Lexicomp Online/Micromedex 2.0

Abstract

Lexicomp Lexicomp contains over 25 items, including 6 sources of monographs on prescription and over-the-counter drugs, 2 books on international monographs, and single books focusing on herbal monographs, patient education for adult and pediatric populations, pregnancy and lactation, toxicology, drug allergies, lab and diagnostic tests, and pharmacogenomics. Micromedex 2.0 Micromedex 2.0 includes more than thirty items of drug information, including three books of over-thecounter and prescription drug monographs (one focused on pediatric and neonatal patients); one herbal monograph source; books focusing on pregnancy and lactation, poisoning or toxicology, laboratory tests, evidence-based information on diseases, and new drugs and drugs in development; the Physician's Desk Reference; RED BOOK (drug pricing); patient care handouts; and interactive tools including twenty clinical calculators, oral or topical drug interactions, intravenous compatibility, and pill identification.

Lexicomp Online. Wolters Kluwer Health, Two Commerce Square, 2001 Market Street, Philadelphia PA 19103; http://www.lexi.com. Various pricing options for individuals, academic institutions, and businesses; contact vendor for pricing.

Micromedex 2.0. Truven Health Analytics, 777 East Eisenhower Parkway, Ann Arbor, MI 48108; http://micromedex.com. Various pricing options for individuals, academic institutions, and businesses; contact vendor for pricing.

Comparative review of Micromedex 2.0 and Lexicomp

This reviewer will discuss the features of Lexicomp and Micromedex 2.0, two popular packages of highquality and reliable drug information. Given my experiences, I focus on academic use and do not discuss mobile apps, although these packages can be licensed for clinical use and mobile apps including portions of the content from each package are available. A ''package'' of drug information combines multiple tertiary information items such as reference books, handbooks, and interactive tools; librarians select specific items to license from the options available in a package. Listing names and descriptions of all items that are available in these two packages would take several pages and would soon be irrelevant as new items are frequently added. When considering a product, I recommend obtaining current lists of items from publishers, then using Drug Information: A Guide to Current Resources [1] to understand the content of each item and the Basic Resources for Pharmacy Education [2] list or similar lists for other disciplines to evaluate the relevance of each item to academic programs that the library supports.

Lexicomp

Lexicomp contains over 25 items, including 6 sources of monographs on prescription and over-the-counter drugs, 2 books on international monographs, and single books focusing on herbal monographs, patient education for adult and pediatric populations, pregnancy and lactation, toxicology, drug allergies, lab and diagnostic tests, and pharmacogenomics. Interactive tools include a pill identifier, oral and topical drug interaction tool, more than 100 clinical calculators, and 2 intravenous-drug interactions tools.

Lexicomp's editorial team produces some items, while other items are licensed from other publishers, resulting in some duplication of information. For example, American Society of Health-System Pharmacists Essentials and Lexidrugs are created by separate publishers but provide similar brief drug monographs, and there are two intravenous-drug interactions tools from two publishers. This duplication is useful, however, as pharmacy information experts recommend that pharmacists examine several items from different publishers when responding to drug information queries [3, 4].

Lexicomp's unique aspects support broad education on the safe use of drugs. The Lexidrugs book includes audio pronunciation of generic drug names and links to freely available guidelines covering related topics (e.g., links are placed to the Infectious Diseases Society of America's guidelines on skin infections in the monograph for an antibiotic). There are extensive monographs produced by Lexicomp's editorial team for geriatric and neonatal/ pediatric populations, which are not well-covered elsewhere. Pharmacogenomics-variation in drug response based on genetic makeup- is an emerging research area. Lexicomp's Pharmacogenomics book is detailed and frequently updated. It summarizes the research on this area to help novices understand the reasoning behind clinical choices.

Lexicomp's single search box can be filtered to search in all text in the package or in eleven specific categories (uses, adverse reactions, contraindications, warnings, etc.). This filtering permits a quick search to answer questions such as ''What drugs cause adverse effect X?'' or ''In the United States, what drugs are approved to treat disease Y?'' In addition to searching, the Explore feature permits browsing through books and access to introductory information such as indexes, information on editorial boards, authors, and methods and frequency of updates. It is extremely difficult to access this information in Micromedex, and reading this information is helpful for assessing reliability of items. A User Guide, Training Videos, and a Quick Start Guide are easily accessible from the main search screen.

