Background
Methods
Approach
Step 1: Selecting eligible online resources
Step 2: Assessing online resource content quality
Step 3: Analysis of DISCERN results
Results
Search results (Fig. 1 )
Findings from eligible articles
References | Article title | Study country | Study design | Article type |
---|---|---|---|---|
Allais et al. [8] | Access to databases in complementary medicine | Italy | Review of medical information resource(s) | Review |
Archer et al. [24] | Development of an alert system to detect drug interactions with herbal supplements using medical record data | USA | Development of alert system prototype | Original Research |
Boddy et al. [25] | Review of reliable information sources related to integrative oncology | UK | Review of medical information resource(s) | Review |
Boehmer et al. [26] | Evaluating the value of a web-based natural medicine clinical decision tool at an academic medical center | USA | Evaluation of web-based clinical decision tool | Original Research |
Clauson et al. [27] | Clinical decision support tools: Personal digital assistant versus online dietary supplement databases | USA | Review and evaluation of databases and personal digital assistants | Review |
Faubert et al. [28] | A pilot study to compare natural health product-drug interactions in two databases in Canada | Canada | Evaluation of databases | Original Research |
Fischer et al. [29] | Complementary and alternative medical reference software for personal digital assistants: Evidence of clinical applicability | USA | Evaluation of databases | Original Research |
Fitzpatrick et al. [30] | Natural standard database | USA | Review of medical information resource(s) | Review |
Gregory et al. [31] | Characterization of complementary and alternative medicine-related consultations in an academic drug information service | USA | Analysis of complementary and alternative medicine drug information consultations | Original Research |
Jackson [9] | An overview of information resources for herbal medicinals and dietary supplements | USA | Review of medical information resource(s) | Review |
Jackson et al. [10] | Resources for information on herbal medicinals and dietary supplements | USA | Review of medical information resource(s) | Review |
Kiefer et al. [12] | Finding information on herbal therapy: A guide to useful sources for clinicians | USA | Review of medical information resource(s) | Review |
Meyer et al. [13] | Evaluation of herbal-drug interaction data in tertiary resources | USA | Review of medical information resource(s) | Review |
Molassiotis et al. [32] | Quality and safety issues of web-based information about herbal medicines in the treatment of cancer | China, UK | Review of medical information resource(s) | Review |
Motl et al. [11] | Health information web sites by therapeutic category for healthcare professionals | USA | Review of medical information resource(s) | Review |
Sun et al. [34] | Development of quantitative structure–activity relationship models to predict potential nephrotoxic ingredients in traditional chinese medicines | China | Development and testing of model | Original Research |
Spanakis et al. [33] | PharmActa: Empowering patients to avoid clinical significant drug-herb interactions | Greece | Evaluation of mobile app | Original Research |
Sweet et al. [14] | Usefulness of herbal and dietary supplement references | USA | Review of medical information resource(s) | Review |
Tomasulo [35] | Natural Standard–new integrative medicine database | USA | Review of medical information resource(s) | Review |
Walker et al. [36] | Evaluation of the ability of seven herbal resources to answer questions about herbal products asked in drug information centers | USA | Evaluation of databases | Original Research |
Yap et al. [37] | Utilizing mobile networks for the detection of clinically relevant interactions between chemotherapy regimens and complementary and alternative medicines | Singapore | Development of an iPhone app | Original Research |
Online resource characteristics
Name of online resource | Source eligible article(s) included in review | Online resource URL | Year established | Availability for anyone to use? | Type of developer | CAM only or CAM/conventional therapies? | How are CAM-specific adverse effects and side effects presented? |
---|---|---|---|---|---|---|---|
About Herbs | Unclear | Yes, entirely free | Researchers | CAM only | Drug summaries (Professional and consumer versions) | ||
