Barriers and facilitators to clinical information seeking: a systematic review

Information-seeking behaviour of primary care clinicians in Singapore at the point-of-care: A qualitative study

BACKGROUND

Clinicians' information-seeking behaviours impact patient care quality. Earlier studies indicated that barriers to accessing information deter clinicians from seeking answers to clinical questions.

OBJECTIVES

To explore primary care clinicians' information-seeking behaviour at point-of-care, focusing on when and how they seek answers to clinical questions.

METHODS

Semi-structured interviews were conducted with 45 clinicians after clinical sessions to investigate their information-seeking habits. Follow-up interviews were conducted after a week for those intending to address unanswered queries.

RESULTS

Two thirds of clinicians encountered questions during care, with nearly three quarters resolving them during the session. Colleagues, guidelines and online platforms were common information sources, with smartphones being used to access Google, WhatsApp or UpToDate®. Facilitators included reliable sources and the drive to confirm knowledge, while barriers included ineffective search methods and high workload. Despite challenges, most clinicians expressed satisfaction with their information-seeking process.

DISCUSSION

The findings underscore the increasing use of smartphones for accessing clinical information among Singaporean primary care clinicians and suggest the need for tailored training programmes and guidelines to optimise information-seeking practices.

CONCLUSION

Insights from this study can inform the development of training programmes and guidelines aimed at improving information-seeking practices among primary care clinicians, potentially enhancing patient care quality.

Identifying primary care clinicians' preferences for, barriers to, and facilitators of information-seeking in clinical practice in Singapore: a qualitative study

BACKGROUND

The growth of medical knowledge and patient care complexity calls for improved clinician access to evidence-based resources. This study aimed to explore the primary care clinicians' preferences for, barriers to, and facilitators of information-seeking in clinical practice in Singapore.

METHODS

A convenience sample of ten doctors and ten nurses was recruited. We conducted semi-structured face-to-face in-depth interviews. The interviews were recorded, transcribed verbatim, and analysed using thematic content analysis.

RESULTS

Of the 20 participants, eight doctors and ten nurses worked at government-funded polyclinics and two doctors worked in private practice. Most clinicians sought clinical information daily at the point-of-care. The most searched-for information by clinicians in practice was less common conditions. Clinicians preferred evidence-based resources such as clinical practice guidelines and UpToDate®. Clinical practice guidelines were mostly used when they were updated or based on memory. Clinicians also commonly sought answers from their peers. Furthermore, clinicians frequently use smartphones to access the Google search engine and UpToDate® app. The barriers to accessing clinical information included the lack of time, internet surfing separation of work computers, limited search functions in the organisation's server, and limited access to medical literature databases. The facilitators of accessing clinical information included convenience, easy access, and trustworthiness of information sources.

CONCLUSION

Most primary care clinicians in our study sought clinical information at the point-of-care daily and reported increasing use of smartphones for information-seeking. Future research focusing on interventions to improve access to credible clinical information for primary care clinicians at the point-of-care is recommended.

TRIAL REGISTRATION

This study has been reviewed by NHG Domain Specific Review Board (NHG DSRB) (the central ethics committee) for ethics approval. NHG DSRB Reference Number: 2018/01355 (31/07/2019).

Modelling of physicians' clinical information-seeking behaviour in Iran: a grounded theory study

OBJECTIVES

Exploring clinical information-seeking behaviour (CISB) and its associated factors contributes to its theoretical advancement and offers a valuable framework for addressing physicians' information needs. This study delved into the dimensions, interactions, strategies and determinants of CISB among physicians at the point of care.

DESIGN

A grounded theory study was developed based on Strauss and Corbin's approach. Data were collected by semistructured interviews and then analysed through open, axial and selective coding.

SETTING

The study was conducted at academic centres affiliated with Isfahan University of Medical Sciences.

PARTICIPANTS

This investigation involved recruiting 21 specialists and subspecialists from the academic centres.

RESULTS

The findings revealed that physicians' CISB encompassed multiple dimensions when addressing clinical inquiries. Seven principal themes emerged from the analysis: 'clinical information needs', 'clinical question characteristics', 'clinical information resources', 'information usability', 'factors influencing information seeking', 'action/interaction encountering clinical questions' and 'consequences of CISB'. The core category identified in this study was 'focused attention'.

CONCLUSIONS

The theoretical explanation demonstrated that the CISB process was interactive and dynamic. Various stimuli, including causal, contextual and intervening conditions, guide physicians in adopting information-seeking strategies and focusing on resolving clinical challenges. However, insufficient stimuli may hinder physicians' engagement in CISB. Understanding CISB helps managers, policy-makers, clinical librarians and information system designers optimally implement several interventions, such as suitable training methods, reviewing monitoring and evaluating information systems, improving clinical decision support systems, electronic medical records and electronic health records, as well as monitoring and evaluating these systems. Such measures facilitate focused attention on clinical issues and promote CISB among physicians.

