Hyla H. Polen

Scope, Completeness, and Accuracy of Drug Information in Wikipedia

Background: With the advent of Web 2.0 technologies, user-edited online resources such as Wikipedia are increasingly tapped for information. However, there is little research on the quality of health information found in Wikipedia. Objective: To compare the scope, completeness, and accuracy of drug information in Wikipedia with that of a free, online, traditionally edited database (Medscape Drug Reference [MDR]). Methods: Wikipedia and MDR were assessed on 8 categories of drug information. Questions were constructed and answers were verified with authoritative resources, Wikipedia and MDR were evaluated according to scope (breadth of coverage) and completeness. Accuracy was tracked by factual errors and errors of omission. Descriptive statistics were used to summarize the components. Fishers exact test was used to compare scope and paired Students Most was used to compare current results in Wikipedia with entries 90 days prior to the current access. Results: Wikipedia was able to answer significantly fewer drug information questions (40.0%) compared with MDR (82.5%; p <0.001). Wikipedia performed poorly regarding information on dosing, with a score of 0% versus the MDR score of 90.0%. Answers found in Wikipedia were 76.0% complete, white MDR provided answers that were 95.5% complete; overall, Wikipedia answers were less complete than those in Medscape (p <0.001). No factual errors were found in Wikipedia, whereas 4 answers in Medscape conflicted with the answer key; errors of omission were higher in Wikipedia (n = 48) than in MDR (n = 14). There was a marked improvement in Wikipedia over time, as current entries were superior to those 90 days prior (p = 0.024). Conclusions: Wikipedia has a more narrow scope, is less complete, and has more errors of omission than the comparator database. Wikipedia may be a useful point of engagement for consumers, but is not authoritative and should only be a supplemental source of drug information.

Clinical decision support tools: analysis of online drug information databases

BackgroundOnline 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.MethodsFive 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. Scheffes 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.ResultsThe 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).ConclusionOnline drug information databases, which belong to clinical decision support, vary in their ability to answer questions across a range of categories.

Clinical Decision Support Tools : Performance of Personal Digital Assistant versus Online Drug Information Databases

Study Objectives. To evaluate personal digital assistant (PDA) drug information databases used to support clinical decision‐making, and to compare the performance of PDA databases with their online versions.

Ability of online drug databases to assist in clinical decision-making with infectious disease therapies.

BackgroundInfectious 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.MethodsEight 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.ResultsScope 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%.ConclusionDrug 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.

Impact of Direct-to-Consumer Advertising (DTCA) on Patient Health-Related Behaviors and Issues

The pharmaceutical industry spends billions of dollars annually on direct-to-consumer advertising (DTCA). Patient perspectives on the impact of televised DTCA on health-related behaviors and issues were assessed by means of a 68-question survey. 58.6% of respondents believed that DTCA allowed consumers to have a more active role in managing their health. However, 27.6% felt DTCA caused confusion, and an alarming 17.8% of respondents stopped taking their medication because of concerns about serious side effects mentioned in DTCA. Overall, participants believed DTCA plays a useful role in health self-management; however, a considerable percentage thought that the cost outweighs the benefits.

Clinical Decision Support Tools: Personal Digital Assistant versus Online Dietary Supplement Databases

Background: Clinical decision support tools (CDSTs) on personal digital assistants (PDAs) and online databases assist healthcare practitioners who make decisions about dietary supplements. Objective: To assess and compare the content of PDA dietary supplement databases and their online counterparts used as CDSTs. Methods: A total of 102 question-and-answer pairs were developed within 10 weighted categories of the most clinically relevant aspects of dietary supplement therapy. PDA versions of AltMedDex. Lexi-Natural, Natural Medicines Comprehensive Database, and Natural Standard and their online counterparts were assessed by scope (percent of correct answers present), completeness (3-point scale), ease of use, and a composite score integrating all 3 criteria. Descriptive statistics and inferential statistics, including a χ2 test, Scheffés multiple comparison test, McNemars test, and the Wilcoxon signed rank test were used to analyze data. Results: The scope scores for PDA databases were: Natural Medicines Comprehensive Database 84.3%, Natural Standard 58.8%, Lexi-Natural 50.0%, and AltMedDex 36.3%, with Natural Medicines Comprehensive Database statistically superior (p < 0.01). Completeness scores were; Natural Medicines Comprehensive Database 78.4%, Natural Standard 51.0%, Lexi-Natural 43.5%, and AltMedDex 29.7%. Lexi-Natural was superior in ease of use (p < 0.01). Composite scores for PDA databases were: Natural Medicines Comprehensive Database 79.3, Natural Standard 53.0, Lexi-Natural 48.0, and AltMedDex 32.5, with Natural Medicines Comprehensive Database superior (p < 0.01). There was no difference between the scope for PDA and online database pairs with Lexi-Natural (50.0% and 53.9%, respectively) or Natural Medicines Comprehensive Database (84.3% and 84.3%, respectively) (p > 0.05), whereas differences existed for AltMedDex (36.3% vs 74.5%, respectively) and Natural Standard (50.8% vs 80.4%, respectively) (p < 0.01). For composite scores, AltMedDex and Natural Standard online were better than their PDA counterparts (p < 0.01). Conclusions: Natural Medicines Comprehensive Database achieved significantly higher scope, completeness, and composite scores compared with other dietary supplement PDA CDSTs in this study. There was no difference between the PDA and online databases for Lexi-Natural and Natural Medicines Comprehensive Database, whereas online versions of AltMedDex and Natural Standard were significantly better than their PDA counterparts.

