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Accuracy of PoC Resources to Answer Clinical Questions

Accuracy of PoC Resources to Answer Clinical Questions

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Accuracy of PoC Resources to Answer Clinical Questions

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  1. Accuracy of PoC Resources to Answer Clinical Questions Ann McKibbon MLS PhD Associate Professor Clinical Epidemiology & Biostatistics McMaster University mckib@mcmaster.ca

  2. POC Information Resources Tremendous need for them Already used heavily Traditionally thought of as being • Positive • Neutral Problems with content (itself or its application) Problems with use (system or user) We need to address the challenges • Complexities • Their possible dark side

  3. Information Needs in Practice External information is vital in healthcare Numbers consistent over time, countries, disciplines, settings, training levels Clinic setting • Covell et al 1985 0.7 need/patient • Ramos et al 2003 0.8 need/patient Hospital setting • Osheroff et al 1991 15/patient/day • Currie et al 2003 11/hour with EMRs (range 1 – 25)

  4. Clinicians use electronic resources during patient care time • 89% of them believe that electronic systems improve care • 75% of questions were answered

  5. Finding Time Recognizing needs Complexities Resources Marketing/packaging Systems Move to simpler ones Inability of resources to provide answers Trust of producers & systems Interpreting Time Recognizing needs Formulating questions Synthesizing evidence Coming up with the answer Matching evidence with clinical situation and patient Application Trust of producers & systems Problems with Information

  6. Seeking Information Most use external resources • People/peers • Electronic information resources • Non electronic resources Half of questions are pursued • 40% evidence found easily • 30% evidence found with difficulty • 30% evidence not found

  7. Time to Find MEDLINE Use Times per Search • 43 minutes in Oregon • 24 minutes in Iowa • 23 minutes in Hamilton Non MEDLINE times (e.g., PIER, UptoDate, CE, Google) • range of 3 to 7 minutes Sackett and Straus: On wards, resources will not be used if search time is > 30 seconds

  8. Size MEDLINE 17,000,000 Version control Cochrane reviews Clinical practice guidelines Multiplicity of resources Numbers and kinds Packaging of systems Data itself Complexities of Systems

  9. Complexity of Systems Clinicians often use systems poorly: Scenario: Is PSA (prostate-specific antigen) a better biochemical predictor than alkaline phosphatase for detecting recurrent prostate cancer? Approach: OVID MEDLINE prostate cancer (18K citations) reads for 5 minutes quits provides answer

  10. Whole content Cochrane Collaboration Database vendor (Wiley) PUBMED OVID MEDLINE EBMR Cochrane Library EBMR Full Text EBMR All InfoRetriever Google Scholar Partial content ACP Journal Club Evidence Based Medicine Evidence Based Nursing InfoPOEMs OVID—EBMR ACP J Club Clinical Evidence Google Evidence-Based Guidelines … Abstracts or full text? Free or pay? Packaging—Cochrane Reviews

  11. Inability to Get Correct Answers From Peers • Dutch study (Schaffsma) of 14 physicians • Asked peers for answers to 12 questions • 47% correct

  12. Inability to Get Correct Answers From Peers • Dutch study (Schaffsma) of 14 physicians • Asked peers for answers to 12 questions • 47% correct • If evidence provided 83% correct • If evidence not available 35% correct

  13. Inability to Get Correct Answers From Electronic Information Resources Medical, NP students: 45% right to 77% right Australian GPs: 29% right to 50% right McKibbon study: 39% right to 42% right

  14. Inability to Get Correct Answers From Electronic Information Resources Medical, NP students: 45% to 77% 12% right  wrong Australian GPs: 29% to 50% 7% right  wrong McKibbon Study: 39% to 42% 11% right  wrong

  15. Providing Answers—EKGs Electrocardiogram with computer interpretation 30 Internal Medicine residents (year 2 or 3) Accuracy • Without e-interpretation of data 48.9% • With e-interpretation of data 55.4%

  16. Providing Answers—EKGs Electrocardiogram with computer interpretation 30 Internal Medicine Residents (year 2 or 3) Accuracy • Without e-interpretation of data 48.9% • With e-interpretation of data 55.4% • If e-interpretration correct 68.1% • If e-interpretation wrong 48.3%

  17. Trust • Producers of information trusted • WHO technical document • Trust of technology • Social conformity • Less vigilance • Diffusion of responsibility • Belief in infallibility of technology

  18. Summary Good systems exist although… …systems that provide • right answer • to right question • at the right time • in the right format • with little or no effort • May not be here yet • But we are getting closer…