Exploring the Information Sources Consulted by Doctors at the Point of Care in Four Selected South African Referral Hospitals

BACKGROUND

To provide an understanding of the clinical information sources consulted by teaching or referral hospital-based doctors in four South African provinces.

METHODS

A quantitative cross-sectional survey design was used. To identify provinces, hospitals, and participants, simple random sampling was adopted. This study targeted a total of 276 doctors from all the four hospitals working across different departments within the hospitals. This study was conducted in four selected South African public referral/teaching hospitals in four different provinces, namely Nelson Mandela Academic Hospital in the Eastern Cape province; Witbank Hospital in Mpumalanga province; Robert Mangaliso Sobukwe Hospital in Northern Cape province and lastly, Pietersburg Hospital in Limpopo province.

RESULTS

Overall, 221 doctors were surveyed. Doctors relied more on colleagues as formal and informal sources of information. They seldomly relied on newspapers, reference, and library books, or used hospital computers to access the internet. They seldomly attended training workshops organised by the district or provincial office. Protocols and clinical guidelines which are kept in the hospitals and easily accessible were often (27.9%) or always (51.1%) used.

CONCLUSIONS

Teaching hospitals need to strengthen information resources to ensure that even when colleagues are used as an information source, they are an accessible means to validate the correctness of the information provided.

Examining primary care provider experiences with using a clinical decision support tool for pain management

Objective

To evaluate primary care provider (PCP) experiences using a clinical decision support (CDS) tool over 16 months following a user-centered design process and implementation.

Materials and Methods

We conducted a qualitative evaluation of the Chronic Pain OneSheet (OneSheet), a chronic pain CDS tool. OneSheet provides pain- and opioid-related risks, benefits, and treatment information for patients with chronic pain to PCPs. Using the 5 Rights of CDS framework, we conducted and analyzed semi-structured interviews with 19 PCPs across 2 academic health systems.

Results

PCPs stated that OneSheet mostly contained the right information required to treat patients with chronic pain and was correctly located in the electronic health record. PCPs used OneSheet for distinct subgroups of patients with chronic pain, including patients prescribed opioids, with poorly controlled pain, or new to a provider or clinic. PCPs reported variable workflow integration and selective use of certain OneSheet features driven by their preferences and patient population. PCPs recommended broadening OneSheet access to clinical staff and patients for data entry to address clinician time constraints.

Discussion

Differences in patient subpopulations and workflow preferences had an outsized effect on CDS tool use even when the CDS contained the right information identified in a user-centered design process.

Conclusions

To increase adoption and use, CDS design and implementation processes may benefit from increased tailoring that accommodates variation and dynamics among patients, visits, and providers.

Smartphone apps for point-of-care information summaries: systematic assessment of the quality and content

BACKGROUND

Clinicians need easy access to evidence-based information to inform their clinical practice. Point-of-care information summaries are increasingly available in the form of smartphone apps. However, the quality of information from the apps is questionable as there is currently no regulation on the content of the medical apps.

OBJECTIVES

This study aimed to systematically assess the quality and content of the medical apps providing point-of-care information summaries that were available in two major app stores. We evaluated apps designed specifically for healthcare professionals and assessed their content development, editorial policy, coverage of medical conditions and trustworthiness.

METHODS

We conducted a systematic assessment of medical apps providing point-of-care information summaries available in Google Play and Apple app stores. Apps launched or updated since January 2020 were identified through a systematic search using 42matters. Apps meeting the inclusion criteria were downloaded and assessed. The data extraction and app assessment were done in parallel and independently by at least two reviewers. Apps were evaluated against the adapted criteria: (1) general characteristics, (2) content presentation of the summaries, (3) editorial quality, (4) evidence-based methodology, (5) coverage (volume) of the medical conditions, (6) usability of apps and (7) trustworthiness of the app based on HONcode principles. HONcode principles are guidelines used to inform users about the credibility and reliability of health information online. The results were reported as a narrative review.

RESULTS

Eight medical apps met the inclusion criteria and were systematically appraised. Based on our evaluation criteria, UpToDate supported 16 languages, and all other apps were English. Bullet points and brief paragraphs were used in all apps, and only DynaMed and Micromedex and Pathway-medical knowledge provided a formal grading system for the strength of recommendations for all the medical conditions in their apps. All the other apps either lacked a formal grading system altogether or offered one for some of the medical conditions. About 30% of the editorial quality assessment and 47.5% of the evidence-based methodology assessment were unclear or missing. UpToDate contained the most point-of-care evidence-based documents with >10 500 documents. All apps except 5-Minute Clinical Consult and DynaMed and Micromedex were available for offline access. Only Medscape complied with the HONcode principles.

