Drug comparison charts

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					                                                               FP Watch
                                                               Surveillance médicale




                     The Rx Files
Drug comparison charts
Detailed, objective, comparative drug information
Loren Regier, BSP Brent Jensen, BSP Tessa Laubscher, MB CHB, CCFP



T   here is no shortage of drug information, but
    where can you find detailed, objective, compara-
tive, up-to-date Canadian drug information? The
                                                               What is in a chart?
                                                               Charts contain a variety of drug information specific to
                                                               a therapeutic area. This often includes generic names,
RxFiles–Drug Comparison Chart Updates book con-                trade names, dosage forms, dosage strengths (which
tains charts summarizing practical information on              tablets are scored), drug classification, contraindications,
the optimal selection and use of medications.                  renal cautions, side effects, pregnancy categories,
                                                               important drug interactions, comparative information,
                                                               initial and maximum doses, usual doses, and compara-
Putting charts together                                        tive cost. Charts provide tips to individualize therapy
Several clinicians and resources provide informa-              and avoid drug-related problems. The resulting infor-
tion for the comparison charts. At the outset, phy-            mation is detailed and summarized on one page, a for-
sicians provide information and identify current               mat that results in some small print but sets each chart
questions and controversies. In a review of ther-              apart from the others.
apy, program staff sort through original clinical
trials, evidence-based reviews, recent overviews,
and clinical guidelines and sift through information           Standard book and pocket edition
from drug databases (Micromedex, Hansten’s Drug                The standard book of RxFiles–Drug Comparison
Interactions, the American Hospital Formulary                  Chart Updates (September 2004) contains 68 pages
System, Briggs’ Drugs in Pregnancy and Lactation,              of colour-tabbed, indexed, coil-bound summaries
Natural Products Database, and Canadian prod-                  of more than 40 drug therapy areas (Table 1). A
uct monographs). This initial compilation is used              pocket edition is also available for those who wish
to draft outlines that are then revised to incorpo-            to carry the book in their laboratory coats and do
rate both outcome evidence and expert opinion.                 not mind small print. Cost for each book is $45,
Family physicians, specialists, pharmacists, and               with substantial discounts for students, residents,
other health professionals peer review the material            and those ordering many copies (order forms are
before publication.                                            on the website www.RxFiles.ca).

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Table 1. RxFiles comparison chart topics                                     Are charts available for
Asthma                                                                       hand-held computers?
Cardiovascular conditions                                                    Many drug comparison charts are available for
 • Antihypertensive guideline and summary                                    Palm-compatible hand-held computers. Charts are
 • Angiotensin-converting enzyme inhibitors and angiotensin                  offered in either Mobile DB or HanDBase formats.
   receptor blockers                                                         Both formats are searchable and require less than
 • β-Blockers                                                                400 to 800 KB of memory, respectively. In addition
 • Calcium channel blockers                                                  to drug comparison charts, a summary of impor-
 • Diuretics and various antihypertensives                                   tant trials on antihypertensive medications is also
 • Lipid-lowering agents and landmark trials
                                                                             available in Palm format.
 • Oral antiplatelet and antithrombotic agents
Diabetes
 • Hypoglycemics
 • Insulins                                                                  Website and e-mail support
Gastrointestinal conditions                                                  Drug comparison charts and newsletters can be
 • Acid suppression                                                          freely accessed in PDF format at www.RxFiles.ca.
 • Helicobacter pylori eradication                                           An e-mail update service is also available for those
Hormonal conditions                                                          wishing to be notified of new or updated postings.
 • Oral contraceptives
 • Postmenopausal herbal therapy
 • Postmenopausal medical therapy                                            About the program
 • Hypersexuality treatment                                                  RxFiles is an academic detailing program with
 • Androgens                                                                 headquarters at Saskatoon City Hospital. The pro-
Infectious diseases
                                                                             gram was pilot-tested in Saskatoon in 1997 and
 • Oral anti-infectives
                                                                             expanded to serve the province of Saskatchewan
 • Influenza drugs
                                                                             in 2000. The program’s goal is to provide objec-
 • Community-acquired pneumonia
 • Urinary tract infections (among adults)                                   tive and unbiased drug information for promot-
Pain                                                                         ing optimal drug therapy. The RxFiles Newsletter is
 • Back pain                                                                 published three or four times yearly and sent to all
 • Migraine (acute and prophylaxis)                                          Saskatchewan physicians. Additional question-and-
 • Nonsteroidal anti-inflammatory drugs and other analgesics                  answer summaries and comparison charts are pub-
 • Opioids                                                                   lished periodically.
 • Rheumatoid arthritis: disease-modifying antirheumatic drugs                  The hallmark of the program is brief visits to phy-
Psychotropics                                                                sicians’ offices to highlight information and discuss
 • Antidepressants                                                           questions arising from the most recent newsletter
 • Antipsychotics                                                            and chart materials. This interaction enhances the
 • Antianxiety agents
                                                                             value of the materials and ensures that the informa-
 • Benzodiazepines
                                                                             tion uncovered gets into practice. The program has
 • Mood stabilizers
 • Sedatives
                                                                             been well received, as documented by its growth
Extras                                                                       and feedback from physicians. The RxFiles is also
 • Anticonvulsants                                                           involved in other drug information and education
 • Topical corticosteroids                                                   initiatives, such as continuing medical education,
 • Topical treatment for glaucoma                                            student and resident teaching rounds, prescribing
 • Drug interactions with herbal products                                    orientation for new physicians, and collaborative
 • Dementia                                                                  research projects. The RxFiles employs a program
 • Intranasal corticosteroids                                                coordinator, six part-time program pharmacists, and
 • Over-the-counter medications                                              several physician consultants. Although funding is

1688   Canadian Family Physician • Le Médecin de famille canadien d VOL 50: DECEMBER • DÉCEMBRE 2004
                                                                  Surveillance médicale                          FP Watch



provided by Saskatchewan Health, an independent               results are often described as number needed to
program advisory committee that includes several              treat or number needed to harm.
family physicians directs program development.

                                                              Check it out!
Sorting through                                               For more information, visit the website www.
the outcome evidence                                          RxFiles.ca; phone (306) 655-8506; or write RxFiles,
Physicians are looking for outcome evidence to                Saskatoon City Hospital, 701 Queen St, Saskatoon,
make drug therapy decisions; results can be spun              SK S7K 0M7.
different ways, however, especially in product mar-
keting. Several additional materials have been
designed to help sort through evidence in poten-              Mr Regier is a pharmacist at Saskatoon City Hospital
tially controversial areas. These materials contain           and Program Coordinator for the RxFiles Academic
interesting observations and summaries of trials              Detailing Program in Saskatchewan. Mr Jensen is a
related to antihypertensives, antihyperlipidemics,            pharmacist at Saskatoon City Hospital and Information
antithrombotics, and hormone replacement ther-                Specialist with the RxFiles Academic Detailing Program
apy. These summaries emphasize key findings,                  in Saskatchewan. Ms Laubscher is a Saskatoon family
limitations, clinical considerations, and absolute            physician and Assistant Medical Director of Northern
differences in both beneficial and harmful effects.              Medical Services, University of Saskatchewan. She serves
To quantify the risk versus benefit of therapy,               as physician advisor to the RxFiles.
                                                        ...




                                   VOL 50: DECEMBER • DÉCEMBRE 2004 d Canadian Family Physician • Le Médecin de famille canadien   1689