scholarly journals Clinician-selected Electronic Information Resources do not Guarantee Accuracy in Answering Primary Care Physicians' Information Needs

2008 ◽  
Vol 3 (1) ◽  
pp. 78
Author(s):  
Martha Ingrid Preddie
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Care Physicians ◽  
Information Needs ◽  
The United States ◽  
Information Resources ◽  
Evidence Based ◽  
Electronic Information ◽  
Electronic Information Resources ◽  
Clinical Questions

A review of: McKibbon, K. Ann, and Douglas B. Fridsma. “Effectiveness of Clinician-selected Electronic Information Resources for Answering Primary Care Physicians’ Information Needs.” Journal of the American Medical Informatics Association 13.6 (2006): 653-9. Objective – To determine if electronic information resources selected by primary care physicians improve their ability to answer simulated clinical questions. Design – An observational study utilizing hour-long interviews and think-aloud protocols. Setting – The offices and clinics of primary care physicians in Canada and the United States. Subjects – 25 primary care physicians of whom 4 were women, 17 were from Canada, 22 were family physicians, and 24 were board certified. Methods – Participants provided responses to 23 multiple-choice questions. Each physician then chose two questions and looked for the answers utilizing information resources of their own choice. The search processes, chosen resources and search times were noted. These were analyzed along with data on the accuracy of the answers and certainties related to the answer to each clinical question prior to the search. Main results – Twenty-three physicians sought answers to 46 simulated clinical questions. Utilizing only electronic information resources, physicians spent a mean of 13.0 (SD 5.5) minutes searching for answers to the questions, an average of 7.3 (SD 4.0) minutes for the first question and 5.8 (SD 2.2) minutes to answer the second question. On average, 1.8 resources were utilized per question. Resources that summarized information, such as the Cochrane Database of Systematic Reviews, UpToDate and Clinical Evidence, were favored 39.2% of the time, MEDLINE (Ovid and PubMed) 35.7%, and Internet resources including Google 22.6%. Almost 50% of the search and retrieval strategies were keyword-based, while MeSH, subheadings and limiting were used less frequently. On average, before searching physicians answered 10 of 23 (43.5%) questions accurately. For questions that were searched using clinician-selected electronic resources, 18 (39.1%) of the 46 answers were accurate before searching, while 19 (42.1%) were accurate after searching. The difference of one correct answer was due to the answers from 5 (10.9%) questions changing from correct to incorrect, while the answers to 6 questions (13.0%) changed from incorrect to correct. The ability to provide correct answers differed among the various resources. Google and Cochrane provided the correct answers about 50% of the time while PubMed, Ovid MEDLINE, UpToDate, Ovid Evidence Based Medicine Reviews and InfoPOEMs were more likely to be associated with incorrect answers. Physicians also seemed unable to determine when they needed to search for information in order to make an accurate decision. Conclusion – Clinician-selected electronic information resources did not guarantee accuracy in the answers provided to simulated clinical questions. At times the use of these resources caused physicians to change self-determined correct answers to incorrect ones. The authors state that this was possibly due to factors such as poor choice of resources, ineffective search strategies, time constraints and automation bias. Library and information practitioners have an important role to play in identifying and advocating for appropriate information resources to be integrated into the electronic medical record systems provided by health care institutions to ensure evidence based health care delivery.

scholarly journals Patient-Care Questions that Physicians Are Unable to Answer

2007 ◽  
Vol 14 (4) ◽  
pp. 407-414 ◽  
Author(s):  
John W. Ely ◽  
Jerome A. Osheroff ◽  
Saverio M. Maviglia ◽  
Marcy E. Rosenbaum
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
Primary Care Physicians ◽  
Clinical Information ◽  
Clinical Findings ◽  
Information Resources ◽  
Clinical Information Systems ◽  
Unanswered Question ◽  
Test Results ◽  
Clinical Questions

