Evaluation of Online Drug References
Objective: To evaluate six drug references for their usefulness in identifying over-the-counter (OTC) solid oral dosage forms (SODFs).
Design: Retrospective evaluation of a convenience sample of requests for product identification.
Setting: Drug information center that accepts information requests from health care providers and law enforcement officials throughout the state in which it is located.
Participants: Researchers.
Interventions: Using a convenience sample of 68 nonprescription drugs and 41 dietary supplements obtained from the drug information center's question and answer database, researchers sought to identify the SODFs using six drug-identification online databases.
Main Outcome Measure: Likelihood of identifying a SODF with a given reference, reported as the percentage identified and the corresponding 95% confidence interval.
Results: Overall, 88.2% of nonprescription drugs could be identified using all six references. The highest percentage of nonprescription drugs (77.9%) were identified using Identidex, followed by Ident-A-Drug (67.6%), Drug Identifier (45.6%), RxList (39.7%), Lexi-Drug ID (33.8%), and Clinical Pharmacology (17.6%). Using Ident-A-Drug and RxList together led to the identification of two fewer nonprescription drugs than did Identidex at approximately 5% of the cost. Only 15 (37.5%) of the dietary supplements had an identifying imprint on the dosage form, and 7 (46.6%) of the imprinted products were identified. But overall, only 17.1% (7 of 41) of dietary supplements could be identified, as none of the products without imprints could be positively identified.
Conclusion: Using these six online references, nonprescription drugs could be identified more frequently than could dietary supplements. The lack of imprints on many dietary supplements is an impediment to identification of these products.
Health care providers are often called upon to identify medications while providing patient care and managing overdoses or poisonings. The providers best poised to respond to such requests are pharmacists who are most familiar with drug products. In the United States drug distribution system, identification of solid oral dosage forms (SODFs) is most practically performed using the imprint code on the product of interest.
Federal regulations require a unique imprint code on SODFs of prescription, nonprescription, and homeopathic drugs. These imprints are submitted to the U.S. Food and Drug Administration (FDA). There is no such requirement for dietary supplements, although some products do have an imprint.
Unfortunately, no central comprehensive database is readily available for health care providers to identify a product by imprint code. To identify an unknown SODF, health care providers must rely on commercial references. Since manufacturers are not required to submit imprint codes to companies that publish drug identification references, the references vary in their content used to identify SODFs.
Previous studies have evaluated the usefulness of references in identifying drugs by their characteristics. In 1964, a guide published by the American Medical Association was studied for its usefulness in identifying SODFs. The identities of one half of the unknown tablets and capsules in the study were found using this guide. A study performed in the early 1990s compared two references, Identidex (Micromedex, Greenwood Village, Colo.) and a "fan" reference of pictures organized by color and shape produced by the publisher of the Physicians' Desk Reference ( PDR ) (Medical Economics, Montvale, N.J.). By using the two references, 93% and 96.4% of unknown medicines, respectively, were identified.
More recently, Raschke and colleagues evaluated seven commercial databases for their usefulness in the identification of medications brought by patients into a hospital. The best reference in this study yielded successful identifications for 86.4% of the agents evaluated; the worst reference yielded only 24.8% successful identifications. Most drugs included the Raschke et al. study were prescription drugs.
Since the Raschke et al. study only contained a small sample of nonprescription drugs and dietary supplements, these observations did not constitute a representative sample of over-the-counter (OTC) products. This can be attributed to the study setting, which was a hospital environment. Patients may be more likely to bring only their prescription drugs to the hospital when instructed to bring their medications, leaving nonprescription drugs and dietary supplements behind.
Community pharmacists are more apt to encounter requests to identify OTC products, as these products are widely available with a high prevalence of use. Thus, a quantitative measure of the usefulness of drug information databases in the identification of such products is important to community pharmacists and, to a lesser extent, hospital practitioners. This information can then be used when selecting identification resources and determining whether to use different sources to identify prescription drugs compared with nonprescription drugs and dietary supplements.
