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Stacey D, Lewis KB, Smith M, Carley M, Volk R, Douglas EE, Pacheco-Brousseau L, Finderup J, Gunderson J, Barry MJ, Bennett CL, Bravo P, Steffensen K, Gogovor A, Graham ID, Kelly SE, Légaré F, Sondergaard H, Thomson R, Trenaman L, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2024; 1:CD001431. [PMID: 38284415 PMCID: PMC10823577 DOI: 10.1002/14651858.cd001431.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Patient decision aids are interventions designed to support people making health decisions. At a minimum, patient decision aids make the decision explicit, provide evidence-based information about the options and associated benefits/harms, and help clarify personal values for features of options. This is an update of a Cochrane review that was first published in 2003 and last updated in 2017. OBJECTIVES To assess the effects of patient decision aids in adults considering treatment or screening decisions using an integrated knowledge translation approach. SEARCH METHODS We conducted the updated search for the period of 2015 (last search date) to March 2022 in CENTRAL, MEDLINE, Embase, PsycINFO, EBSCO, and grey literature. The cumulative search covers database origins to March 2022. SELECTION CRITERIA We included published randomized controlled trials comparing patient decision aids to usual care. Usual care was defined as general information, risk assessment, clinical practice guideline summaries for health consumers, placebo intervention (e.g. information on another topic), or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened citations for inclusion, extracted intervention and outcome data, and assessed risk of bias using the Cochrane risk of bias tool. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made (informed values-based choice congruence) and the decision-making process, such as knowledge, accurate risk perceptions, feeling informed, clear values, participation in decision-making, and adverse events. Secondary outcomes were choice, confidence in decision-making, adherence to the chosen option, preference-linked health outcomes, and impact on the healthcare system (e.g. consultation length). We pooled results using mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs), applying a random-effects model. We conducted a subgroup analysis of 105 studies that were included in the previous review version compared to those published since that update (n = 104 studies). We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the certainty of the evidence. MAIN RESULTS This update added 104 new studies for a total of 209 studies involving 107,698 participants. The patient decision aids focused on 71 different decisions. The most common decisions were about cardiovascular treatments (n = 22 studies), cancer screening (n = 17 studies colorectal, 15 prostate, 12 breast), cancer treatments (e.g. 15 breast, 11 prostate), mental health treatments (n = 10 studies), and joint replacement surgery (n = 9 studies). When assessing risk of bias in the included studies, we rated two items as mostly unclear (selective reporting: 100 studies; blinding of participants/personnel: 161 studies), due to inadequate reporting. Of the 209 included studies, 34 had at least one item rated as high risk of bias. There was moderate-certainty evidence that patient decision aids probably increase the congruence between informed values and care choices compared to usual care (RR 1.75, 95% CI 1.44 to 2.13; 21 studies, 9377 participants). Regarding attributes related to the decision-making process and compared to usual care, there was high-certainty evidence that patient decision aids result in improved participants' knowledge (MD 11.90/100, 95% CI 10.60 to 13.19; 107 studies, 25,492 participants), accuracy of risk perceptions (RR 1.94, 95% CI 1.61 to 2.34; 25 studies, 7796 participants), and decreased decisional conflict related to feeling uninformed (MD -10.02, 95% CI -12.31 to -7.74; 58 studies, 12,104 participants), indecision about personal values (MD -7.86, 95% CI -9.69 to -6.02; 55 studies, 11,880 participants), and proportion of people who were passive in decision-making (clinician-controlled) (RR 0.72, 95% CI 0.59 to 0.88; 21 studies, 4348 participants). For adverse outcomes, there was high-certainty evidence that there was no difference in decision regret between the patient decision aid and usual care groups (MD -1.23, 95% CI -3.05 to 0.59; 22 studies, 3707 participants). Of note, there was no difference in the length of consultation when patient decision aids were used in preparation for the consultation (MD -2.97 minutes, 95% CI -7.84 to 1.90; 5 studies, 420 participants). When patient decision aids were used during the consultation with the clinician, the length of consultation was 1.5 minutes longer (MD 1.50 minutes, 95% CI 0.79 to 2.20; 8 studies, 2702 participants). We found the same direction of effect when we compared results for patient decision aid studies reported in the previous update compared to studies conducted since 2015. AUTHORS' CONCLUSIONS Compared to usual care, across a wide variety of decisions, patient decision aids probably helped more adults reach informed values-congruent choices. They led to large increases in knowledge, accurate risk perceptions, and an active role in decision-making. Our updated review also found that patient decision aids increased patients' feeling informed and clear about their personal values. There was no difference in decision regret between people using decision aids versus those receiving usual care. Further studies are needed to assess the impact of patient decision aids on adherence and downstream effects on cost and resource use.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Meg Carley
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robert Volk
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elisa E Douglas
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael J Barry
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | - Carol L Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Paulina Bravo
- Education and Cancer Prevention, Fundación Arturo López Pérez, Santiago, Chile
| | - Karina Steffensen
- Center for Shared Decision Making, IRS - Lillebælt Hospital, Vejle, Denmark
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec, Canada
| | - Ian D Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Shannon E Kelly
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Université Laval, Quebec, Canada
| | | | - Richard Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
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Walter AL, Baty F, Rassouli F, Bilz S, Brutsche MH. Diagnostic precision and identification of rare diseases is dependent on distance of residence relative to tertiary medical facilities. Orphanet J Rare Dis 2021; 16:131. [PMID: 33745447 PMCID: PMC7983389 DOI: 10.1186/s13023-021-01769-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diagnostic precision and the identification of rare diseases is a daily challenge, which needs specialized expertise. We hypothesized, that there is a correlation between the distance of residence to the next tertiary medical facility with highly specialized care and the diagnostic precision, especially for rare diseases. RESULTS Using a nation-wide hospitalization database, we found a negative association between diagnostic diversity and travel time to the next tertiary referral hospital when including all cases throughout the overall International Classification of Diseases version 10 German Modification (ICD-10-GM) diagnosis codes. This was paralleled with a negative association of standardized incidence rates in all groups of rare diseases defined by the Orphanet rare disease nomenclature, except for rare teratologic and rare allergic diseases. CONCLUSION Our findings indicate a higher risk of being mis-, under- or late diagnosed especially in rare diseases when living more distant to a tertiary medical facility. Greater distance to the next tertiary medical facility basically increases the chance for hospitalization in a non-comprehensive regional hospital with less diagnostic capacity, and, thus, impacts on adapted health care access. Therefore, solutions for overcoming the distance to specialized care as an indicator of health care access are a major goal in the future.
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Affiliation(s)
- Anna-Lena Walter
- Lung Center, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.
| | - Florent Baty
- Lung Center, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Frank Rassouli
- Lung Center, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Stefan Bilz
- Center for Rare Diseases of Eastern Switzerland (ZSK-O), Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Martin Hugo Brutsche
- Lung Center, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
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Rendon P, Roesch J, Dhaliwal G. The Writing on the Wall: An Exercise in Clinical Reasoning. J Gen Intern Med 2020; 35:2462-2466. [PMID: 32472494 PMCID: PMC7403249 DOI: 10.1007/s11606-020-05855-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 12/31/2019] [Accepted: 04/13/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Patrick Rendon
- Department of Internal Medicine, The University of New Mexico Health Sciences Center, University of New Mexico School of Medicine, Albuquerque, NM, USA.
| | - Justin Roesch
- Department of Internal Medicine, The University of New Mexico Health Sciences Center, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Gurpreet Dhaliwal
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Medical Service, San Francisco VA Medical Center, San Francisco, CA, USA
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Frati FY. Using an inquiry-based learning approach to support engagement with information and scholarship in health care education. EDUCATION FOR INFORMATION 2020. [DOI: 10.3233/efi-190334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Harding B, Webber C, Rühland L, Dalgarno N, Armour C, Birtwhistle R, Brown G, Carroll JC, Flavin M, Phillips SP, MacKenzie JJ. Bridging the gap in genetics: a progressive model for primary to specialist care. BMC MEDICAL EDUCATION 2019; 19:195. [PMID: 31185964 PMCID: PMC6558677 DOI: 10.1186/s12909-019-1622-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 05/22/2019] [Indexed: 05/15/2023]
Abstract
BACKGROUND The rapid expansion of genetic knowledge, and the implications for healthcare has resulted in an increased role for Primary Care Providers (PCPs) to incorporate genetics into their daily practice. The objective of this study was to explore the self-identified needs, including educational needs, of both urban and rural Primary Care Providers (PCPs) in order to provide genetic care to their patients. METHODS Using a qualitative grounded theory approach, ten key informant interviews, and one urban and two rural PCP focus groups (FGs) (n = 19) were conducted. All PCPs practiced in Southeastern Ontario. Data was analyzed using a constant comparative method and thematic design. The data reported here represent a subset of a larger study. RESULTS Participants reported that PCPs have a responsibility to ensure patients receive genetic care. However, specific roles and responsibilities for that care were poorly defined. PCPs identified a need for further education and resources to enable them to provide care for individuals with genetic conditions. Based on the findings, a progressive stepped model that bridges primary and specialty genetic care was developed; the model ranged from PCPs identifying patients with genetic conditions that they could manage alone, to patients who they could manage with informal or electronic consultation to those who clearly required specialist referral. CONCLUSIONS PCPs identified a need to integrate genetics into primary care practice but they perceived barriers including a lack of knowledge and confidence, access to timely formal and informal consultation and clearly defined roles for themselves and specialists. To address gaps in PCP confidence in providing genetic care, interventions that are directed at accessible just-in-time support and consultation have the potential to empower PCPs to manage patients' genetic conditions. Specific attention to content, timing, and accessibility of educational interventions is critical to address the needs of both urban and rural PCPs. A progressive framework for bridging primary to specialty care through a 'stepped' model for providing continuing medical education, and genetic care can was developed and can be used to guide future design and delivery of educational interventions and resources.
