scholarly journals Risk Profile May Affect Search Process but Not Results

2007 ◽  
Vol 2 (4) ◽  
pp. 61
Author(s):  
Gale G. Hannigan
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Risk Attitude ◽  
Computer Skills ◽  
Information Resources ◽  
Specific Information ◽  
Think Aloud ◽  
Risk Seeking ◽  
Online Rating ◽  
Clinical Questions

Objective – To compare the use, in terms of process and outcomes, of electronic information resources by primary care physicians with different risk profiles and comfort with uncertainty. Design – Survey, and observation using “think-aloud” method. Setting – Physicians’ offices. Subjects – Canadian and U.S. primary care physicians who report seeing patients in clinic settings. Methods – Volunteers were recruited from personal contacts and the list of physicians who rate current studies for the McMaster Online Rating of Evidence (MORE) project. Physicians completed the Pearson scale to measure attitude toward risk and the Gerrity scale to measure comfort with uncertainty, and those who scored at the extremes of each of these two scales were included in the study (n=25), resulting in four groups (risk-seeking, risk-avoiding, uncertainty-stressed, uncertainty-unstressed). One researcher observed each of these physicians in their offices for an hour during which they completed questionnaires about their computer skills and familiarity with resources, answered multiple-choice clinical questions, and indicated level of certainty with regard to those answers (scale of 0 to 100%). Physicians also chose two of the clinical questions to answer using their own resources. The think-aloud method was employed, and transcripts were coded and analyzed. Main results – The study analysis included two comparisons: risk-seeking (11 subjects) versus risk-avoiding (11 subjects) physicians, and uncertainty-stressed (11 subjects) versus uncertainty-unstressed (10 subjects) physicians. Most physicians were included in both sets of analyses. The researchers found no association of risk attitude and uncertainty stress with computer skills nor with familiarity and use of specific information resources (Internet, MEDLINE, PIER, Clinical Evidence, and UpToDate). No differences were found for the following outcomes: time spent searching, answers correct before searching, answers correct after searching, and certainty of answer if answer is right, certainty of answer if answer is wrong. There was a statistically significant association of participants’ indicating certainty for answers that were correct versus those that were not correct (p

scholarly journals Patient-Care Questions that Physicians Are Unable to Answer

2007 ◽  
Vol 14 (4) ◽  
pp. 407-414 ◽  
Author(s):  
John W. Ely ◽  
Jerome A. Osheroff ◽  
Saverio M. Maviglia ◽  
Marcy E. Rosenbaum
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
Primary Care Physicians ◽  
Clinical Information ◽  
Clinical Findings ◽  
Information Resources ◽  
Clinical Information Systems ◽  
Unanswered Question ◽  
Test Results ◽  
Clinical Questions

Abstract Objective: To describe the characteristics of unanswered clinical questions and propose interventions that could improve the chance of finding answers. Design: In a previous study, investigators observed primary care physicians in their offices and recorded questions that arose during patient care. Questions that were pursued by the physician, but remained unanswered, were grouped into generic types. In the present study, investigators attempted to answer these questions and developed recommendations aimed at improving the success rate of finding answers. Measurements: Frequency of unanswered question types and recommendations to increase the chance of finding answers. Results: In an earlier study, 48 physicians asked 1062 questions during 192 half-day office observations. Physicians could not find answers to 237 (41%) of the 585 questions they pursued. The present study grouped the unanswered questions into 19 generic types. Three types accounted for 128 (54%) of the unanswered questions: (1) “Undiagnosed finding” questions asked about the management of abnormal clinical findings, such as symptoms, signs, and test results (What is the approach to finding X?); (2) “Conditional” questions contained qualifying conditions that were appended to otherwise simple questions (What is the management of X, given Y? where “given Y” is the qualifying condition that makes the question difficult.); and (3) “Compound” questions asked about the association between two highly specific elements (Can X cause Y?). The study identified strategies to improve clinical information retrieval, listed below. Conclusion: To improve the chance of finding answers, physicians should change their search strategies by rephrasing their questions and searching more clinically oriented resources. Authors of clinical information resources should anticipate questions that may arise in practice, and clinical information systems should provide clearer and more explicit answers.

scholarly journals Clinician-selected Electronic Information Resources do not Guarantee Accuracy in Answering Primary Care Physicians' Information Needs

