临床决策支持工具：个人数字助理与在线膳食补充剂数据库

Clinical decision support tools: personal digital assistant versus online dietary supplement databases.

作者信息

Clauson Kevin A, Polen Hyla H, Peak Amy S, Marsh Wallace A, DiScala Sandra L

机构信息

Pharmacy Practice, College of Pharmacy-West Palm Beach, Nova Southeastern University, Palm Beach Gardens, FL 33410, USA.

出版信息

Ann Pharmacother. 2008 Nov;42(11):1592-9. doi: 10.1345/aph.1L297. Epub 2008 Oct 21.

DOI:10.1345/aph.1L297

PMID:18940918

Abstract

BACKGROUND

Clinical decision support tools (CDSTs) on personal digital assistants (PDAs) and online databases assist healthcare practitioners who make decisions about dietary supplements.

OBJECTIVE

To assess and compare the content of PDA dietary supplement databases and their online counterparts used as CDSTs.

METHODS

A total of 102 question-and-answer pairs were developed within 10 weighted categories of the most clinically relevant aspects of dietary supplement therapy. PDA versions of AltMedDex, Lexi-Natural, Natural Medicines Comprehensive Database, and Natural Standard and their online counterparts were assessed by scope (percent of correct answers present), completeness (3-point scale), ease of use, and a composite score integrating all 3 criteria. Descriptive statistics and inferential statistics, including a chi(2) test, Scheffé's multiple comparison test, McNemar's test, and the Wilcoxon signed rank test were used to analyze data.

RESULTS

The scope scores for PDA databases were: Natural Medicines Comprehensive Database 84.3%, Natural Standard 58.8%, Lexi-Natural 50.0%, and AltMedDex 36.3%, with Natural Medicines Comprehensive Database statistically superior (p < 0.01). Completeness scores were: Natural Medicines Comprehensive Database 78.4%, Natural Standard 51.0%, Lexi-Natural 43.5%, and AltMedDex 29.7%. Lexi-Natural was superior in ease of use (p < 0.01). Composite scores for PDA databases were: Natural Medicines Comprehensive Database 79.3, Natural Standard 53.0, Lexi-Natural 48.0, and AltMedDex 32.5, with Natural Medicines Comprehensive Database superior (p < 0.01). There was no difference between the scope for PDA and online database pairs with Lexi-Natural (50.0% and 53.9%, respectively) or Natural Medicines Comprehensive Database (84.3% and 84.3%, respectively) (p > 0.05), whereas differences existed for AltMedDex (36.3% vs 74.5%, respectively) and Natural Standard (58.8% vs 80.4%, respectively) (p < 0.01). For composite scores, AltMedDex and Natural Standard online were better than their PDA counterparts (p < 0.01).

CONCLUSIONS

Natural Medicines Comprehensive Database achieved significantly higher scope, completeness, and composite scores compared with other dietary supplement PDA CDSTs in this study. There was no difference between the PDA and online databases for Lexi-Natural and Natural Medicines Comprehensive Database, whereas online versions of AltMedDex and Natural Standard were significantly better than their PDA counterparts.

摘要

背景

个人数字助理（PDA）和在线数据库上的临床决策支持工具（CDST）可帮助医疗从业者做出有关膳食补充剂的决策。

目的

评估并比较用作CDST的PDA膳食补充剂数据库及其在线对应数据库的内容。

方法

在膳食补充剂治疗最具临床相关性的10个加权类别中，共制定了102对问答。通过范围（正确答案的百分比）、完整性（3分制）、易用性以及综合这三个标准的综合评分，对AltMedDex、Lexi-Natural、天然药物综合数据库和自然标准的PDA版本及其在线对应版本进行评估。使用描述性统计和推断性统计，包括卡方检验、谢费多重比较检验、麦克尼马尔检验和威尔科克森符号秩检验来分析数据。

结果

PDA数据库的范围得分分别为：天然药物综合数据库84.3%，自然标准58.8%，Lexi-Natural 50.0%，AltMedDex 36.3%，天然药物综合数据库在统计学上更具优势（p < 0.01）。完整性得分分别为：天然药物综合数据库78.4%，自然标准51.0%，Lexi-Natural 43.5%，AltMedDex 29.7%。Lexi-Natural在易用性方面更具优势（p < 0.01）。PDA数据库的综合得分分别为：天然药物综合数据库79.3，自然标准53.0，Lexi-Natural 48.0，AltMedDex 32.5，天然药物综合数据库更具优势（p < 0.01）。Lexi-Natural（分别为50.0%和53.9%）或天然药物综合数据库（分别为84.3%和84.3%）的PDA和在线数据库对的范围之间没有差异（p > 0.05），而AltMedDex（分别为36.3%和74.5%）和自然标准（分别为58.8%和80.4%）存在差异（p < 0.01）。对于综合得分，AltMedDex和自然标准的在线版本优于其PDA对应版本（p < 0.01）。