Objective: To evaluate six drug references for their usefulness in identifying over-the-counter (OTC) solid oral dosage forms (SODFs).
Design: Retrospective evaluation of a convenience sample of requests for product identification.
Setting: Drug information center that accepts information requests from health care providers and law enforcement officials throughout the state in which it is located.
Participants: Researchers.
Interventions: Using a convenience sample of 68 nonprescription drugs and 41 dietary supplements obtained from the drug information center's question and answer database, researchers sought to identify the SODFs using six drug-identification online databases.
Main Outcome Measure: Likelihood of identifying a SODF with a given reference, reported as the percentage identified and the corresponding 95% confidence interval.
Results: Overall, 88.2% of nonprescription drugs could be identified using all six references. The highest percentage of nonprescription drugs (77.9%) were identified using Identidex, followed by Ident-A-Drug (67.6%), Drug Identifier (45.6%), RxList (39.7%), Lexi-Drug ID (33.8%), and Clinical Pharmacology (17.6%). Using Ident-A-Drug and RxList together led to the identification of two fewer nonprescription drugs than did Identidex at approximately 5% of the cost. Only 15 (37.5%) of the dietary supplements had an identifying imprint on the dosage form, and 7 (46.6%) of the imprinted products were identified. But overall, only 17.1% (7 of 41) of dietary supplements could be identified, as none of the products without imprints could be positively identified.
Conclusion: Using these six online references, nonprescription drugs could be identified more frequently than could dietary supplements. The lack of imprints on many dietary supplements is an impediment to identification of these products.
Health care providers are often called upon to identify medications while providing patient care and managing overdoses or poisonings. The providers best poised to respond to such requests are pharmacists who are most familiar with drug products. In the United States drug distribution system, identification of solid oral dosage forms (SODFs) is most practically performed using the imprint code on the product of interest.
Federal regulations require a unique imprint code on SODFs of prescription, nonprescription, and homeopathic drugs. These imprints are submitted to the U.S. Food and Drug Administration (FDA). There is no such requirement for dietary supplements, although some products do have an imprint.
Unfortunately, no central comprehensive database is readily available for health care providers to identify a product by imprint code. To identify an unknown SODF, health care providers must rely on commercial references. Since manufacturers are not required to submit imprint codes to companies that publish drug identification references, the references vary in their content used to identify SODFs.
Previous studies have evaluated the usefulness of references in identifying drugs by their characteristics. In 1964, a guide published by the American Medical Association was studied for its usefulness in identifying SODFs. The identities of one half of the unknown tablets and capsules in the study were found using this guide. A study performed in the early 1990s compared two references, Identidex (Micromedex, Greenwood Village, Colo.) and a "fan" reference of pictures organized by color and shape produced by the publisher of the Physicians' Desk Reference ( PDR ) (Medical Economics, Montvale, N.J.). By using the two references, 93% and 96.4% of unknown medicines, respectively, were identified.
More recently, Raschke and colleagues evaluated seven commercial databases for their usefulness in the identification of medications brought by patients into a hospital. The best reference in this study yielded successful identifications for 86.4% of the agents evaluated; the worst reference yielded only 24.8% successful identifications. Most drugs included the Raschke et al. study were prescription drugs.
Since the Raschke et al. study only contained a small sample of nonprescription drugs and dietary supplements, these observations did not constitute a representative sample of over-the-counter (OTC) products. This can be attributed to the study setting, which was a hospital environment. Patients may be more likely to bring only their prescription drugs to the hospital when instructed to bring their medications, leaving nonprescription drugs and dietary supplements behind.
Community pharmacists are more apt to encounter requests to identify OTC products, as these products are widely available with a high prevalence of use. Thus, a quantitative measure of the usefulness of drug information databases in the identification of such products is important to community pharmacists and, to a lesser extent, hospital practitioners. This information can then be used when selecting identification resources and determining whether to use different sources to identify prescription drugs compared with nonprescription drugs and dietary supplements.
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