Abstract Objective: To describe the characteristics of unanswered clinical questions and propose interventions that could improve the chance of finding answers. Design: In a previous study, investigators observed primary care physicians in their offices and recorded questions that arose during patient care. Questions that were pursued by the physician, but remained unanswered, were grouped into generic types. In the present study, investigators attempted to answer these questions and developed recommendations aimed at improving the success rate of finding answers. Measurements: Frequency of unanswered question types and recommendations to increase the chance of finding answers. Results: In an earlier study, 48 physicians asked 1062 questions during 192 half-day office observations. Physicians could not find answers to 237 (41%) of the 585 questions they pursued. The present study grouped the unanswered questions into 19 generic types. Three types accounted for 128 (54%) of the unanswered questions: (1) “Undiagnosed finding” questions asked about the management of abnormal clinical findings, such as symptoms, signs, and test results (What is the approach to finding X?); (2) “Conditional” questions contained qualifying conditions that were appended to otherwise simple questions (What is the management of X, given Y? where “given Y” is the qualifying condition that makes the question difficult.); and (3) “Compound” questions asked about the association between two highly specific elements (Can X cause Y?). The study identified strategies to improve clinical information retrieval, listed below. Conclusion: To improve the chance of finding answers, physicians should change their search strategies by rephrasing their questions and searching more clinically oriented resources. Authors of clinical information resources should anticipate questions that may arise in practice, and clinical information systems should provide clearer and more explicit answers.

scholarly journals Health Care Professionals� Clinical Perspectives on Glycemic Control and Satisfaction With a New Blood Glucose Meter With a Color Range Indicator: Online Evaluation in India, Russia, China, and the United States (Preprint)

2017 ◽  
Author(s):  
Mike Grady ◽  
Laurence Barry Katz ◽  
Pamela Anderson ◽  
Brian Leonard Levy
Keyword(s):  
United States ◽  
Primary Care ◽  
Health Care ◽  
Blood Glucose ◽  
Health Care Professionals ◽  
Primary Care Physicians ◽  
The United States ◽  
Color Features ◽  
Glucose Meter ◽  
Diabetes Educators

BACKGROUND We previously demonstrated in patients with diabetes that displaying blood glucose results in association with color improved their ability to interpret glucose results. OBJECTIVE The objective of this study was to investigate the perceptions of health care professionals (HCPs) in specific countries about the value of color on a new glucose meter and to determine if HCP perspectives among countries differ on the value of this approach in clinical practice. METHODS A total of 180 HCPs, including 105 endocrinologists, 34 primary care physicians, 25 diabetes educators, and 16 pharmacists, were recruited from India (n=50), Russia (n=50), China (n=50), and the United States (n=30). These HCPs experienced the OneTouch Select Plus Simple glucose meter online from their own office computer using interactive demonstrations (webpages, meter simulator, and video clips). After providing demographic and current clinical practice insights, HCPs responded to questions about the utility of the color-enhanced glucose meter. RESULTS Mean age and years in their current professional role for the 180 HCPs was 41.3 (SD 8.1) and 13.3 (SD 6.8) years for endocrinologists, 41.3 (SD 8.3) and 14.1 (SD 6.8) years for primary care physicians, 37.5 (SD 8.7) and 12.7 (SD 6.8) years for diabetes educators, and 35.9 (SD 5.3) and 9.5 (SD 5.2) years for pharmacists. In all, 88% (44/50) of Russian and 83% (25/30) of American HCPs said their patients find it easy to recognize low, in-range, or high blood glucose results compared to 56% (28/50) of HCPs in China and 42% (21/50) in India. Regardless of country, HCPs had less confidence that their patients act on blood glucose results with 52% (26/50) in Russia, 63% (19/30) in the United States, 60% (30/50) in China, and 40% (20/50) in India responding positively. During the interactive online meter experience, HCPs from all countries responded positively to questions about a meter with color features. After reflecting on the value of this meter, most HCPs strongly agreed or agreed their patients would be more inclined to act on results using a meter with color features (Russia: 92%, 46/50; United States: 70%, 21/30; China: 98%, 49/50; India: 94%, 47/50). They also said that color was particularly useful for patients with lower numeracy or education who may struggle with interpreting results (Russia: 98%, 49/50; United States: 77%, 23/30; China: 100%, 50/50; India: 82%, 41/50). CONCLUSIONS This multicountry online study provides evidence that HCPs had high overall satisfaction with the OneTouch Select Plus glucose meter, which uses color-coded information to assist patients with interpreting blood glucose results. This may be especially helpful in patient populations with low numeracy or literacy and limited access to health care and direct interaction with HCPs.

scholarly journals Diagnoses, Drugs, and Treatment Are the Main Information Needs of Primary Care Physicians and Nurses, and the Internet Is the Information Source Most Commonly Used to Meet These Needs