CONCLUSIONS

Future apps should report a more detailed evidence-based methodology, be accessible for offline use and support search in more than one language. There should be clearer information provided in future apps regarding the declaration of authorship and conflict of interest.

Designing for digital transformation of residency education - a post-pandemic pedagogical response

BACKGROUND

The forced transition to emergency remote teaching (ERT) during the COVID-19 pandemic has significantly impacted health professions education worldwide. In Sweden, the need for alternative solutions for the training of junior doctors became urgent, as many of the mandatory onsite courses required for residents to qualify as specialists were canceled. The purpose of this study was to understand course leaders' perceptions and experiences of using digital technologies, such as video conferencing, to teach medical residents (ST) during the pandemic and beyond.

METHODS

A qualitative study using semi-structured interviews was conducted with seven course leaders responsible for residency courses during the first year of the pandemic to capture their perceptions and experiences. The interviews were transcribed verbatim and analyzed using thematic analysis, drawing on the technology affordances and constraints theory (TACT) as a framework to explore pedagogical strategies and new teaching practices emerging from the forced use of digital technologies for remote teaching.

RESULTS

The data analysis revealed affordances of, as well as constraints to, teaching specialist medical training during the pandemic. The findings show that the use of digital conference technologies for ERT can both enable and inhibit social interactions, the interactive learning environment and the utilization of technological features, depending on the individual course leaders' goals of using the technology and the situated context of the teaching.

CONCLUSIONS

The study reflects the course leaders' pedagogical response to the pandemic, as remote teaching became the only way to provide residency education. Initially, the sudden shift was perceived as constraining, but over time they found new affordances through the enforced use of digital technology that helped them not only to cope with the transition but also to innovate their pedagogical methods. After a rapid, forced shift from on-site to digital courses, it is crucial to utilize experiences to create better preconditions for digital technology to facilitate learning in the future.

Locating Medical Information during an Infodemic: Information Seeking Behavior and Strategies of Health-Care Workers in Germany

BACKGROUND

The COVID-19 pandemic has led to a flood of-often contradictory-evidence. HCWs had to develop strategies to locate information that supported their work. We investigated the information-seeking of different HCW groups in Germany.

METHODS

In December 2020, we conducted online surveys on COVID-19 information sources, strategies, assigned trustworthiness, and barriers-and in February 2021, on COVID-19 vaccination information sources. Results were analyzed descriptively; group comparisons were performed using χ²-tests.

RESULTS

For general COVID-19-related medical information (413 participants), non-physicians most often selected official websites (57%), TV (57%), and e-mail/newsletters (46%) as preferred information sources-physicians chose official websites (63%), e-mail/newsletters (56%), and professional journals (55%). Non-physician HCWs used Facebook/YouTube more frequently. The main barriers were insufficient time and access issues. Non-physicians chose abstracts (66%), videos (45%), and webinars (40%) as preferred information strategy; physicians: overviews with algorithms (66%), abstracts (62%), webinars (48%). Information seeking on COVID-19 vaccination (2700 participants) was quite similar, however, with newspapers being more often used by non-physicians (63%) vs. physician HCWs (70%).

CONCLUSION

Non-physician HCWs more often consulted public information sources. Employers/institutions should ensure the supply of professional, targeted COVID-19 information for different HCW groups.

Dengue-Related Information Needs and Information-Seeking Behavior in Pakistan

This present study aims to examine the information needs and information-seeking behavior of Dengue-affected and non-affected people by exploring their information needs, resources used, and obstacles encountered. A structured questionnaire was used to collect data from 100 Dengue patients and 200 non-patients. The collected data were analyzed by applying descriptive and inferential statistics. The findings revealed that a majority of the respondents had information needs regarding nutritional options, best approaches to treatment, and expected benefits of treatment. They mostly sought information to keep themselves up-to-date and to prevent the disease. Television, Internet search engines, and social media outlets were frequently used information sources along with information-seeking from family and friends. Respondents with higher academic qualifications reported comparatively higher Dengue-related information needs. Moreover, age was a positive predictor of both their information needs and frequency of using health information sources. The findings will be helpful for healthcare providers to tailor Dengue awareness campaigns and prevention strategies according to the public needs and preferences.

