Transcript Information Seeking Behavior of Physicians

Information Seeking
Behavior of Physicians
Patti Reynolds
Director, Bishopric Medical Library
Sarasota Memorial Hospital
Critical Skills
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“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
BMC Medical Information and Decision Making 2005
Family Physicians Needs
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Timely access to wide variety of
clinical information sources
Specific questions on patient
management:
• 3.2 questions for every 10 patients seen
• Drug questions most often
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Pursuing answers occurs only about
a third of the time
Pursuing an answer
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Motivation:
• Belief that a definitive answer exists
• The patient’s problem is urgent
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What happens when personal bias or
negative attitudes enters the
picture?
Where are the answers?
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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 the questions require
synthesis of information about a
specific patient with a biomedical
knowledge base
Success Needs…
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Essential to find accurate information
quickly
Family MD’s spend on average less
than 2 minutes finding an answer in a
text book or journal
MD’s found drug info in a palm pilot in
20 seconds
One study – PDA’s used in 64% of
outpatient facilities, with 69% looking
up drug info
Results
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Care may be fragmented or
diminished and less evidence-based
when access is not readily available
or available only through specialists
Study results
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457 family physicians
• 72.7% male
• 27.4% female
• 39.6% practiced in rural areas
• 44.8% graduated from medical school
more than 20 years earlier
Results
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59% regularly use the internet daily
or weekly for clinical information
Also use for personal email
47% report access by modem
Journals were rated first in
importance
73% believed that the Internet was
useful and important to physicians
Results
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54% of md’s were confident in using
the internet
14% not confident at all
Family md’s look for info on a specific
patient problem
• Diagnosis/management – 73%
• Patient education - 58%
• Guideline summaries – 49%
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Specialists were similar but 37%
looked for patient education material
Credibility and relevance
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Credibility was ranked as the most
important characteristic of the
internet related to clinical
informationby all types of md’s.
Family md’s said “too much
information to scan” – barrier
Relevance considered very important
Results
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Because of the broad scope of family
practice and exponential increase in
medical knowledge, mastery of
technology is a core skill.
Family md’s are driven by questions
regarding specific patients rather
than new research findings.
Specialist vs Family MD
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Family
• Current best practices and clinical
guidelines most important
Specialists
• In-depth knowledge in relatively
narrow area
• Access to cutting edge research and
journals
• Contact with more limited population
of colleagues – many far away
Problems for all
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Navigation
Lack of speed
Extensive amount of information to
scan
Lack of specificity for available
information
Obstacles greater for family md’s
Handheld devices –PDA’s
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Family md’s more like to use these
80% of internists use PDA’s to access
drug information
Other uses:
• textbooks
• Journals
• Medical calculators
• Patient tracking programs
• Billing and coding software
• Word processing
• Internet access and more……
PDA’s
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Drug prescribing most common
medical error
PDA’s
• save time in information retrieval,
• easily incorporated into their workflow
• Reduced rate of preventable adverse
drug events
Results
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Family md’s deal with broadest
clinical knowledge bases BUT
• 2/3 of questions go unanswered
• Only pursue urgent needs or high
probability of finding an answer
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MD’s have access to the internet and
are using it
• Consider it important
• Confident in their ability to use it(?)
Results
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They direct more attention to patient
care issues
Overwhelmed by amount of clinical
information
Lack of confidence that they will be
able to find an answer
PDA’s will grow in use
Other studies
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The most commonly reported
obstacle to the pursuit of an answer
was the physician's doubt that an
answer existed
The PDR
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What is the PDR?
Adverse Drug Events
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76.2% ADE’s are dose related
using standard methods of care
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”
Lazarou J, et al Incidence of adverse drug reactions in hospitalized patients:
Usual Dose of Drug
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Doses recommended by
manufacturers package inserts
This is what is found in the PDR
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
Phase 4
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Risks become apparent
New uses for drugs
Independent research reveals
effectiveness of doses that differ
from the manufacturers
recommendations
This information does not get to the
physician.
PDR
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82-90% md’s consider PDR single
most useful reference(“publishing
company source”)
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Average md consults 8 times a week
FREE - underwritten by the
pharmaceutical industry
PDR information
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PDR info rarely updated
PDR drug descriptions are not dated
There is no requirement for drug
companies to update their package
inserts
No dosing adjustments for elderly
Data regarding lower doses often
omitted (NSAIDS)
Good Data
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NSAIDS
• Dose related ADEs from NSAIDS
hae prompted more reports to the
FDA than any other drug group
• Most NSAID ADE’s are dose related
• Annually, 8000-16,000 deaths and
70,000-107,000 hospitalizations
related to NSAID use
• Using lowest dose is critical
“The most common therapeutic
intervention in medicine is writing a
prescription” Inadequate dosing
information affects everyone
Needs
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New constantly updated PDR
Another drug reference with
adequate information
Entirely new reference created from
joint contributions of government,
pharmaceutical industry, foundations
and phsyicians
SMH Access statistics – 1 year
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Mar 2004-Feb 2005, 4,554 articles
downloaded from NEJM.
• 378 searches performed
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ProQuest – 7,598 articles downloaded
in 12 months
UpToDate – more than 300 time per
week
JAMA – 12,000+ articles downloaded
831 articles borrowed
1,900+ requests to library
What does this mean?
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Physicians need information
Consistent, fast access
Valid resources to fit exact needs
Proper education in use of technology
Time
An administration that supports the
financing of good information