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Affiliation(s)
- Brittany Harding
- Department of Pediatrics, McMaster University, Hamilton, Ontario Canada
| | - Colleen Webber
- Queen’s University, 99 University Avenue, Kingston, Ontario K7L 3N6 Canada
| | - Lucia Rühland
- Queen’s University, 99 University Avenue, Kingston, Ontario K7L 3N6 Canada
| | - Nancy Dalgarno
- Botterell Hall, Queen’s University, 18 Stuart Street, Kingston, Ontario K7L 3N6 Canada
| | - Christine Armour
- Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
| | | | - Glenn Brown
- Centre for Studies in Primary Care, Queen’s University, 220 Bagot Street, P.O.#8888, Kingston, Ontario K7L 5E9 Canada
| | - June C. Carroll
- Department of Family and Community Medicine, Granovsky Gluskin Family Medicine Centre, Mount Sinai Hospital, University of Toronto, 60 Murray St., 4th Floor, Box 25, Toronto, Ontario M5T 3L9 Canada
| | - Michael Flavin
- Department of Pediatrics, Faculty of Health Sciences, Queen’s University, Kingston, Ontario Canada
| | - Susan P. Phillips
- Centre for Studies in Primary Care, Queen’s University, 220 Bagot Street, P.O.#8888, Kingston, Ontario K7L 5E9 Canada
| | - Jennifer J. MacKenzie
- Department of Pediatrics, McMaster Children’s Hospital, 1280, Main St. West, 3N11-G, Hamilton, Ontario L8S 4K1 Canada
- Department of Medicine, Queen’s University, Kingston, Ontario Canada
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Safdari R, Ehtesham H, Ziaee N, Robiaty M. The new roles of medical librarians in medical research. INFORMATION AND LEARNING SCIENCES 2018. [DOI: 10.1108/ils-06-2018-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study aims to highlight the role of librarians as an essential element in medical research. For this purpose, the primary research process was divided into three phases: before, during and after. Then, the roles of librarians associated with each phase were separated and the viewpoint of researchers and librarians on the importance of these roles were considered and compared.
Design/methodology/approach
This comparative, descriptive-causal research was conducted using the census method. Birjand University, a type-2 university in the field of Medical Sciences according to the rating of the Iranian Ministry of Health and Medical Education, was selected for the study. The participants were all faculty members and all librarians working in the university’s libraries. The data collection tool was a questionnaire made by authors. Its validity was confirmed by four professors of Library Science, and questionnaire design expert and its reliability was confirmed with a Cronbach's alpha of 0.89. Data were analyzed with the Statistical Package for the Social Sciences, using descriptive statistics.
Findings
From the perspective of researchers, awareness-raising for open access resources, determination of standard subject keywords on the basis of Medical Subject Headings for articles and scientific texts and using scientific research findings as a basis for preventing duplicate studies in future research are the most important roles for librarians in the three stages of medical research. From the perspective of librarians, the use of knowledge management skills, searching scientific information as review of the literature and also selecting standard keywords to search the databases and providing health-care professionals with the findings of latest scientific research have the highest place in the different stages of the research lifecycle.
Originality/value
The difference between the viewpoints of librarians and researchers about the role of medical librarians at the various stages of the research lifecycle shows that there are significant gaps between the librarians’ services and users’ expectations. It is expected that through learning modern professional skills, medical librarians can assume new roles in medical research and make their capabilities known and available to researchers.
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Muse ED, Godino JG, Netting JF, Alexander JF, Moran HJ, Topol EJ. From second to hundredth opinion in medicine: A global consultation platform for physicians. NPJ Digit Med 2018; 1:55. [PMID: 31304334 PMCID: PMC6550165 DOI: 10.1038/s41746-018-0064-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/17/2018] [Accepted: 09/19/2018] [Indexed: 11/19/2022] Open
Abstract
Serious medical diagnostic errors lead to adverse patient outcomes and increased healthcare costs. The use of virtual online consultation platforms may lead to better-informed physicians and reduce the incidence of diagnostic errors. Our aim was to assess the usage characteristics of an online, physician-to-physician, no-cost, medical consultation platform, Medscape Consult, from November 2015 through October 2017. Physicians creating original content were noted as “presenters” and those following up as “responders”. During the study period, 37,706 physician users generated a combined 117,346 presentations and responses. The physicians had an average age of 56 years and were from 171 countries on every continent. Over 90% of all presentations received responses with the median time to first response of 1.5 h. Overall, computer- and device-based medical consultation has the capacity to rapidly reach a global medical community and may play a role in the reduction of diagnostic errors.
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Affiliation(s)
- Evan D Muse
- 1Scripps Research Translational Institute, The Scripps Research Institute, La Jolla, CA USA.,2Division of Cardiovascular Disease, Scripps Clinic-Scripps Health, La Jolla, CA USA
| | - Job G Godino
- 1Scripps Research Translational Institute, The Scripps Research Institute, La Jolla, CA USA.,3University of California San Diego, La Jolla, CA USA
| | | | | | | | - Eric J Topol
- 1Scripps Research Translational Institute, The Scripps Research Institute, La Jolla, CA USA.,2Division of Cardiovascular Disease, Scripps Clinic-Scripps Health, La Jolla, CA USA
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Ayre S, Brettle A, Gilroy D, Knock D, Mitchelmore R, Pattison S, Smith S, Turner J. Developing a generic tool to routinely measure the impact of health libraries. Health Info Libr J 2018; 35:227-245. [PMID: 30019370 DOI: 10.1111/hir.12223] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 06/07/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Health libraries contribute to many activities of a health care organisation. Impact assessment needs to capture that range of contributions. OBJECTIVES To develop and pilot a generic impact questionnaire that: (1) could be used routinely across all English NHS libraries; (2) built on previous impact surveys; and (3) was reliable and robust. METHODS This collaborative project involved: (1) literature search; (2) analysis of current best practice and baseline survey of use of current tools and requirements; (3) drafting and piloting the questionnaire; and (4) analysis of the results, revision and plans for roll out. FINDINGS The framework selected was the International Standard Methods And Procedures For Assessing The Impact Of Libraries (ISO 16439). The baseline survey (n = 136 library managers) showed that existing tools were not used, and impact assessment was variable. The generic questionnaire developed used a Critical Incident Technique. Analysis of the findings (n = 214 health staff and students), plus comparisons with previous impact studies indicated that the questionnaire should capture the impact for all types of health libraries. CONCLUSIONS The collaborative project successfully piloted a generic impact questionnaire that, subject to further validation, should apply to many types of health library and information services.
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Affiliation(s)
| | - Alison Brettle
- School of Nursing, Midwifery, Social Work and Social Sciences, University of Salford, Salford, UK
| | | | - Douglas Knock
- Kings College Hospital NHS Foundation Trust, London, UK
| | | | | | - Susan Smith
- Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK
| | - Jenny Turner
- East Sussex Healthcare NHS Trust, Eastbourne, UK
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Izcovich A, Criniti JM, Popoff F, Ragusa MA, Gigler C, Gonzalez Malla C, Clavijo M, Manzotti M, Diaz M, Catalano HN, Neumann I, Guyatt G. Answering medical questions at the point of care: a cross-sectional study comparing rapid decisions based on PubMed and Epistemonikos searches with evidence-based recommendations developed with the GRADE approach. BMJ Open 2017; 7:e016113. [PMID: 28790039 PMCID: PMC5629721 DOI: 10.1136/bmjopen-2017-016113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Using the best current evidence to inform clinical decisions remains a challenge for clinicians. Given the scarcity of trustworthy clinical practice guidelines providing recommendations to answer clinicians' daily questions, clinical decision support systems (ie, assistance in question identification and answering) emerge as an attractive alternative. The trustworthiness of the recommendations achieved by such systems is unknown. OBJECTIVE To evaluate the trustworthiness of a question identification and answering system that delivers timely recommendations. DESIGN Cross-sectional study. METHODS We compared the responses to 100 clinical questions related to inpatient management provided by two rapid response methods with 'Gold Standard' recommendations. One of the rapid methods was based on PubMed and the other on Epistemonikos database. We defined our 'Gold Standard' as trustworthy published evidence-based recommendations or, when unavailable, recommendations developed locally by a panel of six clinicians following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Recommendations provided by the rapid strategies were classified as potentially misleading or reasonable. We also determined if the potentially misleading recommendations could have been avoided with the appropriate implementation of searching and evidence summary tools. RESULTS We were able to answer all of the 100 questions with both rapid methods. Of the 200 recommendations obtained, 6.5% (95% CI 3% to 9.9%) were classified as potentially misleading and 93.5% (95% CI 90% to 96.9%) as reasonable. 6 of the 13 potentially misleading recommendations could have been avoided by the appropriate usage of the Epistemonikos matrix tool or by constructing summary of findings tables. No significant differences were observed between the evaluated rapid response methods. CONCLUSION A question answering service based on the GRADE approach proved feasible to implement and provided appropriate guidance for most identified questions. Our approach could help stakeholders in charge of managing resources and defining policies for patient care to improve evidence-based decision-making in an efficient and feasible manner.