Performance of a Web-Based Reference Database With Natural Language Searching Capabilities: Usability Evaluation of DynaMed and Micromedex With Watson

BACKGROUND

Evidence-based point-of-care information (POCI) tools can facilitate patient safety and care by helping clinicians to answer disease state and drug information questions in less time and with less effort. However, these tools may also be visually challenging to navigate or lack the comprehensiveness needed to sufficiently address a medical issue.

OBJECTIVE

This study aimed to collect clinicians' feedback and directly observe their use of the combined POCI tool DynaMed and Micromedex with Watson, now known as DynaMedex. EBSCO partnered with IBM Watson Health, now known as Merative, to develop the combined tool as a resource for clinicians. We aimed to identify areas for refinement based on participant feedback and examine participant perceptions to inform further development.

METHODS

Participants (N=43) within varying clinical roles and specialties were recruited from Brigham and Women's Hospital and Massachusetts General Hospital in Boston, Massachusetts, United States, between August 10, 2021, and December 16, 2021, to take part in usability sessions aimed at evaluating the efficiency and effectiveness of, as well as satisfaction with, the DynaMed and Micromedex with Watson tool. Usability testing methods, including think aloud and observations of user behavior, were used to identify challenges regarding the combined tool. Data collection included measurements of time on task; task ease; satisfaction with the answer; posttest feedback on likes, dislikes, and perceived reliability of the tool; and interest in recommending the tool to a colleague.

RESULTS

On a 7-point Likert scale, pharmacists rated ease (mean 5.98, SD 1.38) and satisfaction (mean 6.31, SD 1.34) with the combined POCI tool higher than the physicians, nurse practitioner, and physician's assistants (ease: mean 5.57, SD 1.64, and satisfaction: mean 5.82, SD 1.60). Pharmacists spent longer (mean 2 minutes, 26 seconds, SD 1 minute, 41 seconds) on average finding an answer to their question than the physicians, nurse practitioner, and physician's assistants (mean 1 minute, 40 seconds, SD 1 minute, 23 seconds).

CONCLUSIONS

Overall, the tool performed well, but this usability evaluation identified multiple opportunities for improvement that would help inexperienced users.

Electronic Health Records' Support for Primary Care Physicians' Situation Awareness: A Metanarrative Review

OBJECTIVE

Situation awareness (SA) refers to people's perception and understanding of their dynamic environment. In primary care, reduced SA among physicians increases errors in clinical decision-making and, correspondingly, patients' risk of experiencing adverse outcomes. Our objective was to understand the extent to which electronic health records (EHRs) support primary care physicians (PCPs)' SA during clinical decision-making.

METHOD

We conducted a metanarrative review of papers in selected academic databases, including CINAHL and MEDLINE. Eligible studies included original peer-reviewed research published between January 2012 and August 2020 on PCP-EHR interactions. We iteratively queried, screened, and summarized literature focused on EHRs supporting PCPs' clinical decision-making and care management for adults. Then, we mapped findings to an established SA framework to classify external factors (individual, task, and system) affecting PCPs' levels of SA (1-Perception, 2-Comprehension, and 3-Projection) and identified SA barriers.

RESULTS

From 1504 articles identified, we included and synthesized 19 studies. Study designs were largely noninterventional. Studies described EHR workflow misalignments, usability issues, and communication challenges. EHR information, including lab results and care plans, was characterized as incomplete, untimely, or irrelevant. Unmet information needs made it difficult for PCPs to obtain even basic SA, Level 1 SA. Prevalent barriers to PCPs developing SA with EHRs were errant mental models, attentional tunneling, and data overload.

CONCLUSION

Based on our review, EHRs do not support the development of higher levels of SA among PCPs. Review findings suggest SA-oriented design processes for health information technology could improve PCPs' SA, satisfaction, and decision-making.

Use of Videos by Health Care Professionals for Procedure Support in Acute Cardiac Care: A Scoping Review

BACKGROUND

Cardiology procedures are often life-saving and time-critical, but some are so infrequent that health care staff may have rarely encountered them in practice or need to refresh their skills rapidly. Videos demonstrating procedures have the potential to assist health care professionals and support safe patient care. This scoping review explores the research literature involving the use of video by health care professionals in hospitals.

AIM

To identify what is known from research regarding the use of video to support clinical procedures in hospitals or health care facilities.

METHOD

The Joanna Briggs Institute Scoping review methodology guided our systematic search of peer-reviewed evidence related to video use to support procedures in a hospital or health care facility. Data sources included the electronic databases: ProQuest, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, Excerpta Medica dataBASE (EMBASE), Scopus, and PubMed.

FINDINGS

Seventeen (17) studies that met the inclusion criteria were included in the review, all published between 2012 and 2022. Since 2005, YouTube has become the dominant platform for publishing or sourcing videos related to clinical procedures. Studies to date can be summarised under five themes: 1) video content and purpose, 2) target audience, 3) video hosting site-internal websites versus YouTube, 4) curated versus original 'homegrown' video content, and 5) video development process.