2008 ◽  
Vol 3 (1) ◽  
pp. 78
Author(s):  
Martha Ingrid Preddie
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Care Physicians ◽  
Information Needs ◽  
The United States ◽  
Information Resources ◽  
Evidence Based ◽  
Electronic Information ◽  
Electronic Information Resources ◽  
Clinical Questions

A review of: McKibbon, K. Ann, and Douglas B. Fridsma. “Effectiveness of Clinician-selected Electronic Information Resources for Answering Primary Care Physicians’ Information Needs.” Journal of the American Medical Informatics Association 13.6 (2006): 653-9. Objective – To determine if electronic information resources selected by primary care physicians improve their ability to answer simulated clinical questions. Design – An observational study utilizing hour-long interviews and think-aloud protocols. Setting – The offices and clinics of primary care physicians in Canada and the United States. Subjects – 25 primary care physicians of whom 4 were women, 17 were from Canada, 22 were family physicians, and 24 were board certified. Methods – Participants provided responses to 23 multiple-choice questions. Each physician then chose two questions and looked for the answers utilizing information resources of their own choice. The search processes, chosen resources and search times were noted. These were analyzed along with data on the accuracy of the answers and certainties related to the answer to each clinical question prior to the search. Main results – Twenty-three physicians sought answers to 46 simulated clinical questions. Utilizing only electronic information resources, physicians spent a mean of 13.0 (SD 5.5) minutes searching for answers to the questions, an average of 7.3 (SD 4.0) minutes for the first question and 5.8 (SD 2.2) minutes to answer the second question. On average, 1.8 resources were utilized per question. Resources that summarized information, such as the Cochrane Database of Systematic Reviews, UpToDate and Clinical Evidence, were favored 39.2% of the time, MEDLINE (Ovid and PubMed) 35.7%, and Internet resources including Google 22.6%. Almost 50% of the search and retrieval strategies were keyword-based, while MeSH, subheadings and limiting were used less frequently. On average, before searching physicians answered 10 of 23 (43.5%) questions accurately. For questions that were searched using clinician-selected electronic resources, 18 (39.1%) of the 46 answers were accurate before searching, while 19 (42.1%) were accurate after searching. The difference of one correct answer was due to the answers from 5 (10.9%) questions changing from correct to incorrect, while the answers to 6 questions (13.0%) changed from incorrect to correct. The ability to provide correct answers differed among the various resources. Google and Cochrane provided the correct answers about 50% of the time while PubMed, Ovid MEDLINE, UpToDate, Ovid Evidence Based Medicine Reviews and InfoPOEMs were more likely to be associated with incorrect answers. Physicians also seemed unable to determine when they needed to search for information in order to make an accurate decision. Conclusion – Clinician-selected electronic information resources did not guarantee accuracy in the answers provided to simulated clinical questions. At times the use of these resources caused physicians to change self-determined correct answers to incorrect ones. The authors state that this was possibly due to factors such as poor choice of resources, ineffective search strategies, time constraints and automation bias. Library and information practitioners have an important role to play in identifying and advocating for appropriate information resources to be integrated into the electronic medical record systems provided by health care institutions to ensure evidence based health care delivery.

Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

2003 ◽  
Vol 29 (4) ◽  
pp. 489-524
Author(s):  
Brent Pollitt
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
American Psychological Association ◽  
The United States ◽  
Psychotropic Medications ◽  
American Psychological ◽  
Training Requirements ◽  
Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

1566: BPH Management in an HMO Setting: Differences between Primary Care Physicians and Urologists

2007 ◽  
Vol 177 (4S) ◽  
pp. 517-517
Author(s):  
John M. Hollingsworth ◽  
Stephanie Daignault ◽  
Brent K. Hollenbeck ◽  
John T. Wei
Keyword(s):  
Primary Care ◽  
Primary Care Physicians

Abstract #81: Osteoporosis Screening by Primary Care Physicians in an Inner City Teaching Hospital in Brooklyn

2004 ◽  
Vol 10 ◽  
pp. 27
Author(s):  
Vaidehi Kaza ◽  
Eric A. Jaffe ◽  
Gerald Posner ◽  
Maria Ferandez-Renedo ◽  
Zewge S. Deribe
Keyword(s):  
Primary Care ◽  
Inner City ◽  
Teaching Hospital ◽  
Primary Care Physicians ◽  
Osteoporosis Screening
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