Influence on Consumer Behavior: The Impact of Direct-to-Consumer Advertising on Medication Requests for Gastroesophageal Reflux Disease and Social Anxiety Disorder

A 68-question Internet survey was used to determine the impact of televised direct-to-consumer advertising (DTCA) on consumer-initiated medication changes for the treatment of gastroesophageal reflux disease (GERD) and social anxiety disorder (SAD). Of the 427 respondents, 10% that viewed DTCA for GERD and 6% that viewed DTCA for SAD reported that they subsequently initiated a conversation with their physician. Nearly half of respondents, 47.4% for GERD and 40% for SAD, reported that a change in therapy occurred as a direct result of these discussions. Televised DTCA for these two drug classes can have a significant impact on patient-initiated prescription requests.

Disappearing act: Persistence and attrition of uniform resource locators (URLs) in an open access medical journal

Purpose – The aim of this paper is to assess and catalogue the magnitude of URL attrition in a high‐impact, open access (OA) general medical journal. Design/methodology/approach – All Public Library of Science Medicine (PLoS Medicine) articles for 2005‐2007 were evaluated and the following items were assessed: number of entries per issue; type of article; number of references per entry; number of references that contained URLs; and the access date listed for each URL citation. URLs were then evaluated for accessibility status (i.e. active or defunct). Findings – In total, 1,133 articles were published from 2005‐2007 in PLoS Medicine. The 1,133 articles contained 28,177 references, with 2,503 (8.9 per cent) identified as URLs. Non‐research articles accounted for a substantially higher percentage of URL references (17.4 per cent) compared to research articles (4.2 per cent). Almost 17 per cent of the URL references were defunct and the rate of URL attrition increased as time elapsed. Research limitations/implications – Information management policy makers need to re‐examine the importance of preserving the internet materials long term. Both publisher and author should expand efforts to preserve internet materials. Common guidelines should be developed (e.g. by the International Committee of Medical Journal Editors) and implemented by all publishers to address URL use as references. Originality/value – This article will be of interest to those in the field.

Evaluation of nursing-specific drug information PDA databases used as clinical decision support tools.

BACKGROUND Nursing is arguably the most organizationally diverse healthcare profession. Educational backgrounds may vary, even among similarly credentialed nurses. Drug information databases used as clinical decision support tools can improve access to pharmacologic information at point-of-care when housed on personal digital assistants. They may also help address the disparity in drug information and pharmacology education between nurses. OBJECTIVES To evaluate nursing-specific drug information database content on personal digital assistants (PDAs). METHODS Seven nursing-specific PDA databases were evaluated for scope (absence or presence of an answer) and completeness (three-point scale) via the use of 80 general category and 80 subspecialty drug information questions. Erroneous information was also tracked. Individual scope and completeness scores were delineated by rank order and chi square was performed to determine differences in scope and completeness scores between the databases. RESULTS Daviss Drug Guide for Nurses (DDGN) and Nursing Lexi-Drugs (NLD) tied for the highest scores for scope, including each answering 72.5% of the 160 evaluation questions. No significant differences existed between their scores and those earned by Nursing2008 Drug Handbook (p<0.05). The highest scores for completeness were earned by NLD with 58.1% and DDGN at 57.1%. Saunders Nursing Drug Handbook was the only database that showed a significantly lower score in completeness as compared to the other six databases (p<0.05). A 4.2% overall error rate was found among database answers. DISCUSSION Significant differences were found among the performances in the databases evaluated in this study for their ability to answer commonly encountered drug information issues in nursing practice. All databases contained some erroneous information and even the top performers failed to provide answers to more than one-fourth of the questions posed. The availability of accurate and timely drug information at point-of-care can play a vital role in patient management and outcomes, but current resources that are available need to be improved.

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 at-risk 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.