Evidence Based Medicine at the Point of Care: Maurer’s Mobile POEMS Douglas Maurer, DO, MPH, FAAFP Program Director Madigan Faculty Development Fellowship Sterling Brodniak, DO Fellow
Disclosures The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.
Objectives Distinguished between DOEs / POEMs Learned the best sources of POEMS Solved problems using EBM and Smart Devices Improved the utility of your Smart Device
Information Anxiety Too much information “Ping-pong” between sources “My last case…In my experience…” How do we find the “truth”?
DOE versus POEM Disease-Oriented Evidence -Etiology, pathophysiology, pharmacology -Intermediate outcomes Patient-Oriented Evidence that Matters -Morbidity, mortality, quality of life -The “so-what” questions
DOE versus POEM Disease-Oriented Evidence -Etiology, pathophysiology, pharmacology -Intermediate outcomes Patient-Oriented Evidence that Matters -Morbidity, mortality, quality of life -The “so-what” questions
DOE versus POEM Disease-Oriented Evidence -Etiology, pathophysiology, pharmacology -Intermediate outcomes Patient-Oriented Evidence that Matters -Morbidity, mortality, quality of life -The “so-what” questions
Identifying POEMS Is it something that your patients care about? Is it a common problem in your practice? If true, will it require you to change your current practice behavior?
The Usefulness Equation Usefulness = Relevance X Validity Work
Case 1 An 80 y/o male with Type II diabetes, hypertension, and hyperlipidemia has an A1c of 8, and a blood pressure of 145/90. -What is his goal A1C and blood pressure? -He is on a statin. Should he be? -He is not on aspirin. Should he be? 5 minutes
Where Would I Go? UpToDate OR Dynamed
UpToDate Super EBM textbook Covers multiple specialties Quick and concise Consensus / expert opinion
Dynamed Point of care reference tool Monitors over 500 journals Systematic Literature Surveillance More “up to date” than UpToDate
Case 2 A 65 y/o male presents with CAP, PMHx of CHF, a temp of 101.5, RR 35, HR 130, and BUN 35. -Should the patient be hospitalized? -When could he be discharged? -How effective is Pneumovax 23? 5 minutes
Where Would I Go? Essential Evidence Plus OR Pneumonia OR Any Medical Calculator
Essential Evidence Plus POEMS at the point of care Searches 7 databases at once Over 2000 medical calculators Goal to improve outcomes
Case 3 A 35 y/o G2P101 at 12 wks gestation with prior C-section presents for her new OB appt. Urinalysis shows bacteriuria. -% chance of a successful VBAC? -Risks of VBAC? -Treat asymptomatic bacteriuria? -If so, what would you use? 5 minutes
Where Would I Go? PubMed
Huge database Typically searches are painful Use Clinical Queries or PICO
No REALLY?! UpToDate OR Dynamed OR Essential Evidence Plus
Case 4 A 75 y/o male diabetic, with chronic afib on warfarin, hospital day 5 s/p inferior MI, now has a fever and pneumonia on CXR. -What antibiotic(s) should you rx? -Worried about drug interactions? 5 minutes
Where Would I Go? Johns Hopkins Abx Guide AND/OR Sanford Abx Guide AND/OR Epocrates/Lexicomp
Case 5 A 30 y/o G2P101 at 38 wks gestation presents in active labor. NO GBS testing was performed. Membranes just ruptured at home approx 8 hours ago. -Does this patient require GBS prophylaxis? -Does your answer change if pt’s temp is 100.6? -What antibiotic would you use if PCN allergic? 5 minute
Where Would I Go? UpToDate OR Dynamed OR Prevent GBS
Case 6 12 mo male for WBE and immunizations. Previously received PCV #1 at 8 months and PCV #2 at 11 months. -When can he receive PCV #3 and #4? -What social development milestones should he be meeting? -Should he receive fluoride? How much? i 5 minute
Where Would I Go? SHOTS AND Kidometer AND Smiles for Life
Case 7 A 24 y/o G0P0 presents for f/u of her well woman exam. Her pap revealed LSIL. -What is the next step of her treatment? -What if that intervention revealed LSIL? -When could the patient return to routine screening? 5 minute
Where Would I Go? UpToDate OR Dynamed OR ASCCP App
Dr Maurer’s POEM Finder UpToDate Dynamed Essential Evidence Plus AFP by Topic eMedicine/Medscape PICO PubMed Epocrates/Lexicomp Hopkins Abx Guide/ Sanford Guide Prescriber’s Letter
Dr Maurer’s POEM Finder UpToDate Dynamed Essential Evidence Plus AFP by Topic eMedicine/Medscape PICO PubMed Epocrates/Lexicomp Hopkins Abx Guide/ Sanford Guide Prescriber’s Letter
Take Home Points We suffer from TMI Use POEMS at the POC UpToDate, Dynamed, and EE Plus rock! Yes, there IS an app for that!
Objectives Distinguished between DOEs / POEMs Learned the best sources of POEMS Solved problems using EBM and Smart Devices Improved the utility of your Smart Device
Questions?
Case 4 A 25 y/o G1P0 at 9 weeks gestation presents for vaginitis. Your exam confirms the patient has a vaginal yeast infection. -What antifungal(s) should you rx? -Worried about birth defects? Which ones? 5 minute