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Affiliation(s)
- Ariel Izcovich
- Department of Internal Medicine, Hospital Alemán, Buenos Aires, Argentina
| | | | - Federico Popoff
- Department of Internal Medicine, Hospital Alemán, Buenos Aires, Argentina
| | | | - Cristel Gigler
- Department of Internal Medicine, Hospital Alemán, Buenos Aires, Argentina
| | | | - Manuela Clavijo
- Department of Internal Medicine, Hospital Alemán, Buenos Aires, Argentina
| | - Matias Manzotti
- Department of Internal Medicine, Hospital Alemán, Buenos Aires, Argentina
| | - Martín Diaz
- Department of Internal Medicine, Hospital Alemán, Buenos Aires, Argentina
| | | | - Ignacio Neumann
- Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gordon Guyatt
- Department of Evidence and Impact, Health Research Methods,McMaster University, Hamilton, Ontario, Canada
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Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, Holmes‐Rovner M, Llewellyn‐Thomas H, Lyddiatt A, Thomson R, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2017; 4:CD001431. [PMID: 28402085 PMCID: PMC6478132 DOI: 10.1002/14651858.cd001431.pub5] [Citation(s) in RCA: 1212] [Impact Index Per Article: 173.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Decision aids are interventions that support patients by making their decisions explicit, providing information about options and associated benefits/harms, and helping clarify congruence between decisions and personal values. OBJECTIVES To assess the effects of decision aids in people facing treatment or screening decisions. SEARCH METHODS Updated search (2012 to April 2015) in CENTRAL; MEDLINE; Embase; PsycINFO; and grey literature; includes CINAHL to September 2008. SELECTION CRITERIA We included published randomized controlled trials comparing decision aids to usual care and/or alternative interventions. For this update, we excluded studies comparing detailed versus simple decision aids. DATA COLLECTION AND ANALYSIS Two reviewers independently screened citations for inclusion, extracted data, and assessed risk of bias. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made and the decision-making process.Secondary outcomes were behavioural, health, and health system effects.We pooled results using mean differences (MDs) and risk ratios (RRs), applying a random-effects model. We conducted a subgroup analysis of studies that used the patient decision aid to prepare for the consultation and of those that used it in the consultation. We used GRADE to assess the strength of the evidence. MAIN RESULTS We included 105 studies involving 31,043 participants. This update added 18 studies and removed 28 previously included studies comparing detailed versus simple decision aids. During the 'Risk of bias' assessment, we rated two items (selective reporting and blinding of participants/personnel) as mostly unclear due to inadequate reporting. Twelve of 105 studies were at high risk of bias.With regard to the attributes of the choice made, decision aids increased participants' knowledge (MD 13.27/100; 95% confidence interval (CI) 11.32 to 15.23; 52 studies; N = 13,316; high-quality evidence), accuracy of risk perceptions (RR 2.10; 95% CI 1.66 to 2.66; 17 studies; N = 5096; moderate-quality evidence), and congruency between informed values and care choices (RR 2.06; 95% CI 1.46 to 2.91; 10 studies; N = 4626; low-quality evidence) compared to usual care.Regarding attributes related to the decision-making process and compared to usual care, decision aids decreased decisional conflict related to feeling uninformed (MD -9.28/100; 95% CI -12.20 to -6.36; 27 studies; N = 5707; high-quality evidence), indecision about personal values (MD -8.81/100; 95% CI -11.99 to -5.63; 23 studies; N = 5068; high-quality evidence), and the proportion of people who were passive in decision making (RR 0.68; 95% CI 0.55 to 0.83; 16 studies; N = 3180; moderate-quality evidence).Decision aids reduced the proportion of undecided participants and appeared to have a positive effect on patient-clinician communication. Moreover, those exposed to a decision aid were either equally or more satisfied with their decision, the decision-making process, and/or the preparation for decision making compared to usual care.Decision aids also reduced the number of people choosing major elective invasive surgery in favour of more conservative options (RR 0.86; 95% CI 0.75 to 1.00; 18 studies; N = 3844), but this reduction reached statistical significance only after removing the study on prophylactic mastectomy for breast cancer gene carriers (RR 0.84; 95% CI 0.73 to 0.97; 17 studies; N = 3108). Compared to usual care, decision aids reduced the number of people choosing prostate-specific antigen screening (RR 0.88; 95% CI 0.80 to 0.98; 10 studies; N = 3996) and increased those choosing to start new medications for diabetes (RR 1.65; 95% CI 1.06 to 2.56; 4 studies; N = 447). For other testing and screening choices, mostly there were no differences between decision aids and usual care.The median effect of decision aids on length of consultation was 2.6 minutes longer (24 versus 21; 7.5% increase). The costs of the decision aid group were lower in two studies and similar to usual care in four studies. People receiving decision aids do not appear to differ from those receiving usual care in terms of anxiety, general health outcomes, and condition-specific health outcomes. Studies did not report adverse events associated with the use of decision aids.In subgroup analysis, we compared results for decision aids used in preparation for the consultation versus during the consultation, finding similar improvements in pooled analysis for knowledge and accurate risk perception. For other outcomes, we could not conduct formal subgroup analyses because there were too few studies in each subgroup. AUTHORS' CONCLUSIONS Compared to usual care across a wide variety of decision contexts, people exposed to decision aids feel more knowledgeable, better informed, and clearer about their values, and they probably have a more active role in decision making and more accurate risk perceptions. There is growing evidence that decision aids may improve values-congruent choices. There are no adverse effects on health outcomes or satisfaction. New for this updated is evidence indicating improved knowledge and accurate risk perceptions when decision aids are used either within or in preparation for the consultation. Further research is needed on the effects on adherence with the chosen option, cost-effectiveness, and use with lower literacy populations.
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Affiliation(s)
- Dawn Stacey
- University of OttawaSchool of Nursing451 Smyth RoadOttawaONCanada
- Ottawa Hospital Research InstituteCentre for Practice Changing Research501 Smyth RdOttawaONCanadaK1H 8L6
| | - France Légaré
- CHU de Québec Research Center, Université LavalPopulation Health and Optimal Health Practices Research Axis10 Rue de l'Espinay, D6‐727Québec CityQCCanadaG1L 3L5
| | - Krystina Lewis
- University of OttawaSchool of Nursing451 Smyth RoadOttawaONCanada
| | | | - Carol L Bennett
- Ottawa Hospital Research InstituteClinical Epidemiology ProgramAdministrative Services Building, Room 2‐0131053 Carling AvenueOttawaONCanadaK1Y 4E9
| | - Karen B Eden
- Oregon Health Sciences UniversityDepartment of Medical Informatics and Clinical EpidemiologyBICC 5353181 S.W. Sam Jackson Park RoadPortlandOregonUSA97239‐3098
| | - Margaret Holmes‐Rovner
- Michigan State University College of Human MedicineCenter for Ethics and Humanities in the Life SciencesEast Fee Road956 Fee Road Rm C203East LansingMichiganUSA48824‐1316
| | - Hilary Llewellyn‐Thomas
- Dartmouth CollegeThe Dartmouth Center for Health Policy & Clinical Practice, The Geisel School of Medicine at DartmouthHanoverNew HampshireUSA03755
| | - Anne Lyddiatt
- No affiliation28 Greenwood RoadIngersollONCanadaN5C 3N1
| | - Richard Thomson
- Newcastle UniversityInstitute of Health and SocietyBaddiley‐Clark BuildingRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Lyndal Trevena
- The University of SydneyRoom 322Edward Ford Building (A27)SydneyNSWAustralia2006
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McKeown S, Konrad SL, McTavish J, Boyce E. Evaluation of hospital staff's perceived quality of librarian-mediated literature searching services. J Med Libr Assoc 2017; 105:120-131. [PMID: 28377674 PMCID: PMC5370602 DOI: 10.5195/jmla.2017.201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective The research evaluated the perceived quality of librarian-mediated literature searching services at one of Canada’s largest acute care teaching hospitals for the purpose of continuous quality improvement and investigation of relationships between variables that can impact user satisfaction. Methods An online survey was constructed using evidence-based methodologies. A systematic sample of staff and physicians requesting literature searches at London Health Sciences Centre were invited to participate in the study over a one-year period. Data analyses included descriptive statistics of closed-ended questions and coding of open-ended questions. Results A range of staff including clinicians, researchers, educators, leaders, and analysts submitted a total of 137 surveys, representing a response rate of 71%. Staff requested literature searches for the following “primary” purposes: research or publication (34%), teaching or training (20%), informing a policy or standard practice (16%), patient care (15%), and “other” purposes (15%). While the majority of staff (76%) submitted search requests using methods of written communication, including email and search request forms, staff using methods of verbal communication, including face-to-face and telephone conversations, were significantly more likely to be extremely satisfied with the librarian’s interpretation of the search request (p=0.004) and to rate the perceived quality of the search results as excellent (p=0.005). In most cases, librarians followed up with staff to clarify the details of their search requests (72%), and these staff were significantly more likely to be extremely satisfied with the librarian’s interpretation of the search request (p=0.002). Conclusions Our results demonstrate the limitations of written communication in the context of librarian-mediated literature searching and suggest a multifaceted approach to quality improvement efforts.