American Botanical Council | 1988 | Yes, partially without subscription | Council | CAM only | Monographs | ||
Caremark Drug Interactions | Yap et al. [37] | Unclear | Yes, entirely free | Company | Both | Drug interaction checker | |
Clinical Pharmacology (also known as Gold Standard) | Gregory et al. [31] | Unclear | Yes, but only with a subscription | Company | Both | Drug interaction checker; monographs | |
Drug Information (formerly DrugDigest) | Motl et al. [11] | Unclear | Yes, entirely free | Company | Both | Drug summaries | |
Drug Product Database | Motl et al. [11] | Unclear | Yes, entirely free | Government | Both | Monographs; safety update tables | |
Drugs.com | 2001 | Yes, entirely free | Company | Both | Drug interaction checker; monographs (professional and consumer versions) | ||
Electronic Medicines Compendium | Motl et al. [11] | 1999 | Yes, entirely free | Company | Both | SmPC; patient leaflets; alert cards | |
Epocrates (plus or pro) | Unclear | Yes, but only with a subscription | Company | Both | Drug interaction checker; monographs | ||
Herb-Drug Interactions, NCCIH Clinical Digest | 2015 | Yes, entirely free | Government | CAM only | Summaries provided in an herbal digest | ||
Herbs at a Glance | Unclear | Yes, entirely free | Government | CAM only | Fact sheets | ||
HIV drug interactions | Motl et al. [11] | 1999 | Yes, entirely free | Researchers | Both | Drug interaction checker; interaction charts | |
IBM Micromedex (includes DrugDex, Drug-Reax, AltMedDex) | Mid-1970s | Yes, but only with a subscription | Company | Both | Drug interaction checker; monographs; patient fact sheets | ||
Lexi-Natural (includes LexiComp) | Unclear | Yes, but only with a subscription | Company | Both | Monographs; patient handouts | ||
MedicinesComplete (includes Herbal Medicines; formerly known as the British National Formulary) | Unclear | Yes, but only with a subscription | Company | Both | Monographs | ||
Medscape | 1995 | Yes, entirely free | Company | Both | Drug interaction checker; monographs | ||
Merck Manual | Motl et al. [11] | 1999 | Yes, entirely free | Company | Both | Drug interaction checker; monographs (professional and consumer versions) | |
National Cancer Institute | Boddy et al. [25] | Unclear | Yes, entirely free | Government | CAM only | Drug summaries (professional and consumer versions) | |
Natural Medicines (formerly Natural Medicine Comprehensive Database (NMCD) and Natural Standard Database (NSD)) (online and mobile app) | Archer et al. [24]; Boddy et al. [25]; Boehmer et al. [26]; Clauson et al. [27]; Faubert et al. [28]; Fischer et al. [29]; Fitzpatrick [30]; Gregory et al. [31]; Jackson et al. [10]; Kiefer et al. [12]; Motl et al. [11]; Sun et al. [34]; Sweet et al. [14]; Tomasulo [35]; Walker [36]; Yap et al. [37] | Early 2000s | Yes, but only with a subscription | Company | CAM only | Drug interaction checker; monographs; patient handouts | |
OncoRx Database (called Onco-Rx as a website, and OncoRx-MI as a mobile app) | Yap et al. [37] | 2007 (website), unclear (mobile app) | Yes, but only with a subscription | Researchers | Both | Drug interaction checker | |
PEPID Drug Information Database | Unclear | Yes, but only with a subscription | Company | Both | Drug interaction checker; patient education handouts; monographs | ||
RxList (owned by WebMD) | 1995 | Yes, entirely free | Company | Both | Monographs | ||
RxMed | Motl et al. [11] | 1994 | Yes, entirely free | Company | Both | Monographs |
Summaries of included online resources
About Herbs
American Botanical Council
Caremark Drug Interactions
Clinical Pharmacology (through Clinical Key)
Drug Information (formerly DrugDigest)
Drug Product Database
Drugs.com
Electronic Medicines Compendium
Epocrates (Plus or pro)
Herb-Drug Interactions, NCCIH Clinical Digest
Herbs at a Glance
HIV Drug Interactions
IBM Micromedex (includes DrugDex, Drug-Reax, AltMedDex)
Lexi-Natural (includes LexiComp)
MedicinesComplete (includes Herbal Medicines; formerly known as the British National Formulary)
Medscape
Merck Manual
National Cancer Institute
Natural Medicines (formerly Natural Medicine Comprehensive Database (NMCD) and Natural Standard Database (NSD))
OncoRx Database
PEPID Drug Information Database
RxList (owned by WebMD)
RxMed
DISCERN Instrument Ratings
DISCERN Question | About Herbs | American Botanical Council | Caremark Drug Inter-actions | Drug Infor-mation | Drug Product Database | Drugs.com | Electronic Medicines Compendium | Herbs at a Glance | Herb-Drug Inter-actions | HIV drug Inter-actions | Lexi-Natural | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Section 1: Is the publication reliable? | 1. Are the aims clear? | 5 | 5 | 5 | 1 | 4.5 | 5 | 3 | 5 | 5 | 5 | 5 |
