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Enhancing Clinical Evidence and Search Practices for Better Patient Care

Jon Brassey shares frustrations with current evidence practices and proposes enhancements for robust clinical answers. Highlights issues with evidence quality, search paradigms, and information relevance. Recommends a shift towards prioritizing practical utility over methodological purity. Advocates for improved search tools, collaboration with clinicians, and tailored information delivery to meet their needs effectively.

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Enhancing Clinical Evidence and Search Practices for Better Patient Care

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  1. What frustrates me about evidence and what changes I'd like to see! Jon Brassey, TRIP Database

  2. Background • Worked in information support for over ten years • Started in primary care Q&A - answered over 10,000 clinical questions • Developed the TRIP Database –searched over 50 million times • Main interest – getting robust answers to clinicians queries!

  3. Why am I annoyed? • Evidence is not focussed on supporting clinical practice. For me this can be broken down into: • Problems with the evidence • Problems with search

  4. Problems with evidence • Frequently doesn’t answer clinical questions • Methodological purity seems more important than clinical usefulness

  5. Analysis of dermatology questions • 357 Q&As analysed • How many questions were answered by systematic reviews? • >50% • 25-49% • 10-24% • <10%

  6. Analysis of dermatology questions • Only 3 questions answered by a SR! • 63% therapy, 9% diagnosis, 9% etiology • 20% answered using secondary evidence alone • Not much focus, DUETs aside, at feeding in coal-face information needs with production of evidence

  7. Evidence Updates • Run by Brian Haynes at McMaster via funding from the BMJ • Examine 120 core clinical journals and rate them on: • Quality • Relevance • Newsworthiness • Overall >95% rejected

  8. Problems with search • 100 clinicians • Pain • NHS Evidence

  9. Problems with search – 100 • Information seeking defined by the Google generation • Ask 100 clinicians the support they’d want, how many would say – ‘Give me a search box where I add terms and then return 10 results which I need to read in the hope that they will answer my question’.

  10. Problems with search – pain Pain

  11. Problems with search – NHSE • Nearly £25 million budget • Around £15 million on non-content, including £730,000 marketing • 385,000 searches per month or 4,620,000 annually (excludes CKS and SLs/SCs) • >£3 per search • TRIP Database < 1p

  12. Summary of problems • Evidence not fit for purpose • Not findable • Usefulness medical information = (relevance x validity)/ work (Slawson & Shaughnessy)

  13. Solutions – better evidence • Build on the work of DUETs and create a system to record clinical uncertainty • Better understand the clinical information needs of ‘normal’ clinicians • Better prioritisation of SRs and primary research • Less is more

  14. Solutions – improve search • Work with clinicians and throw away the existing search paradigm • Work better with the search intentions • Break down full-text • Be ambitious and not be constrained by the Google ‘mentality’.

  15. TRIP’s experiments • TILT – http://tilt.tripdatabase.com • Shared learning tool • Clinicians record their learning • Snippets of applicable evidence • Blitter – http://blitter.tripdatabase.com • Curated list of clinicians that blog or tweet • Index of content clinicians feel are noteworthy • Clinicians added based on speciality

  16. Ultimately... • Need to give clinicians the: • The information they need • In the format they need • In the timeframe they need • To me answering their questions is vastly superior to what we currently have

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