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Information Seeking Behavior of Physicians Patti Reynolds Director, Bishopric Medical Library Sarasota Memorial Hospital.

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Presentation on theme: "Information Seeking Behavior of Physicians Patti Reynolds Director, Bishopric Medical Library Sarasota Memorial Hospital."— Presentation transcript:

1 Information Seeking Behavior of Physicians Patti Reynolds Director, Bishopric Medical Library Sarasota Memorial Hospital

2 Critical Skills Using technology to access clinical information has become a critical skill for family physicians. Using technology to access clinical information has become a critical skill for family physicians. Family physicians information seeking behaviors: a survey comparison with other specialties 2005 Family physicians information seeking behaviors: a survey comparison with other specialties 2005 BMC Medical Information and Decision Making 2005 BMC Medical Information and Decision Making 2005

3 Family Physicians Needs Timely access to wide variety of clinical information sources Timely access to wide variety of clinical information sources Specific questions on patient management: Specific questions on patient management: 3.2 questions for every 10 patients seen3.2 questions for every 10 patients seen Drug questions most oftenDrug questions most often Pursuing answers occurs only about a third of the time Pursuing answers occurs only about a third of the time

4 Pursuing an answer Motivation: Motivation: Belief that a definitive answer existsBelief that a definitive answer exists The patients problem is urgentThe patients problem is urgent What happens when personal bias or negative attitudes enters the picture? What happens when personal bias or negative attitudes enters the picture?

5 Where are the answers? Half the questions may be readily answered by information in a clinical record Half the questions may be readily answered by information in a clinical record One quarter of questions require traditional resources – books, journals One quarter of questions require traditional resources – books, journals One quarter of the questions require synthesis of information about a specific patient with a biomedical knowledge base One quarter of the questions require synthesis of information about a specific patient with a biomedical knowledge base

6 Success Needs… Essential to find accurate information quickly Essential to find accurate information quickly Family MDs spend on average less than 2 minutes finding an answer in a text book or journal Family MDs spend on average less than 2 minutes finding an answer in a text book or journal MDs found drug info in a palm pilot in 20 seconds MDs found drug info in a palm pilot in 20 seconds One study – PDAs used in 64% of outpatient facilities, with 69% looking up drug info One study – PDAs used in 64% of outpatient facilities, with 69% looking up drug info

7 Results Care may be fragmented or diminished and less evidence-based when access is not readily available or available only through specialists Care may be fragmented or diminished and less evidence-based when access is not readily available or available only through specialists

8 Study results 457 family physicians 457 family physicians 72.7% male72.7% male 27.4% female27.4% female 39.6% practiced in rural areas39.6% practiced in rural areas 44.8% graduated from medical school more than 20 years earlier44.8% graduated from medical school more than 20 years earlier

9 Results 59% regularly use the internet daily or weekly for clinical information 59% regularly use the internet daily or weekly for clinical information Also use for personal Also use for personal 47% report access by modem 47% report access by modem Journals were rated first in importance Journals were rated first in importance 73% believed that the Internet was useful and important to physicians 73% believed that the Internet was useful and important to physicians

10 Results 54% of mds were confident in using the internet 54% of mds were confident in using the internet 14% not confident at all 14% not confident at all Family mds look for info on a specific patient problem Family mds look for info on a specific patient problem Diagnosis/management – 73%Diagnosis/management – 73% Patient education - 58%Patient education - 58% Guideline summaries – 49%Guideline summaries – 49% Specialists were similar but 37% looked for patient education material Specialists were similar but 37% looked for patient education material

11 Credibility and relevance Credibility was ranked as the most important characteristic of the internet related to clinical informationby all types of mds. Credibility was ranked as the most important characteristic of the internet related to clinical informationby all types of mds. Family mds said too much information to scan – barrier Family mds said too much information to scan – barrier Relevance considered very important Relevance considered very important

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13 Results Because of the broad scope of family practice and exponential increase in medical knowledge, mastery of technology is a core skill. Because of the broad scope of family practice and exponential increase in medical knowledge, mastery of technology is a core skill. Family mds are driven by questions regarding specific patients rather than new research findings. Family mds are driven by questions regarding specific patients rather than new research findings.

14 Specialist vs Family MD Family Family Current best practices and clinical guidelines most importantCurrent best practices and clinical guidelines most important Specialists Specialists In-depth knowledge in relatively narrow areaIn-depth knowledge in relatively narrow area Access to cutting edge research and journalsAccess to cutting edge research and journals Contact with more limited population of colleagues – many far awayContact with more limited population of colleagues – many far away

15 Problems for all Navigation Navigation Lack of speed Lack of speed Extensive amount of information to scan Extensive amount of information to scan Lack of specificity for available information Lack of specificity for available information Obstacles greater for family mds Obstacles greater for family mds

16 Handheld devices –PDAs Family mds more like to use these Family mds more like to use these 80% of internists use PDAs to access drug information 80% of internists use PDAs to access drug information Other uses: Other uses: textbookstextbooks JournalsJournals Medical calculatorsMedical calculators Patient tracking programsPatient tracking programs Billing and coding softwareBilling and coding software Word processingWord processing Internet access and more……Internet access and more……

