As the body of drug information continues to grow in size and complexity, drug information databases have become essential tools for pharmacists in their role as medication experts. The results of this study confirmed the perception that pharmacists rely heavily on such databases, with the majority of study participants reporting that they consulted drug information databases at least daily. This finding further emphasizes the need for active engagement of end-users in objective comparisons between databases. A previous analysis ranked the databases used in this study as the top 3 online drug information databases in terms of scope, completeness, and ease of use. However, that earlier study yielded a different overall rank ordering: Clinical Pharmacology, Micromedex, and Lexi-Comp. Although the rankings in that study were not significantly different among the databases, the difference in rank order was most likely due to the study’s substantially different (and, in our view, less applicable) methodology and to changes to the databases that have occurred over the ensuing 3 years. We found that Lexi-Comp Online was the highest-quality, best-performing, and most preferred online drug information database among those evaluated. Clinical Pharmacology’s lack of Canadian content was identified as the most important disadvantage of this database, which highlights the relevance of completing a study like this from a Canadian perspective. It has been suggested that users’ evaluations of a database may be favourably affected by familiarity with the database. In the current study, participants reporting prior access to a particular database tended to rank that database higher than participants reporting no prior access to the database. However, this difference was not statistically significant, and, despite 88% of study participants reporting prior access to Micromedex, this database was still clearly the least preferred of the 3 databases.
Some limitations of this study deserve mention. Drug information databases are dynamic products that are improved and regularly updated by their publishers, which makes analyses like this one vulnerable to continuous change. Still, the differences in database quality and usability elucidated in this study are less likely to be affected by regularly scheduled content updates, but rather would require publishers to implement major changes to their editorial policies, bundling of database modules, and database design. The drug information questions used in this study could not represent every type of drug information question that a hospital pharmacist is likely to encounter; thus, repeating the study with a different set of questions might lead to different conclusions. However, we selected a subset of drug information questions from those used by other investigators that covered a broad range of drugs, disease states, and drug information categories. Admittedly, however, this subset excluded content areas such as IV compatibility and toxicology. In addition, our overall conclusions were based on other components, such as the quality indicator criteria, that we believe to be less subjective. We recognize that the availability and usefulness of mobile device versions of these online drug information databases, such as those for use on personal digital assistants (PDAs), are important determinants of users’ preferences. However, a comparison between mobile device versions of the online databases included in this study was beyond the intended scope of analysis. Therefore, only a descriptive summary of the availability of mobile device editions is presented (see Table 1), and readers are invited to consult previously published studies evaluating PDA-based drug information databases. Finally, we acknowledge that acquisition cost is an important factor in database-subscription purchasing decisions. Calculation of the subscription cost for a database is often confidential and can be complex, depending on the platform and modules chosen, the size of the institution (i.e., number of hospital beds), and/or the number of users. Thus, an economic analysis was not included in our comparison of online drug information databases, but should be considered in concert with the findings of this study when making database-subscription purchasing decisions.
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From the perspective of Canadian hospital pharmacists, Lexi-Comp Online is superior to Clinical Pharmacology and Micromedex, on the basis of the database quality and performance criteria evaluated; it also appeared to be the database most preferred by study participants. Clinical Pharmacology compared favourably to Lexi-Comp Online in terms of most of the criteria evaluated in this study, but its usefulness in the authors’ practice setting may be hampered by its lack of Canadian drug information. Micromedex was clearly distinguished as the least preferred database. These findings should be considered in future subscription purchasing decisions by hospital pharmacy departments.