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Ho GJ, Liew SM, Ng CJ, Hisham Shunmugam R, Glasziou P. Development of a Search Strategy for an Evidence Based Retrieval Service. PLoS One 2016; 11:e0167170. [PMID: 27935993 PMCID: PMC5147858 DOI: 10.1371/journal.pone.0167170] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 11/09/2016] [Indexed: 11/18/2022] Open
Abstract
Background Physicians are often encouraged to locate answers for their clinical queries via an evidence-based literature search approach. The methods used are often not clearly specified. Inappropriate search strategies, time constraint and contradictory information complicate evidence retrieval. Aims Our study aimed to develop a search strategy to answer clinical queries among physicians in a primary care setting Methods Six clinical questions of different medical conditions seen in primary care were formulated. A series of experimental searches to answer each question was conducted on 3 commonly advocated medical databases. We compared search results from a PICO (patients, intervention, comparison, outcome) framework for questions using different combinations of PICO elements. We also compared outcomes from doing searches using text words, Medical Subject Headings (MeSH), or a combination of both. All searches were documented using screenshots and saved search strategies. Results Answers to all 6 questions using the PICO framework were found. A higher number of systematic reviews were obtained using a 2 PICO element search compared to a 4 element search. A more optimal choice of search is a combination of both text words and MeSH terms. Despite searching using the Systematic Review filter, many non-systematic reviews or narrative reviews were found in PubMed. There was poor overlap between outcomes of searches using different databases. The duration of search and screening for the 6 questions ranged from 1 to 4 hours. Conclusion This strategy has been shown to be feasible and can provide evidence to doctors’ clinical questions. It has the potential to be incorporated into an interventional study to determine the impact of an online evidence retrieval system.
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Affiliation(s)
- Gah Juan Ho
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Su May Liew
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ranita Hisham Shunmugam
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Paul Glasziou
- Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
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Madden A, Collins P, McGowan S, Stevenson P, Castelli D, Hyde L, DeSanto K, O'Brien N, Purdon M, Delgado D. Demonstrating the financial impact of clinical libraries: a systematic review. Health Info Libr J 2016; 33:172-89. [PMID: 27503690 DOI: 10.1111/hir.12151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/21/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Anne Madden
- St. Vincent's University Hospital; Dublin Ireland
| | - Pamela Collins
- The Royal Wolverhampton NHS Trust Education Academy; West Midlands UK
| | | | | | | | - Loree Hyde
- Kaiser Permanente NW Regional Libraries; Clackamas OR USA
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Urquhart C, Turner J. Reflections on the value and impact of library and information services. PERFORMANCE MEASUREMENT AND METRICS 2016. [DOI: 10.1108/pmm-01-2016-0001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to critically review methods of impact assessment and economic analyses.
Design/methodology/approach
– Reviews the literature on impact assessment, and examines some case studies of impact assessment in health libraries. Relates satisfaction and dissatisfaction assessment to impact assessment. Identifies recent impact assessment approaches in public and academic libraries, and explores different uses of terminology for impact and outcome. Reviews literature on economic analysis of value, including cost analyses, cost-effectiveness analysis and return on investment (ROI) studies.
Findings
– Terms for library assessment (outcome, output, impact, value and benefit) vary among different sectors. Impact evaluation should examine initial assumptions of value carefully, and examine possible gaps in the line of argument linking inputs of library services to presumed impacts (positive and negative). More attention to sampling and response rates is required, to avoid problems such as the “warm glow” effect. Qualitative and quantitative evidence should be carefully integrated to tell the impact story. Economic impact can be estimated, but methodology depends on the service aims and sector.
Originality/value
– Demonstrates that some of the requirements for traditional impact assessment also affect economic analyses and ROI studies.
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Nahum-Shani I, Hekler EB, Spruijt-Metz D. Building health behavior models to guide the development of just-in-time adaptive interventions: A pragmatic framework. Health Psychol 2015; 34S:1209-19. [PMID: 26651462 PMCID: PMC4732268 DOI: 10.1037/hea0000306] [Citation(s) in RCA: 259] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Advances in wireless devices and mobile technology offer many opportunities for delivering just-in-time adaptive interventions (JITAIs)-suites of interventions that adapt over time to an individual's changing status and circumstances with the goal to address the individual's need for support, whenever this need arises. A major challenge confronting behavioral scientists aiming to develop a JITAI concerns the selection and integration of existing empirical, theoretical and practical evidence into a scientific model that can inform the construction of a JITAI and help identify scientific gaps. The purpose of this paper is to establish a pragmatic framework that can be used to organize existing evidence into a useful model for JITAI construction. This framework involves clarifying the conceptual purpose of a JITAI, namely, the provision of just-in-time support via adaptation, as well as describing the components of a JITAI and articulating a list of concrete questions to guide the establishment of a useful model for JITAI construction. The proposed framework includes an organizing scheme for translating the relatively static scientific models underlying many health behavior interventions into a more dynamic model that better incorporates the element of time. This framework will help to guide the next generation of empirical work to support the creation of effective JITAIs.
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Affiliation(s)
| | - Eric B. Hekler
- School of Nutrition and Health Promotion, Arizona State University
| | - Donna Spruijt-Metz
- Center for Economic and Social Research, University of Southern California
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Dal-Ré R, Castell M, García-Puig J. If the results of an article are noteworthy, read the entire article; do not rely on the abstract alone. Rev Clin Esp 2015. [DOI: 10.1016/j.rceng.2015.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dal-Ré R, Castell MV, García-Puig J. If the results of an article are noteworthy, read the entire article; do not rely on the abstract alone. Rev Clin Esp 2015; 215:454-7. [PMID: 26165166 DOI: 10.1016/j.rce.2015.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 05/31/2015] [Indexed: 11/19/2022]
Abstract
Clinicians typically update their knowledge by reading articles on the Internet. Easy access to the articles' abstracts and a lack of time to access other information sources creates a risk that therapeutic or diagnostic decisions will be made after reading just the abstracts. Occasionally, however, the abstracts of articles from clinical trials that have not obtained statistically significant differences in the primary study endpoint have reported other positive results, for example, of a secondary endpoint or a subgroup analysis. The article, however, correctly reports all results, including those of the primary endpoint. In the abstract, the safety information of the experimental treatment is usually deficient. The whole article should be read if a clinical decision is to be made.
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Affiliation(s)
- R Dal-Ré
- Investigación Clínica, Programa BUC (Biociencias UAM + CSIC), Centro de Excelencia Internacional, Universidad Autónoma de Madrid, Madrid, España.
| | - M V Castell
- Centro de Salud Dr. Castroviejo, DA Norte, Servicio Madrileño de Salud, Madrid, España
| | - J García-Puig
- Unidad Metabólico Vascular, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España
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De Jonghe M. Prevenção quaternária como diretriz para a equipe editorial de uma revista de medicina baseada em evidência. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2015. [DOI: 10.5712/rbmfc10(35)1067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
O presente artigo tem como objetivo analisar as atividades de redação da revista Minerva, periódico belga de medicina baseada em evidência (MBE), de acordo com as diretrizes da prevenção quaternária. A partir da produção editorial da revista Minerva foi realizada uma análise narrativa de suas atividades de redação em relação ao questionamento clínico, à pesquisa, à crítica e à interpretação de informações clínicas relevantes à prática profissional. São detalhados os limites da MBE e as ferramentas e linhas de reflexão emitidas pela equipe de redação da revista a fim de favorecer a implementação da MBE na prática clínica. Dessa forma, se pretende prevenir o intervencionismo médico desnecessário, ao se fortalecer a prevenção quaternária como uma competência fundamental dos trabalhadores da saúde ao longo de sua vida profissional a serviço dos pacientes, o que pode ser reforçado pelo trabalho da equipe editorial de uma revista de MBE.
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Izcovich A, Criniti JM, Ruiz JI, Catalano HN. Impact of a GRADE-based medical question answering system on physician behaviour: a randomised controlled trial. EVIDENCE-BASED MEDICINE 2015; 20:81-87. [PMID: 25841245 DOI: 10.1136/ebmed-2014-110146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Physicians are frequently faced with questions related to their patients’ care that they cannot answer. A vast number of randomised trials have tested a wide variety of behaviour-changing strategies designed to improve practitioners’ evidence utilisation, but systematic reviews have concluded that the effects are generally small and inconsistent. We conducted a randomised controlled trial to determine whether a question identification and solving system, using structured evidence summaries with recommendations, would change physician’s behavior related to the care of their hospitalised patients. The trial was conducted at the secondary level, internal medicine ward. Relevant clinical questions were the units of randomisation; 14 clinicians participated in the study. The question identification and answering system was carried out using evidence summaries with recommendations based on the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach stressing influence on clinician behaviour (decision/recommendation concordance). During 131 morning reports, 553 questions were identified (4.2 questions per meeting). 398 were excluded because they were not about diagnostic or therapeutic interventions or because their answers could not have impact on clinician behaviour, and 31 were excluded because of lack of time to answer them, leaving 124 included questions. The proportion of clinical decisions concordant with the proposed recommendations was 79%in the intervention arm and 44% in the control arm: relative risk 1.8 (95% CI 1.3 to 2.4), number of evidence summaries needed to change a care decision for one question raised was 3 (95% CI 2 to 6). A question identification and answering system was feasible, effectively performed and significantly influenced clinician behaviour related to the care of hospitalised patients, which suggests that interventions facilitating accessibility and interpretability of the best available evidence at the point of care have the potential to significantly impact on the quality of healthcare.
