Evaluation of adverse drug reaction formatting in drug information mobile phone applications.

Sean M Mcconachie,Dena Berri,Jewel Konja,Christopher A Giuliano

doi:10.5195/jmla.2022.1251

Abstract

Objective:To evaluate the differences in presentation (formatting) of adverse drug reaction (ADR) information within drug monographs in commonly used drug information (DI) mobile device applications.Methods:A cross-sectional analysis of ADR formatting of twenty commonly prescribed oral medications within seven DI mobile applications was performed. Databases were assessed for ADR information, including presence of placebo comparisons, severity of ADR, onset of ADR, formatting of ADRs in percentile (quantitative) format or qualitative format, whether references were used to cite information, and whether ADRs are grouped by organ system. Data was collected by two study investigators and discrepancies were resolved via consensus.Results:The seven DI mobile applications varied significantly on every analyzed ADR variable with the exception of ADR onset, which was absent in all databases. Significant differences were found for variables known to impact clinical judgment such as placebo comparisons and qualitative versus quantitative formatting. Placebo comparisons were most common among monographs in Lexicomp (30%) but were absent among monographs within other applications. Quantitative information was commonly used in most databases but was absent in Epocrates. Qualitative formatting was present in all Epocrates and Micromedex applications but absent in the majority of other applications. Substantial variations were also found in severity and grouping information.Conclusion:Substantial variation in ADR formatting exists among the most common DI mobile applications. These differences may translate into alternative interpretations of medical information and thus impact clinical judgment. Health care librarians and clinicians should consider ADR formatting when choosing between DI applications.

Highlights

Adverse drug reactions (ADRs), which are defined as noxious and unintended responses to medications at normal doses, are common in clinical practice and contribute substantially to patient morbidity and mortality [1, 2]
Clinical scoring tools such as the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) and Naranjo scores have been developed to standardize the process of causal assessment for ADRs, but discordances often exist between the different scoring tools, and disagreement is common among clinical experts who assess potential ADRs [7, 10, 11]
Significant differences were detected between drug information (DI) mobile applications for each of the analyzed ADR variables (p< 0.01), with the exception of ADR onset information

Summary

Introduction

Adverse drug reactions (ADRs), which are defined as noxious and unintended responses to medications at normal doses, are common in clinical practice and contribute substantially to patient morbidity and mortality [1, 2]. The application of clinical judgment may be troublesome as it is prone to individual subjectivity as well as a number of cognitive biases [8, 9] Clinical scoring tools such as the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) and Naranjo scores have been developed to standardize the process of causal assessment for ADRs, but discordances often exist between the different scoring tools, and disagreement is common among clinical experts who assess potential ADRs [7, 10, 11]. With increasing numbers of medications being approved every year, the potential for new and significant ADRs continues to grow, as does the need for appropriate DI for clinicians who seek to prevent ADRs from occurring. For this reason, DI databases, which contain searchable information from

Methods

Results

Conclusion