DISCUSSION/CONCLUSION

Research on the development and utility of videos to support clinical procedures is emerging, with the ability to host videos on platforms such as YouTube becoming more accessible in recent years. All videos were designed to enhance health care professionals' existing knowledge and skills within their scope of practice. The available literature suggests that video can be a valuable clinical resource for both simple and skilled procedures. Video resources can help clinicians perform or assist with rare procedures, providing 'just in time' patient safety prompts and information.

Effective web-based clinical practice guidelines resources: recommendations from a mixed methods usability study

BACKGROUND

Clinical practice guidelines (CPG) are an important knowledge translation resource to help clinicians stay up to date about relevant clinical knowledge. Effective communication of guidelines, including format, facilitates its implementation. Despite the digitalization of healthcare, there is little literature to guide CPG website creation for effective dissemination and implementation. Our aim was to assess the effectiveness of the content and format of the Diabetes Canada CPG website, and use our results to inform recommendations for other CPG websites.

METHODS

Fourteen clinicians (family physicians, nurses, pharmacists, and dieticians) in diabetes care across Canada participated in this mixed-methods study (questionnaires, usability testing and interviews). Participants "thought-aloud" while completing eight usability tasks on the CPG website. Outcomes included task success rate, completion time, click per tasks, resource used, paths, search attempts and success rate, and error types. Participants were then interviewed.

RESULTS

The Diabetes Canada CPG website was found to be usable. Participants had a high task success rate of 79% for all tasks and used 144 (standard deviation (SD) = 152) seconds and 4.6 (SD = 3.9) clicks per task. Interactive tools were most frequently used compared to full guidelines and static tools. Misinterpretation accounted for 48% of usability errors. Participants overall found the website intuitive, with effective content and design elements.

CONCLUSION

Different versions of CPG information (e.g. interactive tools, quick reference guide, static tools) can help answer clinical questions more quickly. Effective web design should be assessed during CPG website creation for effective guideline dissemination and implementation.

Doctor! Did you Google my symptoms? A qualitative study of patient perceptions of doctors' point-of-care information seeking

OBJECTIVE

To explore patient perceptions regarding doctors' information seeking during consultations.

DESIGN AND SETTING

Qualitative interviews with participants from six general practice waiting rooms in South East Queensland, Australia. Participants were asked about their experiences and opinions, and to comment on short videos of simulated consultations in which a doctor sought information. The interviews were analysed through a process of iterative thematic analysis using the framework of Braun and Clarke.

PARTICIPANTS

The 16 participants were purposively sampled including 5 men and 11 women from a diverse range of educational and age groups.

RESULTS

How a doctor's need to look up information impacted patient impressions of competence and trust was an overarching theme. The four dominant themes include: the trust a patient has in the doctor before the consultation, whether the doctor is expected to know the answer to a question without searching, has the doctor added value to the consultation by searching and the consultation skills used in the process.

CONCLUSIONS

Patient trust is fundamental to positive perceptions of general practitioners' information seeking at the point-of-care. Communication is key to building this trust. Understanding the patient's agenda, listening, assessing thoroughly and being honest and transparent about the need to seek information all contribute to a positive experience.

Looking at Library Resource Usage Trends in Medical Residents & Fellows: Survey Results from 2006-2021

Since 2006, the University of Tennessee's Preston Medical Library has collected survey feedback from exiting residents through targeted emails or at the required exit process in the library. Questions ask residents which types of articles or sources they use to find information and address the resident's use of the library's physical space. Survey results from 2006 to 2021 were examined for trends and changes in resident utilization of resources to better inform future library decisions on instruction and marketing. Resident resource usage varied over time and demonstrated an encouraging increase in attention to evidence-based tools. UpToDate's consistent popularity shows the durability of the product. A reported increase in use of reviews, randomized controlled trials, case reports, and practice guidelines reflects greater employment of more in-depth resources than merely expert opinion. At the same time, residents clearly valued the library's physical space. Survey results will inform future outreach focus.

Information retrieval at the point of care of community family physicians in Arab countries

This study is based on Jumana Antoun's PhD thesis at Walden University, USA examining the information retrieval behaviour of 72 community family physicians' at the point of care in eight Arab countries in the Eastern Mediterranean. The key findings were that participants looked for digital clinical information at the point of care on average 14.0 times per week with the majority (80.3%) using a mobile phone. Clinical information about medication dosage and side effects was the most sought clinical question, and patient education was the least. Almost half of the participants considered that they often found relevant (55.6%), useful (56.9%) and unbiased (58.3%) information. Whilst none of the factors examined predicted the physicians' self-reported effectiveness and efficiency at information retrieval, the implication for practice points clearly to the barriers and the need for curricula to focus on search strategies using free resources at the point of care.