17 PDAs Drug prescribing most common medical error Drug prescribing most common medical error PDAs PDAs save time in information retrieval,save time in information retrieval, easily incorporated into their workfloweasily incorporated into their workflow Reduced rate of preventable adverse drug eventsReduced rate of preventable adverse drug events

18 Results Family mds deal with broadest clinical knowledge bases BUT Family mds deal with broadest clinical knowledge bases BUT 2/3 of questions go unanswered2/3 of questions go unanswered Only pursue urgent needs or high probability of finding an answerOnly pursue urgent needs or high probability of finding an answer MDs have access to the internet and are using it MDs have access to the internet and are using it Consider it importantConsider it important Confident in their ability to use it(?)Confident in their ability to use it(?)

19 Results They direct more attention to patient care issues They direct more attention to patient care issues Overwhelmed by amount of clinical information Overwhelmed by amount of clinical information Lack of confidence that they will be able to find an answer Lack of confidence that they will be able to find an answer PDAs will grow in use PDAs will grow in use

20 Other studies The most commonly reported obstacle to the pursuit of an answer was the physician's doubt that an answer existed The most commonly reported obstacle to the pursuit of an answer was the physician's doubt that an answer existed

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22 The PDR What is the PDR? What is the PDR?

23 Adverse Drug Events 76.2% ADEs are dose related using standard methods of care 76.2% ADEs are dose related using standard methods of care Large number of serious ADEs even when drugs are properly prescribed and administered Large number of serious ADEs even when drugs are properly prescribed and administered 1985 – 37,000 ADE reports to FDA 71% involved toxic reactions to usual doses 1985 – 37,000 ADE reports to FDA 71% involved toxic reactions to usual doses Lazarou J, et al Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998;279:

24 Usual Dose of Drug Doses recommended by manufacturers package inserts Doses recommended by manufacturers package inserts This is what is found in the PDR This is what is found in the PDR Manufacturer-recommended doses of medications are usually selected during phase 1 Manufacturer-recommended doses of medications are usually selected during phase 1 After drug is introduced or general use – and the package insert is written and codified in the PDR – THEN Phase 4 starts After drug is introduced or general use – and the package insert is written and codified in the PDR – THEN Phase 4 starts

25 Phase 4 Risks become apparent Risks become apparent New uses for drugs New uses for drugs Independent research reveals effectiveness of doses that differ from the manufacturers recommendations Independent research reveals effectiveness of doses that differ from the manufacturers recommendations This information does not get to the physician. This information does not get to the physician.

26 PDR 82-90% mds consider PDR single most useful reference (publishing company source) 82-90% mds consider PDR single most useful reference (publishing company source) Average md consults 8 times a week Average md consults 8 times a week FREE - underwritten by the pharmaceutical industry FREE - underwritten by the pharmaceutical industry

27 PDR information PDR info rarely updated PDR info rarely updated PDR drug descriptions are not dated PDR drug descriptions are not dated There is no requirement for drug companies to update their package inserts There is no requirement for drug companies to update their package inserts No dosing adjustments for elderly No dosing adjustments for elderly Data regarding lower doses often omitted (NSAIDS) Data regarding lower doses often omitted (NSAIDS)

28 Good Data NSAIDS NSAIDS Dose related ADEs from NSAIDS hae prompted more reports to the FDA than any other drug groupDose related ADEs from NSAIDS hae prompted more reports to the FDA than any other drug group Most NSAID ADEs are dose relatedMost NSAID ADEs are dose related Annually, ,000 deaths and 70, ,000 hospitalizations related to NSAID useAnnually, ,000 deaths and 70, ,000 hospitalizations related to NSAID use Using lowest dose is criticalUsing lowest dose is critical

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30 The most common therapeutic intervention in medicine is writing a prescription Inadequate dosing information affects everyone

31 Needs New constantly updated PDR New constantly updated PDR Another drug reference with adequate information Another drug reference with adequate information Entirely new reference created from joint contributions of government, pharmaceutical industry, foundations and phsyicians Entirely new reference created from joint contributions of government, pharmaceutical industry, foundations and phsyicians

32 SMH Access statistics – 1 year Mar 2004-Feb 2005, 4,554 articles downloaded from NEJM. Mar 2004-Feb 2005, 4,554 articles downloaded from NEJM. 378 searches performed378 searches performed ProQuest – 7,598 articles downloaded in 12 months ProQuest – 7,598 articles downloaded in 12 months UpToDate – more than 300 time per week UpToDate – more than 300 time per week JAMA – 12,000+ articles downloaded JAMA – 12,000+ articles downloaded 831 articles borrowed 831 articles borrowed 1,900+ requests to library 1,900+ requests to library

33 What does this mean? Physicians need information Physicians need information Consistent, fast access Consistent, fast access Valid resources to fit exact needs Valid resources to fit exact needs Proper education in use of technology Proper education in use of technology Time Time An administration that supports the financing of good information An administration that supports the financing of good information


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