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Affiliation(s)
- Ariel Izcovich
- Internal Medicine Department, Hospital Alemán de Buenos Aires, Buenos Aires, Argentina
| | - Juan Martín Criniti
- Internal Medicine Department, Hospital Alemán de Buenos Aires, Buenos Aires, Argentina
| | - Juan Ignacio Ruiz
- Internal Medicine Department, Hospital Alemán de Buenos Aires, Buenos Aires, Argentina
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Blank L, Baxter S, Woods HB, Goyder E, Lee A, Payne N, Rimmer M. What is the evidence on interventions to manage referral from primary to specialist non-emergency care? A systematic review and logic model synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03240] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BackgroundDemand management describes any method used to monitor, direct or regulate patient referrals. Several strategies have been developed to manage the referral of patients to secondary care, with interventions targeting primary care, specialist services, or infrastructure.ObjectiveThis research aimed to conduct an inclusive systematic review and logic model synthesis in order to better understand factors impacting on the effectiveness of interventions targeting referral between primary and secondary medical health care.DesignThe approach combined systematic review with logic modelling synthesis techniques to develop an evidence-based framework of factors influencing the pathway between interventions and system-wide changes.SettingPrimary health care.Main outcome measuresReferral from primary to secondary care.Review methodsSystematic searches were undertaken to identify recent, relevant studies. Quality of individual studies was appraised, with consideration of overall strength of evidence. A narrative synthesis and logic model summary of the data was completed.ResultsFrom a database of 8327 unique papers, 290 were included in the review. The intervention studies were grouped into four categories of education interventions (n = 50); process change interventions (n = 49); system change interventions (n = 38); and patient-focused interventions (n = 3). Effectiveness was assessed variously in these papers; however, there was a gap regarding the mechanisms whereby these interventions lead to demand management impacts. The findings suggest that, although individual-level interventions may be popular, the stronger evidence relates only to peer-review and feedback interventions. Process change interventions appeared to be more effective when the change resulted in the specialist being provided with more or better quality information about the patient. System changes including the community provision of specialist services by general practitioners, outreach provision by specialists and the return of inappropriate referrals appeared to have evidence of effect. The pathway whereby interventions might lead to service-wide impact was complex, with multiple factors potentially acting as barriers or facilitators to the change process. Factors related, first, to the doctor (including knowledge, attitudes and beliefs, and previous experiences of a service), second, to the patient (including condition and social factors) and, third, to the influence of the doctor–patient relationship. We also identified a number of potentially influential factors at a local level, such as perceived waiting times and the availability of a specialist. These elements are key factors in the pathway between an intervention and intended demand management outcomes influencing both applicability and effectiveness.ConclusionsThe findings highlight the complexity of the referral process and multiple elements that will impact on intervention outcomes and applicability to a local area. Any interventions seeking to change referral practice need to address factors relating to the individual practitioner, the patient and also the situation in which the referral is taking place. These conclusions apply especially to referral management in a UK context where this whole range of factors/issues lies well within the remit of the NHS. This work highlights that intermediate outcomes are important in the referral pathway. It is recommended that researchers include measure of these intermediate outcomes in their evaluation of intervention effectiveness in order to determine where blocks to or facilitators of system-wide impact may be occurring.Study registrationThe study is registered as PROSPERO CRD42013004037.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Lindsay Blank
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Susan Baxter
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Helen Buckley Woods
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Lee
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Nick Payne
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Melanie Rimmer
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Walsh JC, Dicks LV, Sutherland WJ. The effect of scientific evidence on conservation practitioners' management decisions. CONSERVATION BIOLOGY : THE JOURNAL OF THE SOCIETY FOR CONSERVATION BIOLOGY 2015; 29:88-98. [PMID: 25103469 PMCID: PMC4515094 DOI: 10.1111/cobi.12370] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 05/13/2014] [Indexed: 05/20/2023]
Abstract
A major justification of environmental management research is that it helps practitioners, yet previous studies show it is rarely used to inform their decisions. We tested whether conservation practitioners focusing on bird management were willing to use a synopsis of relevant scientific literature to inform their management decisions. This allowed us to examine whether the limited use of scientific information in management is due to a lack of access to the scientific literature or whether it is because practitioners are either not interested or unable to incorporate the research into their decisions. In on-line surveys, we asked 92 conservation managers, predominantly from Australia, New Zealand, and the United Kingdom, to provide opinions on 28 management techniques that could be applied to reduce predation on birds. We asked their opinions before and after giving them a summary of the literature about the interventions' effectiveness. We scored the overall effectiveness and certainty of evidence for each intervention through an expert elicitation process-the Delphi method. We used the effectiveness scores to assess the practitioners' level of understanding and awareness of the literature. On average, each survey participant changed their likelihood of using 45.7% of the interventions after reading the synopsis of the evidence. They were more likely to implement effective interventions and avoid ineffective actions, suggesting that their intended future management strategies may be more successful than current practice. More experienced practitioners were less likely to change their management practices than those with less experience, even though they were not more aware of the existing scientific information than less experienced practitioners. The practitioners' willingness to change their management choices when provided with summarized scientific evidence suggests that improved accessibility to scientific information would benefit conservation management outcomes.
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Affiliation(s)
- Jessica C Walsh
- Department of Zoology, University of Cambridge, Downing StreetCambridge, CB2 3E J, United Kingdom
- * email
| | - Lynn V Dicks
- Department of Zoology, University of Cambridge, Downing StreetCambridge, CB2 3E J, United Kingdom
| | - William J Sutherland
- Department of Zoology, University of Cambridge, Downing StreetCambridge, CB2 3E J, United Kingdom
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Marshall JG, Morgan JC, Thompson CA, Wells AL. Library and information services: impact on patient care quality. Int J Health Care Qual Assur 2015; 27:672-83. [PMID: 25417373 DOI: 10.1108/ijhcqa-10-2013-0119] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to explore library and information service impact on patient care quality. DESIGN/METHODOLOGY/APPROACH A large-scale critical incident survey of physicians and residents at 56 library sites serving 118 hospitals in the USA and Canada. Respondents were asked to base their answers on a recent incident in which they had used library resources to search for information related to a specific clinical case. FINDINGS Of 4,520 respondents, 75 percent said that they definitely or probably handled patient care differently using information obtained through the library. In a multivariate analysis, three summary clinical outcome measures were used as value and impact indicators: first, time saved; second, patient care changes; and third, adverse events avoided. The outcomes were examined in relation to four information access methods: first, asking librarian for assistance; second, performing search in a physical library; third, searching library's web site; or fourth, searching library resources on an institutional intranet. All library access methods had consistently positive relationships with the clinical outcomes, providing evidence that library services have a positive impact on patient care quality. ORIGINALITY/VALUE Electronic collections and services provided by the library and the librarian contribute to patient care quality.
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Blank L, Baxter S, Woods HB, Goyder E, Lee A, Payne N, Rimmer M. Referral interventions from primary to specialist care: a systematic review of international evidence. Br J Gen Pract 2014; 64:e765-74. [PMID: 25452541 PMCID: PMC4240149 DOI: 10.3399/bjgp14x682837] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 06/11/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Demand management defines any method used to monitor, direct, or regulate patient referrals. Strategies have been developed to manage the referral of patients to secondary care, with interventions that target primary care, specialist services, or infrastructure. AIM To review the international evidence on interventions to manage referral from primary to specialist care. DESIGN AND SETTING Systematic review. METHOD Iterative, systematic searches of published and unpublished sources public health, health management, management, and grey literature databases from health care and other industries were undertaken to identify recent, relevant studies. A narrative synthesis of the data was completed to structure the evidence into groups of similar interventions. RESULTS The searches generated 8327 unique results, of which 140 studies were included. Interventions were grouped into four intervention categories: GP education (n = 50); process change (n = 49); system change (n = 38); and patient-focused (n = 3). It is clear that there is no 'magic bullet' to managing demand for secondary care services: although some groups of interventions may have greater potential for development, given the existing evidence that they can be effective in specific contexts. CONCLUSIONS To tackle demand management of primary care services, the focus cannot be on primary care alone; a whole-systems approach is needed because the introduction of interventions in primary care is often just the starting point of the referral process. In addition, more research is needed to develop and evaluate interventions that acknowledge the role of the patient in the referral decision.
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Affiliation(s)
- Lindsay Blank
- School of Health and Related Research, University of Sheffield, Sheffield
| | - Susan Baxter
- School of Health and Related Research, University of Sheffield, Sheffield
| | | | - Elizabeth Goyder
- School of Health and Related Research, University of Sheffield, Sheffield
| | - Andrew Lee
- School of Health and Related Research, University of Sheffield, Sheffield
| | - Nick Payne
- School of Health and Related Research, University of Sheffield, Sheffield
| | - Melanie Rimmer
- School of Health and Related Research, University of Sheffield, Sheffield
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Perrier L, Farrell A, Ayala AP, Lightfoot D, Kenny T, Aaronson E, Allee N, Brigham T, Connor E, Constantinescu T, Muellenbach J, Epstein HAB, Weiss A. Effects of librarian-provided services in healthcare settings: a systematic review. J Am Med Inform Assoc 2014; 21:1118-24. [PMID: 24872341 PMCID: PMC4215058 DOI: 10.1136/amiajnl-2014-002825] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 05/07/2014] [Accepted: 05/11/2014] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the effects of librarian-provided services in healthcare settings on patient, healthcare provider, and researcher outcomes. MATERIALS AND METHODS Medline, CINAHL, ERIC, LISA (Library and Information Science Abstracts), and the Cochrane Central Register of Controlled Trials were searched from inception to June 2013. Studies involving librarian-provided services for patients encountering the healthcare system, healthcare providers, or researchers were eligible for inclusion. All librarian-provided services in healthcare settings were considered as an intervention, including hospitals, primary care settings, or public health clinics. RESULTS Twenty-five articles fulfilled our eligibility criteria, including 22 primary publications and three companion reports. The majority of studies (15/22 primary publications) examined librarians providing instruction in literature searching to healthcare trainees, and measured literature searching proficiency. Other studies analyzed librarian-provided literature searching services and instruction in question formulation as well as the impact of librarian-provided services on patient length of stay in hospital. No studies were found that investigated librarians providing direct services to researchers or patients in healthcare settings. CONCLUSIONS Librarian-provided services directed to participants in training programs (eg, students, residents) improve skills in searching the literature to facilitate the integration of research evidence into clinical decision-making. Services provided to clinicians were shown to be effective in saving time for health professionals and providing relevant information for decision-making. Two studies indicated patient length of stay was reduced when clinicians requested literature searches related to a patient's case.