Artificial intelligence behind the scenes: PubMed's Best Match algorithm

This article focuses on PubMed's Best Match sorting algorithm, presenting a simplified explanation of how it operates and highlighting how artificial intelligence affects search results in ways that are not seen by users. We further discuss user search behaviors and the ethical implications of algorithms, specifically for health care practitioners. PubMed recently began using artificial intelligence to improve the sorting of search results using a Best Match option. In 2020, PubMed deployed this algorithm as the default search method, necessitating serious discussion around the ethics of this and similar algorithms, as users do not always know when an algorithm uses artificial intelligence, what artificial intelligence is, and how it may impact their everyday tasks. These implications resonate strongly in health care, in which the speed and relevancy of search results is crucial but does not negate the importance of a lack of bias in how those search results are selected or presented to the user. As a health care provider will not often venture past the first few results in search of a clinical decision, will Best Match help them find the answers they need more quickly? Or will the algorithm bias their results, leading to the potential suppression of more recent or relevant results?

Strategies to implement SARS-CoV-2 point-of-care testing into primary care settings: a qualitative secondary analysis guided by the Behaviour Change Wheel

BACKGROUND

The purpose of this study is to develop a theory-driven understanding of the barriers and facilitators underpinning physicians' attitudes and capabilities to implementing SARS-CoV-2 point-of-care (POC) testing into primary care practices.

METHODS

We used a secondary qualitative analysis approach to re-analyse data from a qualitative, interview study of 22 primary care physicians from 21 primary care practices across three regions in England. We followed the three-step method based on the Behaviour Change Wheel to identify the barriers to implementing SARS-CoV-2 POC testing and identified strategies to address these challenges.

RESULTS

Several factors underpinned primary care physicians' attitudes and capabilities to implement SARS-CoV-2 POC testing into practice. First, limited knowledge of the SARS-CoV-2 POC testing landscape and a demanding workload affected physicians' willingness to use the tests. Second, there was scepticism about the insufficient evidence pertaining to the clinical efficacy and utility of POC tests, which affected physicians' confidence in the accuracy of tests. Third, physicians would adopt POC tests if they were prescribed and recommended by authorities. Fourth, physicians required professional education and training to increase their confidence in using POC tests but also suggested that healthcare assistants should administer the tests. Fifth, physicians expressed concerns about their limited workload capacity and that extra resources are needed to accommodate any anticipated changes. Sixth, information sharing across practices shaped perceptions of POC tests and the quality of information influenced physician perceptions. Seventh, financial incentives could motivate physicians and were also needed to cover the associated costs of testing. Eighth, physicians were worried that society will view primary care as an alternative to community testing centres, which would change perceptions around their professional identity. Ninth, physicians' perception of assurance/risk influenced their willingness to use POC testing if it could help identify infectious individuals, but they were also concerned about the risk of occupational exposure and potentially losing staff members who would need to self-isolate.

CONCLUSIONS

Improving primary care physicians' knowledgebase of SARS-CoV-2 POC tests, introducing policies to embed testing into practice, and providing resources to meet the anticipated demands of testing are critical to implementing testing into practice.

Unmet informatics needs of nurses regarding the use of personal smartphones in the workplace

AIMS

This study aimed to investigate the differences in practices, policies, and perceptions of nurses regarding work-related utilization of smartphones in acute-care settings.

BACKGROUND

Mobile devices utilizing emerging technology are widely used in acute-care settings; however, concerns such as potential distraction, improper use, and negative impact on the nursing image in clinical practice remain valid.

METHODS

Nurse managers (n = 8) and nurses (n = 181) were enrolled from eight academic tertiary hospitals that have comprehensive electronic medical record systems and mobile versions. Between October 2018 and February 2019, participants completed a questionnaire designed to explore their use of smartphones. The reporting guide for self-administered surveys of clinicians was applied.

RESULTS

Approximately 80% of nurses carried personal smartphones while working, with 70% using their devices for work. The prevalence of work-related smartphone use ranged from 3% to 43% by functionality, which was lower than that estimated by managers. Frequent uses included taking pictures/videos and internet browsing. Nurses were more positive than managers about the benefits of smartphone use and less burdened by related concerns. Novice and junior nurses were more optimistic than senior nurses. Only one hospital had a policy on nurses' use of personal devices at work.

CONCLUSION

Two unmet needs in the current clinical information system were identified: information supporting task-related knowledge at the bedside and security of data capture and communication.

