accuracy of poc resources to answer clinical questions ann mckibbon mls phd associate professor...
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![Page 1: Accuracy of PoC Resources to Answer Clinical Questions Ann McKibbon MLS PhD Associate Professor Clinical Epidemiology & Biostatistics McMaster University](https://reader036.vdocuments.us/reader036/viewer/2022081602/5517760b55034645368b4e14/html5/thumbnails/1.jpg)
Accuracy of PoC Resources to Answer Clinical Questions
Ann McKibbon MLS PhDAssociate ProfessorClinical Epidemiology & BiostatisticsMcMaster [email protected]
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POC Information Resources
Tremendous need for themAlready 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
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Information Needs in Practice
External information is vital in healthcare Numbers consistent over time, countries, disciplines, settings,
training levels
Clinic setting– Covell et al 1985 0.7 need/patient– Ramos et al 2003 0.8 need/patient
Hospital setting– Osheroff et al 1991 15/patient/day– Currie et al 2003 11/hour with EMRs
(range 1 – 25)
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• Clinicians use electronic resources during patient care time• 89% of them believe that electronic systems improve care• 75% of questions were answered
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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
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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
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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
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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
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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 MEDLINEprostate cancer (18K citations)reads for 5 minutesquitsprovides answer
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Packaging—Cochrane 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 OVID—EBMR ACP J Club Clinical Evidence Google Evidence-Based Guidelines …
Abstracts or full text? Free or pay?
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Inability to Get Correct Answers
From Peers
Dutch study (Schaffsma) of 14 physicians Asked peers for answers to 12 questions 47% correct
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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
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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
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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
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Providing Answers—EKGs
Electrocardiogram with computer interpretation
30 Internal Medicine residents (year 2 or 3)
Accuracy Without e-interpretation of data 48.9% With e-interpretation of data 55.4%
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Providing Answers—EKGs
Electrocardiogram with computer interpretation30 Internal Medicine Residents (year 2 or 3)
Accuracy Without e-interpretation of data 48.9% With e-interpretation of data 55.4%
– If e-interpretration correct 68.1%– If e-interpretation wrong 48.3%
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Trust
Producers of information trusted– WHO technical document
Trust of technology– Social conformity– Less vigilance – Diffusion of responsibility – Belief in infallibility
of technology
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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…