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Affiliation(s)
- Laure Perrier
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
| | | | - A Patricia Ayala
- Gerstein Science Library, University of Toronto, Toronto, Canada
| | | | - Tim Kenny
- George J Farha Medical Library, Kansas University School of Medicine-Wichita, Wichita, USA
| | | | - Nancy Allee
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, USA
| | - Tara Brigham
- Winn-Dixie Foundation Medical Library, Mayo Clinic, Jacksonville, USA
| | - Elizabeth Connor
- Daniel Library, The Citadel, The Military College of South Carolina, Charleston, USA
| | - Teodora Constantinescu
- Psychiatry Library, Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, Canada
| | | | | | - Ardis Weiss
- Pomona Valley Hospital Medical Center, Ponoma, USA
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Sims MH, Fagnano M, Halterman JS, Halterman MW. Provider impressions of the use of a mobile crowdsourcing app in medical practice. Health Informatics J 2014; 22:221-31. [PMID: 25167866 DOI: 10.1177/1460458214545896] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In our prior work, we conducted a field trial of the mobile application DocCHIRP (Crowdsourcing Health Information Retrieval Protocol for Doctors), designed to help clinicians problem-solve at the point of care by crowdsourcing their peers. Here, we present the results of our post-trial survey that investigated the impressions of participating clinicians regarding the use of medical crowdsourcing and to identify factors influencing adoption of the technology. In all, 72 valid surveys were received from 85 registered users (85% response rate). The majority of clinicians (>80%) felt crowdsourcing would be useful to diagnose unusual cases, facilitate patient referrals, and problem-solve at the point of care. Perceived barriers to adoption included interruptions in workflow and the reluctance to publicly expose knowledge gaps. While considered a useful alternative to existing methods, future studies are needed to investigate whether the approach and application can be modified to effectively address these barriers, and to determine whether crowdsourcing will enhance provider performance and the quality of care delivered.
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The Herzl Patient Health Information Service: An innovative solution to the problem of informing patients in primary care. JOURNAL OF THE CANADIAN HEALTH LIBRARIES ASSOCIATION 2014. [DOI: 10.5596/c11-034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Jackson L, Goldsmith L, Skirton H. Guidance for patients considering direct-to-consumer genetic testing and health professionals involved in their care: development of a practical decision tool. Fam Pract 2014; 31:341-8. [PMID: 24473677 DOI: 10.1093/fampra/cmt087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Direct-to-consumer (DTC) genetic tests are available online, but there is little practical guidance for health professionals and consumers concerning their use. Work to produce such guidance was initially informed by three systematic reviews assessing the evidence on views and experiences of users and health professionals and policies of professional and bioethics organizations. The evidence suggested that consumers' motivations include general curiosity, improving their general health, ascertaining the risk of a particular condition or planning for future children. However, health professionals and bioethics organizations expressed concerns about potential harms resulting from these tests. Using this evidence, we constructed a list of topics to be included in proposed guidelines. METHODS Using an expert group technique, we aimed to develop guidance for (i) potential consumers and (ii) health professionals approached by patients considering or having undertaken such tests. We considered it important to involve a wide range of participants with relevant experience. Accordingly, researchers and clinicians based in four countries were invited to a 2-day workshop in August 2012. Following an iterative process, we decided to produce clinically relevant and pragmatic guidance in the form of a decision support tool for use in primary care. RESULTS By utilizing both the relevant literature and the experience of the expert group, we identified seven key underlying reasons that might prompt individuals to consider DTC testing. We considered primary care physicians as the most likely health professionals from whom individuals would seek advice. CONCLUSIONS Based on the outcomes of the workshop, we developed a decision support tool encompassing varied clinical scenarios. Health professionals and patients are guided through a pathway that includes relevant actions and information on the appropriateness of the test. This tool will be freely accessible to health professionals and patients online.
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Affiliation(s)
- Leigh Jackson
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Lesley Goldsmith
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Heather Skirton
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK.
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Stacey D, Légaré F, Col NF, Bennett CL, Barry MJ, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, Trevena L, Wu JHC. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2014:CD001431. [PMID: 24470076 DOI: 10.1002/14651858.cd001431.pub4] [Citation(s) in RCA: 838] [Impact Index Per Article: 83.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Decision aids are intended to help people participate in decisions that involve weighing the benefits and harms of treatment options often with scientific uncertainty. OBJECTIVES To assess the effects of decision aids for people facing treatment or screening decisions. SEARCH METHODS For this update, we searched from 2009 to June 2012 in MEDLINE; CENTRAL; EMBASE; PsycINFO; and grey literature. Cumulatively, we have searched each database since its start date including CINAHL (to September 2008). SELECTION CRITERIA We included published randomized controlled trials of decision aids, which are interventions designed to support patients' decision making by making explicit the decision, providing information about treatment or screening options and their associated outcomes, compared to usual care and/or alternative interventions. We excluded studies of participants making hypothetical decisions. DATA COLLECTION AND ANALYSIS Two review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. The primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were:A) 'choice made' attributes;B) 'decision-making process' attributes.Secondary outcomes were behavioral, health, and health-system effects. We pooled results using mean differences (MD) and relative risks (RR), applying a random-effects model. MAIN RESULTS This update includes 33 new studies for a total of 115 studies involving 34,444 participants. For risk of bias, selective outcome reporting and blinding of participants and personnel were mostly rated as unclear due to inadequate reporting. Based on 7 items, 8 of 115 studies had high risk of bias for 1 or 2 items each.Of 115 included studies, 88 (76.5%) used at least one of the IPDAS effectiveness criteria: A) 'choice made' attributes criteria: knowledge scores (76 studies); accurate risk perceptions (25 studies); and informed value-based choice (20 studies); and B) 'decision-making process' attributes criteria: feeling informed (34 studies) and feeling clear about values (29 studies).A) Criteria involving 'choice made' attributes:Compared to usual care, decision aids increased knowledge (MD 13.34 out of 100; 95% confidence interval (CI) 11.17 to 15.51; n = 42). When more detailed decision aids were compared to simple decision aids, the relative improvement in knowledge was significant (MD 5.52 out of 100; 95% CI 3.90 to 7.15; n = 19). Exposure to a decision aid with expressed probabilities resulted in a higher proportion of people with accurate risk perceptions (RR 1.82; 95% CI 1.52 to 2.16; n = 19). Exposure to a decision aid with explicit values clarification resulted in a higher proportion of patients choosing an option congruent with their values (RR 1.51; 95% CI 1.17 to 1.96; n = 13).B) Criteria involving 'decision-making process' attributes:Decision aids compared to usual care interventions resulted in:a) lower decisional conflict related to feeling uninformed (MD -7.26 of 100; 95% CI -9.73 to -4.78; n = 22) and feeling unclear about personal values (MD -6.09; 95% CI -8.50 to -3.67; n = 18);b) reduced proportions of people who were passive in decision making (RR 0.66; 95% CI 0.53 to 0.81; n = 14); andc) reduced proportions of people who remained undecided post-intervention (RR 0.59; 95% CI 0.47 to 0.72; n = 18).Decision aids appeared to have a positive effect on patient-practitioner communication in all nine studies that measured this outcome. For satisfaction with the decision (n = 20), decision-making process (n = 17), and/or preparation for decision making (n = 3), those exposed to a decision aid were either more satisfied, or there was no difference between the decision aid versus comparison interventions. No studies evaluated decision-making process attributes for helping patients to recognize that a decision needs to be made, or understanding that values affect the choice.C) Secondary outcomes Exposure to decision aids compared to usual care reduced the number of people of choosing major elective invasive surgery in favour of more conservative options (RR 0.79; 95% CI 0.68 to 0.93; n = 15). Exposure to decision aids compared to usual care reduced the number of people choosing to have prostate-specific antigen screening (RR 0.87; 95% CI 0.77 to 0.98; n = 9). When detailed compared to simple decision aids were used, fewer people chose menopausal hormone therapy (RR 0.73; 95% CI 0.55 to 0.98; n = 3). For other decisions, the effect on choices was variable.The effect of decision aids on length of consultation varied from 8 minutes shorter to 23 minutes longer (median 2.55 minutes longer) with 2 studies indicating statistically-significantly longer, 1 study shorter, and 6 studies reporting no difference in consultation length. Groups of patients receiving decision aids do not appear to differ from comparison groups in terms of anxiety (n = 30), general health outcomes (n = 11), and condition-specific health outcomes (n = 11). The effects of decision aids on other outcomes (adherence to the decision, costs/resource use) were inconclusive. AUTHORS' CONCLUSIONS There is high-quality evidence that decision aids compared to usual care improve people's knowledge regarding options, and reduce their decisional conflict related to feeling uninformed and unclear about their personal values. There is moderate-quality evidence that decision aids compared to usual care stimulate people to take a more active role in decision making, and improve accurate risk perceptions when probabilities are included in decision aids, compared to not being included. There is low-quality evidence that decision aids improve congruence between the chosen option and the patient's values.New for this updated review is further evidence indicating more informed, values-based choices, and improved patient-practitioner communication. There is a variable effect of decision aids on length of consultation. Consistent with findings from the previous review, decision aids have a variable effect on choices. They reduce the number of people choosing discretionary surgery and have no apparent adverse effects on health outcomes or satisfaction. The effects on adherence with the chosen option, cost-effectiveness, use with lower literacy populations, and level of detail needed in decision aids need further evaluation. Little is known about the degree of detail that decision aids need in order to have a positive effect on attributes of the choice made, or the decision-making process.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada
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Dadich A. Citizen social science: a methodology to facilitate and evaluate workplace learning in continuing interprofessional education. J Interprof Care 2014; 28:194-9. [PMID: 24404844 DOI: 10.3109/13561820.2013.874982] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Workplace learning in continuing interprofessional education (CIPE) can be difficult to facilitate and evaluate, which can create a number of challenges for this type of learning. This article presents an innovative method to foster and investigate workplace learning in CIPE - citizen social science. Citizen social science involves clinicians as co-researchers in the systematic examination of social phenomena. When facilitated by an open-source online social networking platform, clinicians can participate via computer, smartphone, or tablet in ways that suit their needs and preferences. Furthermore, as co-researchers they can help to reveal the dynamic interplay that facilitates workplace learning in CIPE. Although yet to be tested, citizen social science offers four potential benefits: it recognises and accommodates the complexity of workplace learning in CIPE; it has the capacity to both foster and evaluate the phenomena; it can be used in situ, capturing and having direct relevance to the complexity of the workplace; and by advancing both theoretical and methodological debates on CIPE, it may reveal opportunities to improve and sustain workplace learning. By describing an example situated in the youth health sector, this article demonstrates how these benefits might be realised.