IMPLICATION FOR NURSING POLICY

The unintended perception gaps between nurses and managers regarding work-related smartphone use can be closed by nursing leadership. Unmet nursing informatics, particularly for information-seeking purposes, can be addressed in the context of quality assurance. Nurse leaders can advocate secure and proper use of smartphones in clinical practice.

Personalized and Self-Management: Systematic Search and Evaluation Quality Factors and User Preference of Drug Reference Apps in Taiwan

Background: Drug reference apps promote self-management and improve the efficiency and quality of work for physicians, nurses, pharmacists, and patients. This study aimed to describe a systematic and stepwise process to identify drug reference apps in Taiwan, assess the quality of these apps, and analyze the influential factors for user ratings. Methods: A two-step algorithm (KESS) consisting of keyword growing and systematic search was proposed. Seven independent reviewers were trained to evaluate these apps using Mobile App Rating Scale (MARS). A logistic regression model was fitted and average marginal effects (AME) were calculated to identify the effects of factors for higher user ratings. Results: A total of 23 drug reference apps in Taiwan were identified and analyzed. Generally, these drug reference apps were evaluated as acceptable quality with an average MARS score of 3.23. Higher user engagement, more functionality, better aesthetics, and more information associated with higher user ratings. Navigation is the most influential factor on higher user ratings (AME: 13.15%) followed by performance (AME: 11.03%), visual appeal (AME: 10.87%), credibility (AME: 10.67%), and quantity of information (AME: 10.42%). Conclusions: User experience and information clearly affect user ratings of drug reference apps. Five key factors should be considered when designing drug reference apps.

A Novel Partnership Between Physicians and Medical Librarians During the COVID-19 Pandemic

An ongoing collaboration between physicians and librarians provided critical information during the COVID-19 pandemic. A development team, which consisted of the hospital and medical school disaster preparedness medical director, the medical library director, professional librarians, and the Departments of IT and Marketing in a multi-state healthcare system worked together to develop a shared website to distribute and curate timely resources during COVID-19. The initial impacts of this collaboration and the website show the benefits of this novel partnership.

Why are they not accessing it? User barriers to clinical information access

The Medical Library Association's InSight Initiative provides an open and collaborative environment for library and industry partners to discuss vexing problems and find solutions to better serve their users. The initiative's fifth summit, continuing work from the previous summit, focused on understanding how users discover and access information in the clinical environment. During the summit, participants were divided into working groups and encouraged to create a tangible product as a result of their discussions. At the end of the summit, participants established a framework for understanding users' pain points, discussed possible solutions to those points, and received feedback on their work from an End User Advisory Board comprising physicians, clinical researchers, and clinical faculty in biomedicine. In addition to the pain point framework, participants are developing MLA InSight Initiative Learning content with modules to educate librarians and publishers about critical aspects of user behavior. The 2020 Insight Initiative Fall Forum will serve as a virtual home for constructive dialogue between health sciences librarians and publishers on improving discovery and access to information.

Physiotherapists' Use of Web-Based Information Resources to Fulfill Their Information Needs During a Theoretical Examination: Randomized Crossover Trial

Background

The widespread availability of internet-connected smart devices in the health care setting has the potential to improve the delivery of research evidence to the care pathway and fulfill health care professionals’ information needs.

Objective

This study aims to evaluate the frequency with which physiotherapists experience information needs, the capacity of digital information resources to fulfill these needs, and the specific types of resources they use to do so.

Methods

A total of 38 participants (all practicing physiotherapists; 19 females, 19 males) were randomly assigned to complete three 20-question multiple-choice questionnaire (MCQ) examinations under 3 conditions in a randomized crossover study design: assisted by a web browser, assisted by a federated search portal system, and unassisted. MCQ scores, times, and frequencies of information needs were recorded for overall examination-level and individual question-level analyses. Generalized estimating equations were used to assess differences between conditions for the primary outcomes. A log file analysis was conducted to evaluate participants’ web search and retrieval behaviors.

Results

Participants experienced an information need in 55.59% (845/1520) MCQs (assisted conditions only) and exhibited a mean improvement of 10% and 16% in overall examination scores for the federated search and web browser conditions, respectively, compared with the unassisted condition (P<.001). In the web browser condition, Google was the most popular resource and the only search engine used, accounting for 1273 (64%) of hits, followed by PubMed (195 hits; 10% of total). In the federated search condition, Wikipedia and PubMed were the most popular resources with 1518 (46% of total) and 1273 (39% of total) hits, respectively.

