Winning Abstracts from the 2013 Medical Student Abstract Competition: Primary Care Physicians: Answering Clinical Questions in the Digital Age
Author: L. Austin Fredrickson, Northeastern Ohio University College of Medicine, Class of 2014
Introduction: With increased demands and limited time, doctors need quick and reliable resources to answer clinical questions regarding all aspects of patient care. The purpose of this study is to assess the information-seeking behavior and resource needs of primary care physicians at the point of care.
Methods: Consenting primary care physicians were observed during routine patient care delivery for three half-days. Data collected included physician demographics, practice type, length of the patient encounter, type of question, clinical category of question, information resource used to answer questions, device used to access the resource, and whether or not an answer was identified. Question types were categorized for analysis using Ely’s taxonomy of generic clinical questions.
Results: Twenty two physicians were observed in 600 patient-care encounters. The physicians were predominately male (72.7%), and spent an average of 17.5 years in practice (SD=9.8, r=1-35). The average encounter lasted approximately 13 minutes (r=1.05-50.78). Physicians who used an electronic health record or who worked in underserved clinics spent significantly less time with their patients than those who did not (p=<0.000).
Physicians had few clinical questions that they needed an answer to in relation to the number of encounters, averaging only 13 questions per 100 encounters. Most physicians (88.9%) used mobile devices to answer their questions, most often a cellular phone (66.7%). Medication questions were the most common, with the majority of questions associated with dosage (42.9%) and cost (14.3%). Correspondingly, Epocrates was the most commonly used resource (n=43). The times when physicians actually researched a clinical question, they did so more frequently while patients were in the room (66.2%), and usually found an answer (92.2%).
Conclusions: Physicians rarely needed to rely on an external source to answer their point-of-care clinical questions. However when they did have questions, medication-related questions were the most common. Physician practice may be positively impacted by educating physicians on quality medication resources that can easily and rapidly answer questions. By increasing access to these resources, physicians can directly improve patient care.
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