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Affiliation(s)
- Ann Dadich
- School of Business, University of Western Sydney , Parramatta , Australia
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Sibbald SL, Wathen CN, Kothari A, Day AMB. Knowledge flow and exchange in interdisciplinary primary health care teams (PHCTs): an exploratory study. J Med Libr Assoc 2013; 101:128-37. [PMID: 23646028 DOI: 10.3163/1536-5050.101.2.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Improving the process of evidence-based practice in primary health care requires an understanding of information exchange among colleagues. This study explored how clinically oriented research knowledge flows through multidisciplinary primary health care teams (PHCTs) and influences clinical decisions. METHODS This was an exploratory mixed-methods study with members of six PHCTs in Ontario, Canada. Quantitative data were collected using a questionnaire and analyzed with social network analysis (SNA) using UCINet. Qualitative data were collected using semi-structured interviews and analyzed with content analysis procedures using NVivo8. RESULTS It was found that obtaining research knowledge was perceived to be a shared responsibility among team members, whereas its application in patient care was seen as the responsibility of the team leader, usually the senior physician. PHCT members acknowledged the need for resources for information access, synthesis, interpretation, or management. CONCLUSION Information sharing in interdisciplinary teams is a complex and multifaceted process. Specific interventions need to be improved such as formalizing modes of communication, better organizing knowledge-sharing activities, and improving the active use of allied health professionals. Despite movement toward team-based models, senior physicians are often gatekeepers of uptake of new evidence and changes in practice.
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Affiliation(s)
- Shannon L Sibbald
- Faculties of Health Sciences and Information and Media Studies, Western University, London ON, N6A 5B9, Canada. ssibbald@ uwo.ca
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The Value of Library and Information Services in Patient Care: Canadian Results From an International Multisite Study. JOURNAL OF THE CANADIAN HEALTH LIBRARIES ASSOCIATION 2013. [DOI: 10.5596/c13-063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: This paper presents the Canadian results from a larger, international study with the objective of assessing the value of health library and information services and their impact on patient care. Methods: Data were collected using a web-based survey of healthcare providers in 13 Canadian hospitals collectively served by four libraries, and data were analyzed statistically using SPSS. The survey centred on a specific, recent, patient care incident for which the respondent had sought information. Follow-up semi-structured phone interviews with librarians at the participating sites provided supplemental data. Results: Twelve hundred and thirty-one people from the Canadian sites responded to the survey. Over 70% indicated that their management of the clinical situation changed as a result of the information. Positive changes included advice given to patient or family (48%), choice of drugs (31%), and choice of treatment (30%); adverse events that were avoided included patient misunderstanding of disease (23%), additional tests or procedures (18%), and patient mortality (5%). Results also showed which information resources were used and from where they were accessed. The information resources were valued as much, if not more, than other sources of information such as laboratory reports or medical records. Discussion: The results showed that participants perceive health library and information services to be highly valued and reported that their use has a positive impact on a range of patient care outcomes. They also highlighted the preferred information resources and access points among different groups of health professionals.
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Labrecque M, Ratté S, Frémont P, Cauchon M, Ouellet J, Hogg W, McGowan J, Gagnon MP, Njoya M, Légaré F. Decision making in family medicine: randomized trial of the effects of the InfoClinique and Trip database search engines. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2013; 59:1084-1094. [PMID: 24130286 PMCID: PMC3796978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To compare the ability of users of 2 medical search engines, InfoClinique and the Trip database, to provide correct answers to clinical questions and to explore the perceived effects of the tools on the clinical decision-making process. DESIGN Randomized trial. SETTING Three family medicine units of the family medicine program of the Faculty of Medicine at Laval University in Quebec city, Que. PARTICIPANTS Fifteen second-year family medicine residents. INTERVENTION Residents generated 30 structured questions about therapy or preventive treatment (2 questions per resident) based on clinical encounters. Using an Internet platform designed for the trial, each resident answered 20 of these questions (their own 2, plus 18 of the questions formulated by other residents, selected randomly) before and after searching for information with 1 of the 2 search engines. For each question, 5 residents were randomly assigned to begin their search with InfoClinique and 5 with the Trip database. MAIN OUTCOME MEASURES The ability of residents to provide correct answers to clinical questions using the search engines, as determined by third-party evaluation. After answering each question, participants completed a questionnaire to assess their perception of the engine's effect on the decision-making process in clinical practice. RESULTS Of 300 possible pairs of answers (1 answer before and 1 after the initial search), 254 (85%) were produced by 14 residents. Of these, 132 (52%) and 122 (48%) pairs of answers concerned questions that had been assigned an initial search with InfoClinique and the Trip database, respectively. Both engines produced an important and similar absolute increase in the proportion of correct answers after searching (26% to 62% for InfoClinique, for an increase of 36%; 24% to 63% for the Trip database, for an increase of 39%; P = .68). For all 30 clinical questions, at least 1 resident produced the correct answer after searching with either search engine. The mean (SD) time of the initial search for each question was 23.5 (7.6) minutes with InfoClinique and 22.3 (7.8) minutes with the Trip database (P = .30). Participants' perceptions of each engine's effect on the decision-making process were very positive and similar for both search engines. CONCLUSION Family medicine residents' ability to provide correct answers to clinical questions increased dramatically and similarly with the use of both InfoClinique and the Trip database. These tools have strong potential to increase the quality of medical care.
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Affiliation(s)
- Michel Labrecque
- Laval University, Département de médecine familiale et de médecine d'urgence, Hôpital St-François d'Assise, D6-728, 10 rue de l'Espinay, Quebec city, QC G1L 3L5.
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Marshall JG, Sollenberger J, Easterby-Gannett S, Morgan LK, Klem ML, Cavanaugh SK, Oliver KB, Thompson CA, Romanosky N, Hunter S. The value of library and information services in patient care: results of a multisite study. J Med Libr Assoc 2013; 101:38-46. [PMID: 23418404 DOI: 10.3163/1536-5050.101.1.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The research conducted a large-scale, multisite study on the value and impact of library and information services on patient care. METHODS THE STUDY USED: (1) 2 initial focus groups of librarians; (2) a web-based survey of physicians, residents, and nurses at 56 library sites serving 118 hospitals; and (3) 24 follow-up telephone interviews. Survey respondents were asked to base their responses on a recent incident in which they had sought information for patient care. RESULTS Of the 16,122 survey respondents, 3/4 said that they had definitely or probably handled aspects of the patient care situation differently as a result of the information. Among the reported changes were advice given to the patient (48%), diagnosis (25%), and choice of drugs (33%), other treatment (31%), and tests (23%). Almost all of the respondents (95%) said the information resulted in a better informed clinical decision. Respondents reported that the information allowed them to avoid the following adverse events: patient misunderstanding of the disease (23%), additional tests (19%), misdiagnosis (13%), adverse drug reactions (13%), medication errors (12%), and patient mortality (6%). CONCLUSIONS Library and information resources were perceived as valuable, and the information obtained was seen as having an impact on patient care.
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Affiliation(s)
- Joanne Gard Marshall
- School of Information and Library Science, University of North Carolina at Chapel Hill, 100 Manning Hall, CB# 3360, Chapel Hill, NC 27599-3360, USA.
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Fontelo P, Gavino A, Sarmiento RF. Comparing data accuracy between structured abstracts and full-text journal articles: implications in their use for informing clinical decisions. ACTA ACUST UNITED AC 2013; 18:207-11. [PMID: 23786759 DOI: 10.1136/eb-2013-101272] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The abstract is the most frequently read section of a research article. The use of 'Consensus Abstracts', a clinician-oriented web application formatted for mobile devices to search MEDLINE/PubMed, for informing clinical decisions was proposed recently; however, inaccuracies between abstracts and the full-text article have been shown. Efforts have been made to improve quality. METHODS We compared data in 60 recent-structured abstracts and full-text articles from six highly read medical journals. RESULTS Data inaccuracies were identified and then classified as either clinically significant or not significant. Data inaccuracies were observed in 53.33% of articles ranging from 3.33% to 45% based on the IMRAD format sections. The Results section showed the highest discrepancies (45%) although these were deemed to be mostly not significant clinically except in one. The two most common discrepancies were mismatched numbers or percentages (11.67%) and numerical data or calculations found in structured abstracts but not mentioned in the full text (40%). There was no significant relationship between journals and the presence of discrepancies (Fisher's exact p value =0.3405). Although we found a high percentage of inaccuracy between structured abstracts and full-text articles, these were not significant clinically. CONCLUSIONS The inaccuracies do not seem to affect the conclusion and interpretation overall. Structured abstracts appear to be informative and may be useful to practitioners as a resource for guiding clinical decisions.