Conclusions

In agreement with the findings of previous research studies among medical physicians, the results of this study demonstrate that physiotherapists frequently experience information needs. This study provides new insights into the preferred digital information resources used by physiotherapists to fulfill these needs. Future research should clarify the implications of physiotherapists’ apparent high reliance on Google, whether these results reflect the authentic clinical environment, and whether fulfilling clinical information needs alters practice behaviors or improves patient outcomes.

A scoping review of clinical decision support tools that generate new knowledge to support decision making in real time

OBJECTIVE

A growing body of observational data enabled its secondary use to facilitate clinical care for complex cases not covered by the existing evidence. We conducted a scoping review to characterize clinical decision support systems (CDSSs) that generate new knowledge to provide guidance for such cases in real time.

MATERIALS AND METHODS

PubMed, Embase, ProQuest, and IEEE Xplore were searched up to May 2020. The abstracts were screened by 2 reviewers. Full texts of the relevant articles were reviewed by the first author and approved by the second reviewer, accompanied by the screening of articles' references. The details of design, implementation and evaluation of included CDSSs were extracted.

RESULTS

Our search returned 3427 articles, 53 of which describing 25 CDSSs were selected. We identified 8 expert-based and 17 data-driven tools. Sixteen (64%) tools were developed in the United States, with the others mostly in Europe. Most of the tools (n = 16, 64%) were implemented in 1 site, with only 5 being actively used in clinical practice. Patient or quality outcomes were assessed for 3 (18%) CDSSs, 4 (16%) underwent user acceptance or usage testing and 7 (28%) functional testing.

CONCLUSIONS

We found a number of CDSSs that generate new knowledge, although only 1 addressed confounding and bias. Overall, the tools lacked demonstration of their utility. Improvement in clinical and quality outcomes were shown only for a few CDSSs, while the benefits of the others remain unclear. This review suggests a need for a further testing of such CDSSs and, if appropriate, their dissemination.

Use of online knowledge base in primary health care and correlation to health care quality: an observational study

Background

Evidence-based information available at the point of care improves patient care outcomes. Online knowledge bases can increase the application of evidence-based medicine and influence patient outcome data which may be captured in quality registries. The aim of this study was to explore the effect of use of an online knowledge base on patient experiences and health care quality.

Methods

The study was conducted as a retrospective, observational study of 24 primary health care centers in Sweden exploring their use of an online knowledge base. Frequency of use was compared to patient outcomes in two national quality registries. A socio-economic Care Need Index was applied to assess whether the burden of care influenced the results from those quality registries. Non-parametric statistical methods and linear regression were used.

Results

Frequency of knowledge base use showed two groups: frequent and non-frequent users, with a significant use difference between the groups (p < 0.001). Outcome data showed significant higher values for all seven National Primary Care Patient Survey dimensions in the frequent compared to the non-frequent knowledge base users (p < 0.001), whereas 10 out of 11 parameters in the National Diabetes Register showed no differences between the groups (p > 0.05). Adjusting for Care Need Index had almost no effect on the outcomes for the groups.

Conclusions

Frequent users of a national online knowledge base received higher ratings on patient experiences, but figures on health care quality in diabetes showed near to no correlation. The findings indicate that some effects may be attributed to the use of knowledge bases and requires a controlled evaluation.

Characterizing physicians' information needs related to a gap in knowledge unmet by current evidence

OBJECTIVE

The study sought to explore information needs arising from a gap in clinicians' knowledge that is not met by current evidence and identify possible areas of use and target groups for a future clinical decision support system (CDSS), which will guide clinicians in cases where no evidence exists.

MATERIALS AND METHODS

We interviewed 30 physicians in a large academic medical center, analyzed transcripts using deductive thematic analysis, and developed a set of themes of information needs related to a gap in knowledge unmet by current evidence. We conducted additional statistical analyses to identify the correlation between clinical experience, clinical specialty, settings of clinical care, and the characteristics of the needs.

RESULTS

This study resulted in a set of themes and subthemes of information needs arising from a gap in current evidence. Experienced physicians and inpatient physicians had more questions and the number of questions did not decline with clinical experience. The main areas of information needs included patients with comorbidities, elderly and children, new drugs, and rare disorders. To address these questions, clinicians most often used a commercial tool, guidelines, and PubMed. While primary care physicians preferred the commercial tool, specialty physicians sought more in-depth knowledge.

DISCUSSION

The current medical evidence appeared to be inadequate in covering specific populations such as patients with multiple comorbidities and elderly, and was sometimes irrelevant to complex clinical scenarios. Our findings may suggest that experienced and inpatient physicians would benefit from a CDSS that generates evidence in real time at the point of care.

CONCLUSIONS

We found that physicians had information needs, which arose from the gaps in current medical evidence. This study provides insights on how the CDSS that aims at addressing these needs should be designed.