NLM LACT Final Report Solomon Solutions [email protected] Voice 201.434.0404 Mobile: 917.601.1273 ©2005 Solomon

NLM LACT Final Report

Solomon [email protected]

Voice 201.434.0404Mobile: 917.601.1273

www.Solomon-Solutions.com©2005 Solomon Solutions

Qualitative Research Studyon

LACT

Prepared for:

November 30, 2005

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©2005 Solomon Solutions

I. Background

II. Study Objectives

III. Methodology: Online Focus Group

IV. Summary Conclusions

V. Overall Findings: LACT

VI. Recommendations

VII. Appendix

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Background

As part of an ongoing qualitative evaluation of NLM websites, the National Library of Medicine conducted one online focus group on LACT – Drugs and Lactation – a database of information on the use of prescription drugs during lactation.

This qualitative study had as its objective understanding the value, usefulness, strengths, and weaknesses of the proposed database for potential users of the site (physicians, community health professionals, lactation consultants, and nursing mother.).

The online focus group on the LACT proposed database was conducted on November 21, 2005.

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I. Background





VI. Recommendations

VII. Appendix

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Study Objectives

The main objective of this qualitative study on LACT was to evaluate the value and usefulness to potential users of a database that addresses how pharmaceutical medications impact lactation. Additional objectives included:

Gauging the strengths and weaknesses of the content

Gaining feedback on additional content users would like to see

Understanding how users anticipate using the database

Getting reactions to the database name (LACT)

Target respondents. Screening parameters for respondents were as follows:

Mix of potential users

Employed as professionals in the healthcare professions related to nursing and lactation, as well as lactation consultants, nursing mothers and representatives of La Leche League

Recruited from a listserv subscriptions within the lactation community

All were asked to spend approximately 15-20 minutes viewing/navigating the password-protected database and completing three brief tasks prior to the discussion.

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I. Background





VI. Recommendations

VII. Appendix

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Methodology: Online Focus Group*

Testing consisted of ONE online focus group of professionals (and some non-professionals) in the lactation community.

Respondents were recruited via listserv subscription, including (among others) La Leche League.

The session lasted approximately 90 minutes and was comprised of 11 participants. (See Appendix.)

The group was asked to visit LACT and given a user name and password prior to the session. They were also asked to complete a series of tasks using the database.

All participants received an incentive payment of $45.

* The online focus group represents a qualitative methodology used for the purposes of ideation, brainstorming, and evaluation. Qualitative methodologies are based on a small sample size, and the findings are intended to be directional only, not projectable to the larger population.

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I. Background





VI. Recommendations

VII. Appendix

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Summary Conclusions

Impressions of LACT

Reactions to LACT were generally positive.

Respondents liked the idea of a database that will address the needs of the lactation community with regard to medications and other factors that impact nursing moms.

The majority of respondents had little difficulty navigating or searching for information.

Areas for improvement were primarily related to the completeness of content (i.e., not complete enough), specifics about the drug or medication listed, and the page layout on a drug result page.

Respondents noted that they would like to see the content expanded beyond pharmaceutical medications, possibly to herbs, vitamins, and even nutrition.

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Summary Conclusions (cont’d.)

Strengths and Weaknesses: LACT

Strengths of the LACT database were its generally easy search functionality and useful information.

Weaknesses of the database included a lack of complete information in some areas, the absence of brand or trade names for the medications, and the absence of certain medications they expected to find (e.g., Methotrexate).

Also mentioned was a need for a "more orderly" layout on the drug result page.

Several respondents used "Hale's book" as a reference point from which to compare LACT, which emerged somewhat lacking in content and detail.

Additionally, inclusion of links to the AAP, CBI (Center for Breastfeeding Information), and LLLI (La Leche League) were recommended.

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Summary Conclusions (cont’d.)

LACT

There was high anticipation for usage of LACT, as well as a strong expectation that they would recommend the database to colleagues and others in the lactation community.

The name LACT was mildly received, though suggested alternatives included MedLact and LactRX.

Also recommended was a "peer review" that would validate information in the database, though credibility and reliability were already perceived as high.

Following are additional findings from the online focus group testing on LACT.

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I. Background





VI. Recommendations

VII. Appendix

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Overall Findings: LACT

Current information gathering practices

"Hale's book" (Medications and Mothers' Milk: A Manual of Lactational Pharmacology by Thomas Hale, Ph.D.) was the resource most frequently mentioned as a way of getting information related to pharmaceutical medication and lactation.