2014 ◽  
Vol 9 (3) ◽  
pp. 107 ◽  
Author(s):  
Carol Perryman
Keyword(s):  
Primary Care ◽  
Literature Review ◽  
Information Seeking ◽  
Primary Care Physicians ◽  
Information Needs ◽  
Bibliographic Databases ◽  
The Internet ◽  
Evidence Based ◽  
Advantages And Disadvantages ◽  
Information Seeking Behaviour

A Review of: Clarke, M. A., Belden, J. L., Koopman, R. J., Steege, L. M., Moore, J. L., Canfield, S. M., & Kim, M. S. (2013). Information needs and information-seeking behaviour analysis of primary care physicians and nurses: A literature review. Health Information & Libraries Journal, 30(3), 178-190. http://dx.doi.org/10.1111/hir.12036 Abstract Objective – To improve information support services to health practitioners making clinical decisions by reviewing the literature on the information needs and information seeking behaviours of primary care physicians and nurses. Within this larger objective, specific questions were 1) information sources used; 2) differences between the two groups; and 3) barriers to searching for both groups. Design – Literature review. Setting – SCOPUS, CINAHL, OVID Medline, and PubMed databases. Subjects – Results from structured searches in four bibliographic databases on the information needs of primary care physicians and nurses. Methods – Medical Subject Heading (MeSH) and keyword search strategies tailored to each of four databases were employed to retrieve items pertinent to research objectives. Concepts represented in either controlled or natural language vocabularies included “information seeking behaviour, primary health care, primary care physicians and nurses” (p. 180). An initial yield of 1169 items was filtered by language (English only), pertinence to study objectives, publication dates (2000-2012), and study participant age (>18). After filtering, 47 articles were examined and summarized, and recommendations for further research were made. Main Results – Few topical differences in information needed were identified between primary care physicians and nurses. Across studies retrieved, members of both groups sought information on drugs, diagnoses, and therapy. The Internet (including bibliographic databases and web-based searching) was the source of information most frequently mentioned, followed by textbooks, journals, colleagues, drug compendiums, professional websites, and medical libraries. There is insufficient evidence to support conclusions about the differences between groups. In most research, information needs and behaviours for both groups have been discussed simultaneously, with no real distinction made, suggesting that there may not be significant differences even though a few studies have found that nurses’ emphasis is on policy and procedures. Barriers to access include time, searching skills, and geographic location; for the last, improvements have been made but rural practitioners continue to be adversely affected by limited access to people and resources. Conclusion – Both primary care physicians and nurses seek information on diagnosis and treatment. The Internet is of increasing utility for both groups, but all resources have advantages and disadvantages in identifying evidence based information for use in practice. Further research is required to support access and use of evidence based resources, and to explore how focused, evidence based information can be integrated into electronic health record systems.

scholarly journals Cancer Care and Cancer Survivorship Care in the United States: Will We Be Able to Care for These Patients in the Future?

2009 ◽  
Vol 5 (3) ◽  
pp. 119-123 ◽  
Author(s):  
Lawrence N. Shulman ◽  
Linda A. Jacobs ◽  
Sheldon Greenfield ◽  
Barbara Jones ◽  
Mary S. McCabe ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Health Care ◽  
Cancer Survivors ◽  
Cancer Care ◽  
Primary Care Physicians ◽  
The United States ◽  
Survivorship Care ◽  
Patients With Cancer ◽  
Number Of Patients

The combination of a shortfall in oncologists and primary care physicians and an increased number of patients using more health care resources raises concerns about our health care system's ability to accommodate future patients with cancer and cancer survivors.

scholarly journals Retail Therapy: How a Trip to the Store Can Make You Feel Better in the Evolving Health Care Landscape Created by the Affordable Care Act

2015 ◽  
Vol 33 (2) ◽  
pp. 239-260
Author(s):  
Cynthia Liba
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Care Physicians ◽  
The United States ◽  
Care Physician ◽  
Poverty Level ◽  
Health Clinics ◽  
Medicaid Eligibility ◽  
Individual Mandate ◽  
The Individual

As the ACA expands Medicaid eligibility by creating a national Medicaid minimum eligibility level of 133% of the federal poverty level and requires U.S. citizens to purchase health insurance as a result of the individual mandate, the shortage of primary care physicians will become painfully apparent for those seeking treatment. As a result, many health policy analysts and lawmakers are examining the potential ability of retail health clinics (RHCs) to address the consequences of primary care physician shortages in the United States, among other deficiencies in the provision of health care.

scholarly journals Measuring and Improving Evidence-Based Patient Care Using a Web-Based Gamified Approach in Primary Care (QualityIQ): Randomized Controlled Trial (Preprint)

