Information is the best medicine: Aligning clinical and medication decisions

Quality care requires reliable clinical content easily accessible to caregivers and patients

While providers, pharmacists, and patients have different but related needs for clinical and medication information, each of these needs and perspectives can be satisfied with complementary, comprehensive solutions grounded in a unified editorial source.

• Physicians need quick access to the latest clinical information. Standards of care and protocols are always evolving. With UpToDate, clinicians gain access to current evaluation and diagnostic information, as well as data about adult and pediatric dosing, IV compatibility, and renal dosing to make informed diagnostic and therapy decisions. UpToDate® Lexidrug™ provides complementary information on adverse events, alternative agents for when a patient is allergic to a drug, and alternative use profiles to consider or avoid.
• Pharmacists require easy access to in-depth, current medication information. Pharmacists must consult and synthesize drug data quickly. Medi-Span provides comprehensive drug descriptive data, including therapeutic classification and pricing information. Pharmacists can then turn to Lexidrug to find answers to complex patient questions. Unlike other pharmacology references, the in-depth information in Lexidrug is aligned with what physicians see in UpToDate clinical decision support — saving time, reducing confusion, and potentially preventing dangerous medication errors. Using Medi-Span and UpToDate Lexidrug allows providers to integrate pharmacists more deeply into the care team while meeting the broad information needs of clinicians and patients.
• Patients’ varying needs dictate different information requirements. The sickest patients require that physicians and pharmacists communicate more information about their conditions and care decisions, and medication, particularly if they have complicated comorbidities, see many clinicians, and take medications that may interact. Even people with few and well-controlled conditions benefit from coordinated communication among doctors, nurses, and pharmacists. Using UpToDate clinical information, Medi-Span medication information with drug reference data in UpToDate Lexidrug ensures that patients have the information they need. The education leaflets in Lexidrug come from the same source that pharmacists refer to daily, while information in UpToDate® Patient Engagement education resources explains diagnoses and treatments in understandable terms.

Integrated information resources benefit all stakeholders in the continuum of care by improving decision-making and workflow, and with them clinician and patient experiences. Information in complementary solutions such as UpToDate, Medi-Span and Lexidrug is updated automatically without requiring IT action. This support delivers accuracy, reliability, and consistency, and increases efficient information retrieval.

Simplified, coordinated information: The best medicine for common clinical scenarios

Medical science and clinical guidance change quickly, requiring recent medical school graduates as well as highly experienced medical professionals to consult external resources to develop and deliver high-quality care plans. Complementary, comprehensive clinical and medication information resources such as UpToDate, Medi-Span, and UpToDate Lexidrug put current information at clinicians’ fingertips, supporting the best care decisions and patient outcomes. Information in UpToDate Patient Engagement solutions is updated continually, ensuring that the clinical team and patient remain aligned.

Scenario 1: Nursing mothers

A new mother with Type II diabetes makes a postpartum visit after a cesarean section. She has been taking diabetes medication and acetaminophen with codeine for postpartum pain. Her infant sleeps for more hours during the day than she expected. Are the medications causing this? Are they safe alone or in combination? She’s been looking this up online. Now she’s panicked. What should she do?

In the lactation section of Lexidrug, her physician finds a thorough review of studies relevant to drug safety in breastfeeding mothers. In addition, with access through Lexidrug to content from Gerald G. Briggs’ authoritative guide to drugs in pregnancy and lactation, the physician can adjust the medications and answer the patient’s questions.

With easy access to Briggs content via Lexidrug and the EHR, providers need not purchase a separate book or a Briggs-only online resource. This saves time and ensures they are consulting the best resource to care for new mothers and infants.

Scenario 2: Alternative medications

A patient with unipolar major depression heard that St. John’s wort, an alternative, over-the-counter medicine derived from a flower, may alleviate symptoms of depression. During a visit with her primary-care clinician, she asks about taking St. John’s wort in addition to her antidepressant, citalopram, a selective serotonin reuptake inhibitor.

Her doctor reads about St. John’s wort in UpToDate and learns it has some efficacy in treating depression. The doctor is prompted to access Lexidrug and finds that St. John’s wort should not be used with citalopram. The combination can result in a serotonin syndrome, a potentially life-threatening condition. The doctor informs the patient of the interaction and possible side effects. She is relieved that she inquired before taking the alternative medication.

The extensive natural products database of unbiased, referenced reviews within UpToDate Lexidrug includes history, chemistry, pharmacology, uses, abuses, and toxicities information that providers need to make the right decisions.

Scenario 3: Side effects and adverse drug events

A patient with a cancer diagnosis presents with bone pain. He is on multiple medications, many of which he is taking for the first time. The initial evaluation finds no bone metastases or any other etiology of the pain.

Using the Adverse Drug Report available only in Lexidrug, the physician quickly generates a list of medications known to cause bone pain. He determines that pegfilgrastim, a granulocyte colony stimulating factor, is a potential cause. He then searches UpToDate and finds information on management of pegfilgrastim-related bone pain.

Scenario 4: Drug interactions

A woman has chronic pain unresponsive to non-opiate medications. Her primary-care physician is managing her case well with an opiate. The patient has no red flags for misuse of drugs, yet as part of her routine management, a drug screen returns a positive reading for amphetamine.

The physician and patient discuss the fact that she started on bupropion since her last drug screen. It could be why her test came up positive. The monograph in Lexidrug confirms that bupropion is known to generate false positive results to amphetamine—critical information not included in many other drug resources.

Scenario 5: Off-label indications

A patient complains of severely decreased libido after starting citalopram for depression. The clinician confirms that decreased libido is a potential side effect. The patient also complains of recurring severe tension headaches.

From the citalopram monograph in Lexidrug, the clinician locates an in-depth table comparing antidepressant adverse effects and finds that mirtazapine is not associated with sexual side effects. The clinician also learns that mirtazapine is used off-label to prevent tension headaches, with links to supporting professional guidelines. This information enables quick identification of an alternative drug to treat the patient’s depression without the sexual side effect.

IT leaders are partners in delivering comprehensive, simplified clinical decision support

Healthcare is an information-rich environment, and IT teams play a critical role in helping clinical team members obtain and use information they need. Selecting which information and decision support resources to integrate has both clinical and financial implications. The best decisions are grounded in trusted, comprehensive clinical and medication information. The UpToDate and Medi-Span solution suites provide physicians, nurse practitioners, nurses, and pharmacists with quick access to current clinical and medication information from a single, trusted source. Especially now, as turnover and staffing shortages among healthcare employees grow, relying on effective, efficient, and easy-to-use technology solutions is more critical than ever. Trusted, coordinated information is the best medicine. IT teams can help ensure that the patient journey from diagnosis to treatment and recovery is supported at every phase.

Learn more about clinical decision support solutions from Wolters Kluwer Health and contact us if you’d like to align clinical decisions for better care.

The following experts from our editorial team contributed to this report: Sandy Falk, MD, Director, Editorial Relations; Steven P. Hart, MD, Director of Content, Clinical Informatics; Ted W. Post, MD, Editor-in-Chief, Clinical Effectiveness; Steve Stout, PharmD, MS, Director, Clinical Content; Elizabeth A. Tomsik, PharmD, BCPS, Senior Director; Reference Drug Content; David M. Weinstein, RPh, PhD, Senior Director, Clinical Content; Jennifer Mitty, MD, Deputy Editor, Infectious Diseases.