2. Does it achieve its aims? | 5 | 5 | 5 | 1 | 3 | 5 | 3.5 | 5 | 5 | 5 | 5 | |
3. Is it relevant? | 4.5 | 5 | 4.5 | 2.5 | 3 | 5 | 5 | 4.5 | 3.5 | 4 | 5 | |
4. Is it clear what sources of information were used to compile the publication (other than the author or producer)? | 5 | 5 | 1 | 2 | 3.5 | 4.5 | 1.5 | 4.5 | 5 | 2.5 | 5 | |
5. Is it clear when the information used or reported in the publication was produced? | 5 | 5 | 2.5 | 2 | 5 | 5 | 5 | 5 | 5 | 2.5 | 5 | |
6. Is it balanced and unbiased? | 5 | 5 | 2.5 | 3 | 4.5 | 5 | 4 | 5 | 5 | 3.5 | 5 | |
7. Does it provide details of additional sources of support and information? | 4.5 | 5 | 1 | 1 | 4.5 | 5 | 2.5 | 5 | 5 | 2.5 | 5 | |
8. Does it refer to areas of uncertainty? | 5 | 5 | 3.5 | 3.5 | 5 | 5 | 3.5 | 5 | 5 | 5 | 5 | |
Section 2: How good is the quality of information on treatment choices? | 9. Does it describe how each treatment works? | 5 | 5 | 3 | 2.5 | 3 | 5 | 5 | 1.5 | 2.5 | 2 | 4 |
10. Does it describe the benefits of each treatment? | 5 | 4.5 | 2 | 2.5 | 3 | 4.5 | 5 | 4.5 | 5 | 1 | 5 | |
11. Does it describe the risks of each treatment? | 5 | 4.5 | 5 | 2.5 | 3 | 5 | 5 | 4.5 | 5 | 4 | 5 | |
12. Does it describe what would happen if no treatment is used? | 1 | 1 | 1 | 1 | 1.5 | 1 | 1 | 1 | 1 | 1 | 1 | |
13. Does it describe how the treatment choices affect overall quality of life? | 1 | 2.5 | 2 | 3 | 2.5 | 3 | 2.5 | 1.5 | 1.5 | 1 | 2 | |
14. Is it clear that there may be more than one possible treatment choice? | 1.5 | 3.5 | 1 | 1.5 | 2 | 4.5 | 4 | 4 | 2.5 | 3 | 2.5 | |
15. Does it provide support for shared decision-making? | 3.5 | 2.5 | 3.5 | 4 | 2 | 4 | 3 | 4 | 2 | 1 | 4 | |
Section 3: Overall Rating of the Publication | 16. Based on the answers to all of the above questions, rate the overall quality of the publication as a source of information about treatment choices | 4 | 4 | 2 | 3 | 3 | 4.5 | 3.5 | 4 | 3.5 | 3 | 4.5 |
Total DISCERN score (sum of Q1–15) | 61.00 | 63.50 | 42.50 | 33.0 | 50.00 | 66.50 | 53.50 | 60.00 | 58.00 | 43.00 | 66.50 |
DISCERN Question | Med-scape | Merck Manual | Micro-medex | National Cancer Institute | Natural Medicines | PEPID Drug Information Database | RxList | Rx-Med | Mean score | SD | |
---|---|---|---|---|---|---|---|---|---|---|---|
Section 1: Is the publication reliable? | 1. Are the aims clear? | 5 | 4.5 | 5 | 5 | 5 | 4.5 | 4.5 | 5 | 4.58 | 0.99 |
2. Does it achieve its aims? | 5 | 5 | 5 | 5 | 5 | 5 | 5 | 4.5 | 4.58 | 1.03 | |
3. Is it relevant? | 4.5 | 5 | 5 | 5 | 5 | 4 | 5 | 4 | 4.42 | 0.75 | |
4. Is it clear what sources of information were used to compile the publication (other than the author or producer)? | 1 | 4 | 4 | 5 | 4 | 2.5 | 4 | 2.5 | 3.50 | 1.41 | |
5. Is it clear when the information used or reported in the publication was produced? | 1 | 5 | 4 | 5 | 5 | 2.5 | 5 | 2 | 4.03 | 1.41 | |
6. Is it balanced and unbiased? | 4.5 | 5 | 5 | 5 | 5 | 2.5 | 5 | 3 | 4.34 | 0.94 | |
7. Does it provide details of additional sources of support and information? | 1 | 5 | 5 | 5 | 5 | 1.5 | 5 | 1.5 | 3.68 | 1.71 | |
8. Does it refer to areas of uncertainty? | 5 | 4.5 | 4.5 | 5 | 5 | 4 | 5 | 3.5 | 4.58 | 0.63 | |
Section 2: How good is the quality of information on treatment choices? | 9. Does it describe how each treatment works? | 5 | 4 | 5 | 5 | 5 | 5 | 5 | 5 | 4.08 | 1.24 |
10. Does it describe the benefits of each treatment? | 5 | 5 | 4.5 | 5 | 5 | 5 | 5 | 5 | 4.29 | 1.22 | |
11. Does it describe the risks of each treatment? | 5 | 5 | 5 | 5 | 5 | 5 | 5 | 5 | 4.66 | 0.73 | |
12. Does it describe what would happen if no treatment is used? | 1 | 4 | 2.5 | 1 | 1 | 1 | 1.5 | 1 | 1.29 | 0.75 | |
13. Does it describe how the treatment choices affect overall quality of life? | 1 | 3.5 | 5 | 2 | 1 | 1 | 1 | 1 | 2.00 | 1.09 | |
14. Is it clear that there may be more than one possible treatment choice? | 1.5 | 5 | 4.5 | 2.5 | 5 | 2 | 3 | 3 | 2.97 | 1.25 | |
15. Does it provide support for shared decision-making? | 1 | 3 | 4.5 | 5 | 4 | 4 | 3 | 1.5 | 3.13 | 1.18 | |
Section 3: Overall Rating of the Publication | 16. Based on the answers to all of the above questions, rate the overall quality of the publication as a source of information about treatment choices | 3 | 4.5 | 5 | 4.5 | 4.5 | 3 | 3.5 | 3 | 3.68 | 0.79 |
Total DISCERN score (sum of Q1–15) | 46.50 | 67.50 | 68.50 | 65.50 | 65.00 | 49.50 | 62.00 | 47.50 | 56.13 | 10.25 |