Long-Term Patterns of Online Evidence Retrieval Use in General Practice: A 12-Month Study

Background: Provision of online evidence at the point of care is one strategy that could provide clinicians with easy access to up-to-date evidence in clinical settings in order to support evidence-based decision making. Objective: The aim was to determine long-term use of an online evidence system in routine clinical practice. Methods: This was a prospective cohort study. 59 clinicians who had a computer with Internet access in their consulting room participated in a 12-month trial of Quick Clinical, an online evidence system specifically designed around the needs of general practitioners (GPs). Patterns of use were determined by examination of computer logs and survey analysis. Results: On average, 9.9 searches were conducted by each GP in the first 2 months of the study. After this, usage dropped to 4.4 searches per GP in the third month and then levelled off to between 0.4 and 2.6 searches per GP per month. The majority of searches (79.2%, 2013/2543) were conducted during practice hours (between 9 am and 5 pm) and on weekdays (90.7%, 2315/2543). The most frequent searches related to diagnosis (33.6%, 821/2291) and treatment (34.5%, 844/2291). Conclusion: GPs will use an online evidence retrieval system in routine practice; however, usage rates drop significantly after initial introduction of the system. Long-term studies are required to determine the extent to which GPs will integrate the use of such technologies into their everyday clinical practice and how this will affect the satisfaction and health outcomes of their patients.14 page(s

Impact of web searching and social feedback on consumer decision making : a prospective online experiment

Background: The World Wide Web has increasingly become an important source of information in health care consumer decision making. However, little is known about whether searching online resources actually improves consumers' understanding of health issues. Objectives: The aim was to study whether searching on the World Wide Web improves consumers' accuracy in answering health questions and whether consumers' understanding of health issues is subject to further change under social feedback. Methods: This was a pre/post prospective online study. A convenience sample of 227 undergraduate students was recruited from the population of the University of New South Wales. Subjects used a search engine that retrieved online documents from PubMed, MedlinePlus, and HealthInsite and answered a set of six questions (before and after use of the search engine) designed for health care consumers. They were then presented with feedback consisting of a summary of the post-search answers provided by previous subjects for the same questions and were asked to answer the questions again. Results: There was an improvement in the percentage of correct answers after searching (pre-search 61.2% vs post-search 82.0%, P <.001) and after feedback with other subjects' answers (pre-feedback 82.0% vs post-feedback 85.3%, P =.051). The proportion of subjects with highly confident correct answers (ie, confident or very confident) and the proportion with highly confident incorrect answers significantly increased after searching (correct pre-search 61.6% vs correct post-search 95.5%, P <.001; incorrect pre-search 55.3% vs incorrect post-search 82.0%, P <.001). Subjects who were not as confident in their post-search answers were 28.5% more likely than those who were confident or very confident to change their answer after feedback with other subjects' post-search answers (?2 1= 66.65, P <.001). Conclusions: Searching across quality health information sources on the Web can improve consumers' accuracy in answering health questions. However, a consumer's confidence in an answer is not a good indicator of the answer being correct. Consumers who are not confident in their answers after searching are more likely to be influenced to change their views when provided with feedback from other consumers.13 page(s

Answers to Questions Posed During Daily Patient Care Are More Likely to Be Answered by UpToDate Than PubMed

Contains fulltext : 69818.pdf (publisher's version ) (Open Access)BACKGROUND: UpToDate and PubMed are popular sources for medical information. Data regarding the efficiency of PubMed and UpToDate in daily medical care are lacking. OBJECTIVE: The purpose of this observational study was to describe the percentage of answers retrieved by these information sources, comparing search results with regard to different medical topics and the time spent searching for an answer. METHODS: A total of 40 residents and 30 internists in internal medicine working in an academic medical center searched PubMed and UpToDate using an observation portal during daily medical care. The information source used for searching and the time needed to find an answer to the question were recorded by the portal. Information was provided by searchers regarding the topic of the question, the situation that triggered the question, and whether an answer was found. RESULTS: We analyzed 1305 patient-related questions sent to PubMed and/or UpToDate between October 1, 2005 and March 31, 2007 using our portal. A complete answer was found in 594/1125 (53%) questions sent to PubMed or UpToDate. A partial or full answer was obtained in 729/883 (83%) UpToDate searches and 152/242 (63%) PubMed searches (P < .001). UpToDate answered more questions than PubMed on all major medical topics, but a significant difference was detected only when the question was related to etiology (P < .001) or therapy (P = .002). Time to answer was 241 seconds (SD 24) for UpToDate and 291 seconds (SD 7) for PubMed. CONCLUSIONS: Specialists and residents in internal medicine generally use less than 5 minutes to answer patient-related questions in daily care. More questions are answered using UpToDate than PubMed on all major medical topics