additional resources according to specialty or site including: chemotherapy, compounding, dialysis, immunization, parenterals, nuclear/radiopharmaceuticals, sterile injectables, as well as clinics, hospital pharmacies, home health services, opioid treatment programs, specialty pharmacies, long-term care pharmacies, prison clinics, and tele-pharmacies. Only 3.8% of States (South Dakota and Minnesota) require print or hardcopy editions of resources must be kept in the pharmacy. Seventy-seven percent of States also mandate that current law resources must be maintained in the pharmacy. Conclusion. Almost all States now allow electronic resources to satisfy Board of Pharmacy requirements. The majority of States also require that DI resources other than core holdings be maintained when the scope or setting includes specialty practices. Consequently, pharmacists need to be aware that their scope of practice can dictate which DI resources they need to maintain to be in compliance for their State

Chronic Obstructive Pulmonary Disease and Heart Failure Self-Management Kits for Outpatient Transitions of Care

OBJECTIVE: To develop heart failure (HF) and chronic obstructive pulmonary disease (COPD) self-management kits in an accountable care organization (ACO) to facilitate patients\u27 self-care and prevent hospital readmissions. SETTING: Pharmacists practice in an outpatient-based ACO. They participate in interprofessional office visits with providers and independently manage maintenance pharmacotherapies. PRACTICE DESCRIPTION: Pharmacists collaborate with an interprofessional team within the ACO including physicians, nurses, case managers, and paramedics. Two commonly encountered diseases are chronic COPD and HF. Reducing preventable readmissions for these conditions are important quality benchmarks and cost-saving strategies. PRACTICE INNOVATION: Pharmacists were responsible for developing HF and COPD self-management kits containing patient education materials and prescriptions to facilitate self-care. Prior to kit development, pharmacists performed a literature review to determine the presence of previously published findings on these topics. MAIN OUTCOME MEASUREMENTS: The interprofessional team continually evaluates the successes and limitations of this initiative. Pharmacists developed training and instructions for ACO allied health professionals in an effort to incorporate the self-management kits in clinical practice. RESULTS: The initial literature search revealed no studies describing the intervention of interest. Innovative programs designed to help reduce preventable readmissions are lacking in primary care. Implementation of the self-management kits was accepted by interprofessional ACO leadership and is currently being integrated into allied health workflow. CONCLUSION: Patients at risk for having an exacerbation of COPD or HF should receive self-management strategies. Prompt therapy prior to exacerbations reduces hospital admissions and readmissions, speeds recovery, and slows disease progression. Pharmacist-facilitated implementation of self-management kits may be developed by interprofessional health care teams