Micromedex 2.0

Micromedex 2.0 includes more than thirty items of drug information, including three books of over-thecounter and prescription drug monographs (one focused on pediatric and neonatal patients); one herbal monograph source; books focusing on pregnancy and lactation, poisoning or toxicology, laboratory tests, evidence-based information on diseases, and new drugs and drugs in development; the Physician's Desk Reference; RED BOOK (drug pricing); patient care handouts; and interactive tools including twenty clinical calculators, oral or topical drug interactions, intravenous compatibility, and pill identification. Micromedex's editorial team creates some items, while others are licensed from outside publishers. Micromedex includes less duplication than Lexicomp does. Instead, Micromedex offers a summary item that provides brief information on a drug or topic and a comprehensive item that provides in-depth information: for example, ToxPoints provides guidance for managing an emerging poisoning event and POISONDEX provides long-term management and research evidence on the mechanism of poisoning.

Micromedex's unique features include comparative materials developed by their editorial team, innovative display, and deep linking between items. The DRUGDEX book provides continually updated evidence on the relative efficacy of two drugs for the same condition; this literature is difficult to find, so these summaries are valuable. The ''drug tools'' feature permits two drug monographs to be displayed sideby-side, which is a simple idea, yet no other drug information package provides this feature. Contextual linking helps users access related information easily. For example, a reader finds a link to patient care handouts in the patient education section of a drug monograph and a link to an international list of trade names in a drug monograph on drug names. Similar deep links can be found throughout other content. These efforts to help readers understand the place of drugs in a larger context and discover additional information showcase Micromedex's commitment to providing evidence.

The Micromedex interface is a single search screen with access to interactive tools across a top bar. The search box can be altered to search only items that focus on drugs, diseases, or toxicology. If the user does not focus a search this way, the search results display can be confusing, and novices to drug information can be overwhelmed by the amount of information that is presented when searching Micromedex. The results are split into two sections. The top half of the page includes links to the items that best match the search, which are reordered based on the search query and relevance of specific items. The bottom half of the page includes search results from every item contained in a subscription, even when only tenuously relevant (e.g., a search for the antibiotic amoxicillin results in about 500 hits, and 150 of those hits lead to drug monographs for other antibiotics that use the word amoxicillin once, but provide no substantial information on amoxicillin). Micromedex's search box is also able to parse specific short phrases and keywords: for example, typing ''drugs that cause (name of adverse effect)'' leads to a list of drugs with that adverse effect, and typing ''REMS'' provides a list of drugs that include federally required Risk Evaluation and Mitigation Strategies. A recent redesign of the home page includes quick links to frequently used sources like drug class monographs, patient counseling materials, comparative tables, pharmaceutical and drugrelated news, and links to the searchable knowledgebase, training center, and live and recorded video training.

Conclusion

Both packages include high-quality items and are useful for teaching access to and use of drug information. Lexicomp focuses on depth and duplication of information, which provides a better training environment for learning to use and compare multiple sources of drug information. Search results are displayed in a simple list where items are always in the same order. However, moving between items can be difficult, as few links are available between items. It is easier to access information like the publisher, update date, and complete descriptions of content for the items included in the package. These features make it more suitable for training novices.

Micromedex 2.0 focuses on breadth andevidence-basedcomparisons.The search box itself is easy to use, but the search result display is complex, and items are not always presented in the same order. It is very difficult to access information about the content, update schedule, and authors of individual books. Micromedex focuses more on helping the user access and use drug information to make evidence-based decisions, making it a more appealing package for individuals with a more sophisticated understanding of drug information.

Acknowledgments

Trial access to the complete package of Micromedex 2.0 was provided by Truven Health Analytics. All products and the content within are E2014 TRUVEN HEALTH ANALYTICS INC. Trial access to the complete package of Lexicomp was provided by Wolters Kluwer Health.

References

References

1. Snow B. Drug information: a guide to current resources. 3rd ed. New York, NY: Neil-Schuman Publishers; 2008.

2. Library and Information Sciences Section of the American Association of Colleges of Pharmacy. Basic resources for pharmacy education [Internet]. Alexandria, VA: The Association; 2013 [rev. Jun 2014; cited 20 Nov 2014]. ,http:// www.aacp.org/governance/SECTIONS/ libraryinformationscience/Pages/Library InformationScienceSpecialProjectsand Information.aspx..

3. Malone PM, Kier KL, Stanovich JE, Malone MJ. Drug information: a guide for pharmacists. 5th ed. New York, NY: McGraw-Hill Medical; 2014.

4. Gaebelein CJ, Gleason BL. Contemporary drug information: an evidencebased approach. Baltimore, MD: Lippincott Williams & Wilkins; 2008.

DOI: http://dx.doi.org/10.3163/1536-5050 .103.2.016