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

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Presentation on theme: "Accuracy of PoC Resources to Answer Clinical Questions Ann McKibbon MLS PhD Associate Professor Clinical Epidemiology & Biostatistics McMaster University."— Presentation transcript:

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

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 need/patient – Ramos et al need/patient Hospital setting – Osheroff et al /patient/day – Currie et al200311/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 Problems with Information 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

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

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 PackagingCochrane Reviews 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 OVIDEBMR ACP J Club Clinical Evidence Google Evidence-Based Guidelines … Abstracts or full text? Free or pay?

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 AnswersEKGs Electrocardiogram with computer interpretation 30 Internal Medicine residents (year 2 or 3) Accuracy Without e-interpretation of data48.9% With e-interpretation of data55.4%

16 Providing AnswersEKGs Electrocardiogram with computer interpretation 30 Internal Medicine Residents (year 2 or 3) Accuracy Without e-interpretation of data48.9% With e-interpretation of data55.4% – If e-interpretration correct68.1% – If e-interpretation wrong48.3%

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…


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