By Daniel B. Hier, MD, MBA, FAAN
Medication safety is a serious issue in the United States. It is estimated that:
Medication errors and adverse drug events are common. A 2006 Institute of Medicine report, "Preventing Medication Errors," estimates that at least 1,500,000 preventable adverse drug events (ADEs) occur annually in the US (380,000 in hospitals, 800,000 in long-term facilities, and 530,000 in the outpatient setting). Some common drug safety issues include:
Helping our patients understand their medications better is an important patient education goal. During office visits, time is often at a premium, so it you may find it useful to refer your patients to one of two free Internet drug safety sites, MedNotes and iGuard. Although both sites are free, they differ somewhat in how they are funded and what information they provide patients.
When visiting these sites, patients can do the following:
MedNotes is a free drug safety website supported by Drugs.com. MedNotes receives support through advertising from pharmacies, pharmaceutical companies, and other drug-related businesses. The site, run by the Drugsite Trust from New Zealand, is a privately held trust administered by two pharmacists.
The site allows patients to track both illnesses and medications. For each drug, MedNotes offers information about efficacy, indications, and side effects. Patients can receive email alerts regarding new developments affecting both their illnesses and medications. Knowledge content at MedNotes comes from the Physicians' Desk Reference (PDR), Wolters Kluwer Health, Cerner Multum, and Thomson Micromedex. The site also has a medical dictionary from Steadmans and a medical encyclopedia from A.D.A.M., Inc. Email alerts come from the FDA, online news services, and industry press releases. The site allows each patient to print out a handy summary of their diagnoses and medications. Patients can link their account at MedNotes to their personal health record (PHR) at Google Health.
iGuard was launched in 2007 by a foundation investment by Quintiles Transnational (a drug research support company) and is supported by website sponsors including Microsoft® HealthVault™, SDI Health/Verispan, Laboratory Corporation of America, Kerr Drug, Allscripts, and several other health related entities (view the complete list of sponsors). There is no advertising. The website indicates that, in the future, revenue will come from reselling information about drug use, drug safety, and side effects collected from registered patients at the website.
Knowledge content on this website is derived from a proprietary database generated by pharmacists employed by iGuard. Similar to MedNotes, registered patients record their disorders and medications. The website identifies any drug-disease or drug-drug interactions. Patients can research the efficacy, indications, and side effects of their medications. The website collects patient comments regarding both efficacy and side effects, then shares them with registered patients. The site also provides links to Wikipedia (view example, on "Fish Oil" page) and the FDA guides to medications. Registered patients get email alerts specific to their medications regarding FDA alerts, pharmaceutical company press releases, and relevant citations from the medical literature.
iGuard provides useful information regarding the number of patients tracked taking each medication, any safety alerts, patient reports on why they are taking each medication, black box warnings, pregnancy warnings, and lactation warnings. There is a patient blog where patients can add comments on their experience with each drug and read other patients' comments. The account at iGuard can be synchronized with a personal health record (PHR) at Microsoft® HealthVault™.
Neurologists can refer patients to two drug safety websites to improve drug safety. These websites inform patients about actions, side effects, and risks of their medications. In addition, when patients register, they can print out a useful list of medications, be warned about drug-drug interactions, and keep informed by email of drug recalls or new drug warnings.
Dr. Hier presented some of this material for this article at the Patient Safety Colloquium at the 2009 AAN Annual Meeting in Seattle. Dr. Hier serves as Education Editor for AAN.com and is Director of Physician Practice for the Neuroscience Center of the University of Illinois at Chicago. He has received compensation for work as an expert witness in medical legal cases. Within the last 24 months, he has received compensation as a physician editor for the Neurology edition of MDnetguide.