Subsequently, "Hale's site" was also mentioned frequently as a resource.

Additional resources cited for getting information on lactation and medication (both online and traditional) included ePocrates, kellymom.com, Lactnet, La Leche League (LLLI), Micromedex, USPDI, and PubMed.

Some respondents also rely on google.com to conduct searches on specific topics.

Specifically, users seek information on drug safety as it relates to lactation, drug concentration in the mother, fat solubility, clinical studies and side effects, and some information on non-prescription drugs as well.

The majority of respondents reported that they seek information on breastfeeding, as well as specifically on nursing mothers, and even more specifically on nutrition related to lactation.

Non-prescription topics of interest included herbs, illegal drugs, diet pills, glue, paint, amphetamines, and vitamins.

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Challenges in Finding Information

The challenges encountered in finding useful information included reports of "not enough" information, or information that is missing important details.

Respondents reported that they handle these challenges by presenting the data that IS available and extrapolate from it. In other cases, their need to find information goes unmet.

"data is usually lacking or sparse.” (Daniel) "data is usually lacking or sparse.” (Daniel)

“There simply isn't enough research and what is there is often contradictory. Also the PDR that cautions every drug for breastfeeding mothers and the FDA website

which follows closely without references or clinical/research citations.” (Cathy)

“There simply isn't enough research and what is there is often contradictory. Also the PDR that cautions every drug for breastfeeding mothers and the FDA website

which follows closely without references or clinical/research citations.” (Cathy)

“I give mothers a copy of the information I have and suggest they discuss with their HCP.” (Mary)

“I give mothers a copy of the information I have and suggest they discuss with their HCP.” (Mary)

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Impressions of LACT

Initial reactions to LACT, based on pre-discussion review of the database, were generally positive, and users were particularly pleased that a useful database would be available to them.

Strengths of the LACT database, based on initial impressions, were that it was "easy to search" (though one respondent disagreed), "useful," and impressive.

“Overall I found the monographs useful and complete and objective.” (Sharon) “Overall I found the monographs useful and complete and objective.” (Sharon)

"Impressed! it seems to contain the published data & studies … I think that it is significant advance- it’s similar to a Hale online and then some.” (Daniel)

"Impressed! it seems to contain the published data & studies … I think that it is significant advance- it’s similar to a Hale online and then some.” (Daniel)

"I was impressed that each entry I found actually had more references and was more detailed than Hale. I was really excited. it just wasn't nearly as complete as Hale, because it mostly did prescription drugs (although I did find Aspirin).” (Melissa)

"I was impressed that each entry I found actually had more references and was more detailed than Hale. I was really excited. it just wasn't nearly as complete as Hale, because it mostly did prescription drugs (although I did find Aspirin).” (Melissa)

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LACT Weaknesses and Areas for Improvement

Respondents encountered several challenges, however. Some had difficulty finding complete information, such as brand names and certain medications.

One respondent felt that the information on LACT did not compare favorably to the information provided by the Hale book and site.

"no Hale information, which is quite useful … the L1-L5 rating, theoretic infant dose, his charts of T1/2 PHL PK MW Vd etc … maybe a summary of what the drug is, what it

is used for, common side effects.” (Cathy)

"no Hale information, which is quite useful … the L1-L5 rating, theoretic infant dose, his charts of T1/2 PHL PK MW Vd etc … maybe a summary of what the drug is, what it

is used for, common side effects.” (Cathy)

“You need to add ALL the trade names to each drug listing main page … Methotrexate was not there.” (Nancy)

“You need to add ALL the trade names to each drug listing main page … Methotrexate was not there.” (Nancy)

“It was easy to search except that in the real world many physicians use brand names and the database did not reference those completely. There were

significant drugs missing like metronidazole.” (Sharon)

“It was easy to search except that in the real world many physicians use brand names and the database did not reference those completely. There were

significant drugs missing like metronidazole.” (Sharon)

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LACT Weaknesses and Areas for Improvement (cont'd.)

There were a few comments on the layout, unrelated to content.

Also related to layout was a recommendation that an abstract or summary (currently showing up at the bottom of the page) be presented at the top of each drug result page.

“… I'd set left hand column/tool bar a little more narrow...” (Anna) “… I'd set left hand column/tool bar a little more narrow...” (Anna)

“I would have liked to have seen an orderly layout identifying the drug, common name for recognition then maybe list something about what it's used for and how it's metabolized.