2021 ◽  
Author(s):  
Trever Burgon ◽  
Linda Casebeer ◽  
Holly Aasen ◽  
Czarlota Valdenor ◽  
Diana Tamondong-Lachica ◽  
...  
Keyword(s):  
Primary Care ◽  
Real Time ◽  
Primary Care Physicians ◽  
Primary Care Providers ◽  
The United States ◽  
Physician Satisfaction ◽  
Evidence Based ◽  
Clinical Decisions ◽  
Care Providers ◽  
Evidence Based Care

BACKGROUND Unwarranted variability in clinical practice is a challenging problem in practice today, leading to poor outcomes for patients and low-value care for providers, payers, and patients. OBJECTIVE In this study, we introduced a novel tool, QualityIQ, and determined the extent to which it helps primary care physicians to align care decisions with the latest best practices included in the Merit-Based Incentive Payment System (MIPS). METHODS We developed the fully automated QualityIQ patient simulation platform with real-time evidence-based feedback and gamified peer benchmarking. Each case included workup, diagnosis, and management questions with explicit evidence-based scoring criteria. We recruited practicing primary care physicians across the United States into the study via the web and conducted a cross-sectional study of clinical decisions among a national sample of primary care physicians, randomized to continuing medical education (CME) and non-CME study arms. Physicians “cared” for 8 weekly cases that covered typical primary care scenarios. We measured participation rates, changes in quality scores (including MIPS scores), self-reported practice change, and physician satisfaction with the tool. The primary outcomes for this study were evidence-based care scores within each case, adherence to MIPS measures, and variation in clinical decision-making among the primary care providers caring for the same patient. RESULTS We found strong, scalable engagement with the tool, with 75% of participants (61 non-CME and 59 CME) completing at least 6 of 8 total cases. We saw significant improvement in evidence-based clinical decisions across multiple conditions, such as diabetes (+8.3%, <i>P</i>&lt;.001) and osteoarthritis (+7.6%, <i>P</i>=.003) and with MIPS-related quality measures, such as diabetes eye examinations (+22%, <i>P</i>&lt;.001), depression screening (+11%, <i>P</i>&lt;.001), and asthma medications (+33%, <i>P</i>&lt;.001). Although the CME availability did not increase enrollment in the study, participants who were offered CME credits were more likely to complete at least 6 of the 8 cases. CONCLUSIONS Although CME availability did not prove to be important, the short, clinically detailed case simulations with real-time feedback and gamified peer benchmarking did lead to significant improvements in evidence-based care decisions among all practicing physicians. CLINICALTRIAL ClinicalTrials.gov NCT03800901; https://clinicaltrials.gov/ct2/show/NCT03800901

Awareness and Use of Electronic Information Resources in Polytechnic Library Zungeru, Niger State, Nigeria.

2019 ◽  
pp. 223-231
Author(s):  
Mustapha H.T. ◽  
Ahmad A.O. ◽  
Saka Katamba A.
Keyword(s):  
Information Needs ◽  
Rating Scale ◽  
Sampling Technique ◽  
Information Resources ◽  
Full Time ◽  
Electronic Information ◽  
Monthly Basis ◽  
Cd Rom ◽  
Library Management ◽  
Electronic Information Resources

The study investigated the awareness and use of electronic information resources in the Polytechnic library Zungeru, Niger State, Nigeria. The study was anchored on four objectives and one hypothesis. Survey research design was adopted. The population of the study consisted of 1,373 full time National Diploma (ND) II and High National Diploma (HND) II students and a sample size of 301 respondents was adopted through random sampling technique. Structured and four rating scale questionnaire and observation check-list were used as data collection instruments. Data collected were analysed using descriptive and inferential statistics. The findings revealed that e-books, e-journals, CD-ROM data bases and online e-resources databases were the available electronic information resources in the Polytechnic library Zungeru. The level of awareness of electronic information resources was low, while the mean frequency use of library electronic information resources was on monthly basis. Some of the challenges encountered in the use of electronic information resources include: inadequate awareness of the electronic information resources, irregular power supply and inadequate Internet facilities in the library. The study recommended that electronic information resources such as electronic theses/dissertations should be acquired and made available to students; the library management should use education program to sensitise students more on the availability and usefulness of the electronic information resources to their studies. The library management should also ensure that acquisition policy is tailored towards users‟ information needs.

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