well-developed telephone intervention and helpline support system in the world—NHS Direct (Caithain et al., 2005). Individuals can call the service and receive advice for a per minute fee; the average call costs £18.00 or roughly US$31.00. In all cases, nurses are the primary health professionals providing telephone intervention and helpline support (Greatbatch et al., 2005). Strict protocols and standards for evaluating consumers’ health needs, along with clinical decision-support software, guide the helpline consultations.

In the United States, consumers receive telephone assistance with questions about their prescription medications by directly contacting their health care provider, local pharmacist, or prescription benefit manager or going to the emergency room. This approach may not be able to meet the growing health demands and information needs and the changing demographics of the U.S. population. Use of all medications has increased tremendously in recent decades, now representing 11 percent of overall health care expenditures (NCHS, 2005). Of these expenditures, ADEs are the largest safety-related cost to the health system. Many of these events are the result of misunderstanding proper use of a drug. There are also enormous gaps in timely access to advice and information about medications, particularly for the 43 million Americans who are uninsured (IOM, 2004b) and those with literacy and language difficulties (IOM, 2004a).

Consumers need quick, easy access to drug information, advice about minor problems, and information on what to do about side effects and adverse reactions for the range of products on the market. The committee believes establishing a national drug information telephone helpline (a “drugline”) could serve this purpose. The drugline would give consumers a third option for obtaining information about proper medication use, complementing paper and online sources they may not be able to access, read, or understand. In particular, establishing the drugline would accelerate the availability of medication assistance to consumers with health literacy, language, and other barriers. However, it will take significant time and funding to expand existing online resources. Building a national drugline similar to that in the United Kingdom would be expensive. In fiscal year 2002– 2003, the cost of the NHS Direct program was £124 million (US$216.6 million). Thus, leveraging the existing health care and public health infrastructure may be the best option for developing the drugline and trimming the overall costs for doing so.

One possibility may be the expansion of poison control centers to include drug safety counseling. Several centers have collaborated with nearby universities and already initiated expansion in this capacity. For example, the Arizona Poison and Drug Information Center operates as part of the University of Arizona, Health Sciences Center, College of Pharmacy, providing accessible poison- and medication-related emergency treatment



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