After that, the information from the research would be logical from my clinical perspective. After that the safety summary and then the other rating pieces that were there.” (Nanette)

“I would have liked to have seen an orderly layout identifying the drug, common name for recognition then maybe list something about what it's used for and how it's metabolized.

After that, the information from the research would be logical from my clinical perspective. After that the safety summary and then the other rating pieces that were there.” (Nanette)

“… I strongly STRONGLY recommend that the summary statement be on the top. If lay people are reading this, they may read about one adverse event and freak out. Everyone

doesn't have to know about every little study.” (Melissa)

“… I strongly STRONGLY recommend that the summary statement be on the top. If lay people are reading this, they may read about one adverse event and freak out. Everyone

doesn't have to know about every little study.” (Melissa)

“The ‘browse’ feature was somewhat confusing -- there was a point in the search where there were boxes to check, but no ‘search’ button, but then I realized that

the names were hot-links that would send me to the page.” (Margaret)

“The ‘browse’ feature was somewhat confusing -- there was a point in the search where there were boxes to check, but no ‘search’ button, but then I realized that

the names were hot-links that would send me to the page.” (Margaret)

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Target Audience

Some respondents questioned whether the database would be exclusively for a professional audience or for the general public. The target was not entirely clear, based on their own usage of the database.

Respondents did, however, agree that it could benefit professionals and non-professionals alike, though one questioned whether it should be available to non-professionals.

"My understanding is that this is meant for health care professionals and completeness is an asset." (Sharon)

"My understanding is that this is meant for health care professionals and completeness is an asset." (Sharon)

“if non professionals will be using it, maybe a page about how aspects affect - milk/plasma, half life, peak, oral bioavailabiltiy, etc... ” (Anna)

“if non professionals will be using it, maybe a page about how aspects affect - milk/plasma, half life, peak, oral bioavailabiltiy, etc... ” (Anna)

“It is targeted/ oriented MORE towards professionals who can interpret medical studies" (Daniel)

“It is targeted/ oriented MORE towards professionals who can interpret medical studies" (Daniel)

“I think anyone can benefit from it. I think most lay people who would use it would probably be the types to use the information with prudence and guidance." (Anna)

“I think anyone can benefit from it. I think most lay people who would use it would probably be the types to use the information with prudence and guidance." (Anna)

“This kind of a database can be a problem in a lay person's hands. It's a lot of information and there are never any promises; even with amoxicillin." (Nanette)

“This kind of a database can be a problem in a lay person's hands. It's a lot of information and there are never any promises; even with amoxicillin." (Nanette)

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Content Development

Respondents suggested expanding content with over-the-counter medications, as well as anything that would circumvent the need to use a variety of other resources.

“As an office clinician with an EMR, I am looking for ‘one stop shopping’ a place to go that has everything as I don't have time to go to one resource then reference a second or a third. I need as much information as I can get at one place." (Nanette)

“As an office clinician with an EMR, I am looking for ‘one stop shopping’ a place to go that has everything as I don't have time to go to one resource then reference a second or a third. I need as much information as I can get at one place." (Nanette)

“Industrial chemicals are problems and over the counters would be a good expansion. I find radioisotope exposures very difficult to answer since there are so many variables.” (Sharon)

“Industrial chemicals are problems and over the counters would be a good expansion. I find radioisotope exposures very difficult to answer since there are so many variables.” (Sharon)

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Searching and Navigation

Not all expectations were met when it came to searching. Several respondents needed more information to round out the picture. Offering features such as a browsing capacity and printable formats (easy to share) would benefit users in this capacity.

On the other hand, the database was perceived as a highly reliable, credible, and accurate resource.

"sometimes a mom calls with incomplete drug name and I don't know which one she is talking about so a alphabetical browse feature would be helpful." (Mary)

"sometimes a mom calls with incomplete drug name and I don't know which one she is talking about so a alphabetical browse feature would be helpful." (Mary)

"Yes, reliable and accurate. And nothing's perfect. It's still worth saying that lexapro is better than celexa-- just have to caution lay people using this. Mom can switch to lexapro." (Melissa)

"Yes, reliable and accurate. And nothing's perfect. It's still worth saying that lexapro is better than celexa-- just have to caution lay people using this. Mom can switch to lexapro." (Melissa)

“not as comprehensive and not organized in a way to share easily with a mother." (Cathy)

“not as comprehensive and not organized in a way to share easily with a mother." (Cathy)

"I would definitely use this as a reliable resource and recommend it for other health care providers." (Sharon)

"I would definitely use this as a reliable resource and recommend it for other health care providers." (Sharon)

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Currency/Updates

The issue of how frequently the database would be updated emerged, with respondents preferring updates every three months minimum.

