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To assess the content of dietary supplement databases used for clinical decision support. Four online dietary supplement databases were assessed according to scope, completeness, and ease of use. Additionally, a composite score integrating all 3 criteria was determined. One hundred two question-and-answer pairs were developed and distributed among 10 weighted categories dealing with the most clinically relevant aspects of dietary supplement therapy. Descriptive and inferential statistics were used to summarize the evaluation components and to compare databases. Chi-square was used to investigate differences in scope scores. Scheffe's multiple comparison procedure was used to determine statistical differences in completeness and ease of use. The percentage of questions that each database answered successfully were as follows: Natural Medicines Comprehensive Database, 84.3%; Natural Standard, 80.4%; AltMedDex, 74.5%; and Lexi-Natural Products, 53.9%, indicating 2 statistical groupings (P< .05) in which the first 3 databases performed significantly better than Lexi-Natural. Completeness scores were similarly stratified. Ease-of-use scores were Natural Standard, 1.96; Natural Medicines Comprehensive Database, 2.00; Lexi-Natural, 2.02; and AltMedDex, 2.50. Composite scores indicating overall performance were Natural Medicines Comprehensive Database, 81.5%; Natural Standard, 76.9%; AltMedDex, 71.6%; and Lexi-Natural, 50.7%. Many clinicians may be unprepared to deal with patient-related dietary supplement questions; therefore, clinical decision support tools that address this knowledge gap are needed. There was significant heterogeneity in the content of dietary supplement-focused online databases, with clustering in the top tier.

DISCUSSION

This study evaluated the content of 4 dietary supplementfocused clinical decision support tools according to scope, completeness, and ease of use. To the authors' knowledge, it represents the first published systematic study of the full online content of these 4 databases-including the first objective evaluation of the online version of Natural Standard. The largest number of questions and broadest range of categories to date were also used in determining the best content in these databases.

The best performer based on the composite score, which integrated all 3 components, was NMCD. NMCD also had the best mean score for scope and achieved or tied for the top score for the most answers provided in 6 of the 10 question categories. While NMCD also had the highest mean score for completeness, NS and AMD actually earned or tied for the top score for the most complete answers in 6 of the 10 individual categories compared to NMCD, which had the best score or tied for best score for only 4 categories.

It should also be noted that none of the databases were able to answer all of the questions posed, showing that all databases have room for improvement. The best performer, NMCD, was unable to answer 16% of the questions. NS was unable to answer 20% of the questions. AMD did not provide information for almost 1 out of every 4 questions. LN was incapable of providing information almost half of the time. Additionally, while there were significant differences in completeness, even the best score earned was still missing more than 20% of the possible points.

While strides have been made in adding CAM instruction to the curriculum for HCPs, many goals have yet to be reached.16-18 Integrating CAM therapies and modalities as a required element of healthcare education could assist in training new HCPs entering into practice. Additionally, mandatory continuing education credits in the area of dietary supplements could help ensure the education of practicing HCPs. More funding for clinical trials studying the efficacy of dietary supplements is also necessary to assist HCPs in making informed, evidence-based decisions. As long as knowledge of CAM therapies such as dietary supplements remains below ideal levels in HCPs, clinical decision support tools offer a viable method to help address knowledge gaps and supplement patient care.6