"Like any other database updates should be continuous with some way to track the last date of update." (Sharon)

"Like any other database updates should be continuous with some way to track the last date of update." (Sharon)

“I would say every 3 months (journals are out every month) so new information can be added on as soon as possible." (Molika)

“I would say every 3 months (journals are out every month) so new information can be added on as soon as possible." (Molika)

"I think there needs to be a date of when it was updated." (Mary)"I think there needs to be a date of when it was updated." (Mary)

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Database Name: LACT

The name LACT alone did not resonate with this group. Many suggested alternative names, such as "LACTrx," "LactMed," and "MedLact."

“OK, MedLact? www.Medlact.gov." (Melissa) “OK, MedLact? www.Medlact.gov." (Melissa)

“LACT just says breastfeeding to me. How about LACTRx?" (Daniel)“LACT just says breastfeeding to me. How about LACTRx?" (Daniel)

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Peer Review

Respondents stated that the ideal peer review for LACT would include physicians (pediatricians, internists), nurses, pharmacists, and other health professionals in the lactation community.

Some also suggested a collaboration with CBI (Center for Breastfeeding Information).

"Ideal peer review would include ABM members, IBCLCs and LLL Leaders.” (Cathy)

"Ideal peer review would include ABM members, IBCLCs and LLL Leaders.” (Cathy)

“Yes, since this isn't a money-making endeavor, could something be done to collaborate with Hale or the CBI -- that's a good resource.” (Margaret)

“Yes, since this isn't a money-making endeavor, could something be done to collaborate with Hale or the CBI -- that's a good resource.” (Margaret)

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Other Issues

The idea of a "teaching module" within the database did not resonate significantly with this group of respondents.

Peer review was an important element in the database.

Also important was the necessity to maintain the database as a free resource, whether to professionals, non-professionals, or both.

The inclusion of photographs of pills in the database was a very low priority and not generally perceived as a necessity (or particularly relevant) to respondents.

Links, on the other hand, were perceived as highly relevant and useful elements to include in the database.

Most respondents expected to find LACT via links on Google, LactNet, AAP, and other related sites.

There was high anticipation for using LACT in the future when it becomes available.

Following is a series of recommendations that emerged from the results of this online focus group.

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I. Background





VI. Recommendations

VII. Appendix

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Recommendations

A few recommendations that emerged from this focus group included the following:

Expand content to include details on each medication listed (e.g., drug safety, clinical trials, side effects, etc.).

Include over-the-counter medications, as well as pharmaceuticals, if possible.

Redesign the results page layout in such a way that a summary or abstract precedes the rest of the detail on the page.

Also include non-medication items, such as glue and other inhalants, herbs, vitamins, and some foods.

Clarify the "aim" of the site (i.e., target audience). If non-professionals are included, create content that is easily searchable and accessible, using "lay" language throughout the database.

Link to other relevant sites, such as CBI (Center for Breastfeeding Information) or LLL (La Leche League) to increase exposure and include the non-professional lactation community.

Following is a respondent profile of participants in this online focus group.

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I. Background





VI. Recommendations

VII. Appendix: Respondent Profile

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Appendix: Respondent Profile

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Appendix: Respondent Profile - LACT

# Name Gender City, State Occupation

1 Anna F Sebring, FL Nursing student

2 Cathy F College Station, TX

IBCLC, Research associate

3 Daniel M Bronx, NY Neonatologist

4 Margaret F Silver Spring, MD Lactation consultant

5 Mary F Antioch, CA La Leche League leader

6 Melissa F Massachusetts Internist, Massachusetts Breastfeeding Coalition

7 Molika F Melbourne, Australia

Pharmacist

8 Nancy F San Diego, CA Neonatologist

9 Nanette F Hillsboro, OR Private pediatrics and lactation

10 Sharon F Rochester, NY Clinical pharmacist, National Lactation Study Center

11 Susan F Fairview, NC Perinatal support specialist

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Contact:

Mary Beth Solomon

For inquiries and capabilities on

Qualitative Analytics

201.434.0404917.601.1273

Contact:

Mary Beth Solomon

For inquiries and capabilities on

Qualitative Analytics

201.434.0404917.601.1273

Documents

NLM LACT Final Report Solomon Solutions [email protected] Voice 201.434.0404 Mobile: 917.601.1273 ©2005 Solomon