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Affiliation(s)
- Paul Fontelo
- Lister Hill National Center for Biomedical Communications, U.S. National Library of Medicine, , Bethesda, Maryland, USA
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Marcelo A, Gavino A, Isip-Tan IT, Apostol-Nicodemus L, Mesa-Gaerlan FJ, Firaza PN, Faustorilla JF, Callaghan FM, Fontelo P. A comparison of the accuracy of clinical decisions based on full-text articles and on journal abstracts alone: a study among residents in a tertiary care hospital. EVIDENCE-BASED MEDICINE 2013; 18:48-53. [PMID: 22782923 PMCID: PMC3607116 DOI: 10.1136/eb-2012-100537] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Many clinicians depend solely on journal abstracts to guide clinical decisions. OBJECTIVES This study aims to determine if there are differences in the accuracy of responses to simulated cases between resident physicians provided with an abstract only and those with full-text articles. It also attempts to describe their information-seeking behaviour. METHODS Seventy-seven resident physicians from four specialty departments of a tertiary care hospital completed a paper-based questionnaire with clinical simulation cases, then randomly assigned to two intervention groups-access to abstracts-only and access to both abstracts and full-text. While having access to medical literature, they completed an online version of the same questionnaire. FINDINGS The average improvement across departments was not significantly different between the abstracts-only group and the full-text group (p=0.44), but when accounting for an interaction between intervention and department, the effect was significant (p=0.049) with improvement greater with full-text in the surgery department. Overall, the accuracy of responses was greater after the provision of either abstracts-only or full-text (p<0.0001). Although some residents indicated that 'accumulated knowledge' was sufficient to respond to the patient management questions, in most instances (83% of cases) they still sought medical literature. CONCLUSIONS Our findings support studies that doctors will use evidence when convenient and current evidence improved clinical decisions. The accuracy of decisions improved after the provision of evidence. Clinical decisions guided by full-text articles were more accurate than those guided by abstracts alone, but the results seem to be driven by a significant difference in one department.
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Affiliation(s)
- Alvin Marcelo
- National Telehealth Center, University of the Philippines, Manila, Philippines
- Department of Surgery, Philippine General Hospital, Manila, Philippines
| | - Alex Gavino
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | | | - Paul Nimrod Firaza
- National Telehealth Center, University of the Philippines, Manila, Philippines
| | | | - Fiona M Callaghan
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Paul Fontelo
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
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Divall P, Camosso-Stefinovic J, Baker R. The use of personal digital assistants in clinical decision making by health care professionals: A systematic review. Health Informatics J 2013; 19:16-28. [DOI: 10.1177/1460458212446761] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ownership of personal digital assistants (PDAs) and smartphones by health professionals is increasingly common. Providing the best available evidence at the point of care is important for time-poor clinical staff and may lead to benefits in the processes and outcomes of clinical care. This review was performed to investigate the usefulness of PDAs in the clinical setting. MEDLINE, Embase, CINAHL and the Cochrane Central Register of Controlled Trials were searched from 2000 to March 2010. Randomised controlled trials that evaluated the effects on the processes or outcomes of clinical care of using PDAs compared with not using a PDA were included. Two reviewers independently reviewed citations and abstracts, assessed full text articles and abstracted data from the studies. Seven trials met the review inclusion criteria, of which only three were of satisfactory quality. Studies investigated the use of PDAs either in recording patient information or in decision support for diagnoses or treatment. An increase in data collection quality was reported, and the appropriateness of diagnosis and treatment decisions was improved. PDAs appear to have potential in improving some processes and outcomes of clinical care, but the evidence is limited and reliable conclusions on whether they help, in what circumstances and how they should be used are not possible. Further research is required to assess their value and ensure full benefits from their widespread use, but the pace of technological development creates problems for the timely evaluation of these devices and their applications.
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Affiliation(s)
- Pip Divall
- University Hospitals of Leicester NHS Trust, UK
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Recursos bibliográficos para Atención Primaria en las bibliotecas virtuales de salud de las comunidades autónomas. Aten Primaria 2013; 45:165-71. [PMID: 22824151 PMCID: PMC6985531 DOI: 10.1016/j.aprim.2012.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 05/18/2012] [Accepted: 05/21/2012] [Indexed: 11/25/2022] Open
Abstract
La Declaración de la Sociedad Española de Medicina Familiar y Comunitaria (SemFYC) sobre acceso a fuentes de información resalta la necesidad de disponer de ciertos recursos en las bibliotecas virtuales de las comunidades autónomas (CCAA). El objetivo principal de este trabajo es estudiar la colección de MBE que SemFYC recomienda en las bibliotecas virtuales autonómicas. Se identifican las bibliotecas virtuales de salud (BVS) y se analiza el tipo de acceso, la presencia en Internet, la existencia de acceso remoto integral y los recursos. Los resultados sugieren una cobertura amplia en 8 CCAA. A la cabeza se encuentran la Biblioteca Virtual de Ciencias de la Salud de Navarra, la Biblioteca Virtual de Ciències de la Salut de les Illes Balears y la Biblioteca Virtual del Sistema Sanitario Público de Andalucía. Para determinar con mayor precisión el grado de cobertura sería necesario ampliar el presente estudio al resto de especialidades biomédicas.
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Marshall JG, Sollenberger J, Easterby-Gannett S, Morgan LK, Klem ML, Cavanaugh SK, Oliver KB, Thompson CA, Romanosky N, Hunter S. The value of library and information services in patient care: results of a multisite study. J Med Libr Assoc 2013. [PMID: 23418404 DOI: 10.3163/1536-5050.101.1.007.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The research conducted a large-scale, multisite study on the value and impact of library and information services on patient care. METHODS THE STUDY USED: (1) 2 initial focus groups of librarians; (2) a web-based survey of physicians, residents, and nurses at 56 library sites serving 118 hospitals; and (3) 24 follow-up telephone interviews. Survey respondents were asked to base their responses on a recent incident in which they had sought information for patient care. RESULTS Of the 16,122 survey respondents, 3/4 said that they had definitely or probably handled aspects of the patient care situation differently as a result of the information. Among the reported changes were advice given to the patient (48%), diagnosis (25%), and choice of drugs (33%), other treatment (31%), and tests (23%). Almost all of the respondents (95%) said the information resulted in a better informed clinical decision. Respondents reported that the information allowed them to avoid the following adverse events: patient misunderstanding of the disease (23%), additional tests (19%), misdiagnosis (13%), adverse drug reactions (13%), medication errors (12%), and patient mortality (6%). CONCLUSIONS Library and information resources were perceived as valuable, and the information obtained was seen as having an impact on patient care.
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Affiliation(s)
- Joanne Gard Marshall
- School of Information and Library Science, University of North Carolina at Chapel Hill, 100 Manning Hall, CB# 3360, Chapel Hill, NC 27599-3360, USA.
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Bjerre LM, Paterson NR, McGowan J, Hogg W, Campbell CM, Viner G, Archibald D. What do primary care practitioners want to know? A content analysis of questions asked at the point of care. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2013; 33:224-234. [PMID: 24347101 DOI: 10.1002/chp.21191] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Assessing physician needs to develop continuing medical education (CME) activities is an integral part of CME curriculum development. The purpose of the present study was to demonstrate the feasibility of identifying areas of perceived greatest needs for continuing medical education (CME) by using questions collected electronically at the point of care. METHODS This study is a secondary analysis of the "Just-in-Time" (JIT) information librarian consultation service database of questions using quantitative content analysis methods. The original JIT project demonstrated the feasibility of a real-time librarian service for answering questions asked by primary care clinicians at the point of care using a Web-based platform or handheld device. Data were collected from 88 primary care practitioners in Ontario, Canada, from October 2005 to April 2006. Questions were answered in less than 15 minutes, enabling clinicians to use the answer during patient encounters. RESULTS Description of type and frequency of questions asked, including the organ system on which the questions focused, was produced using 2 classification systems, the "taxonomy of generic clinical questions" (TGCQ), and the International Classification for Primary Care version 2 (ICPC-2). Of the original 1889 questions, 1871 (99.0%) were suitable for analysis. A total of 970 (52%) of questions related to therapy; of these, 671 (69.2%) addressed questions about drug therapy, representing 36% of all questions. Questions related to diagnosis (24.8%) and epidemiology (13.5%) were also common. Organ systems questions concerning musculoskeletal, endocrine, skin, cardiac, and digestive systems were asked more than other categories. DISCUSSION Questions collected at the point of care provide a valuable and unique source of information on the true learning needs of practicing clinicians. The TGCQ classification allowed us to show that a majority of questions had to do with treatment, particularly drug treatment, whereas the use of the ICPC-2 classification illustrated the great variety of questions asked about the diverse conditions encountered in primary care. It is feasible to use electronically collected questions asked by primary care clinicians in clinical practice to categorize self-identified knowledge and practice needs. This could be used to inform the development of future learning activities.
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Affiliation(s)
- Lise M Bjerre
- Department of Family Medicine, University of Ottawa, Ottawa, Canada;; C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada;; Department of Epidemiology and Community Medicine, University of Ottawa, Canada;.
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Pluye P, Grad R, Repchinsky C, Jovaisas B, Johnson-Lafleur J, Carrier ME, Granikov V, Farrell B, Rodriguez C, Bartlett G, Loiselle C, Légaré F. Four levels of outcomes of information-seeking: A mixed methods study in primary health care. ACTA ACUST UNITED AC 2012. [DOI: 10.1002/asi.22793] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Pierre Pluye
- Department of Family Medicine; McGill University; 517 Pine Avenue West; Montreal; Quebec; Canada; H2W 1S4
| | - Roland Grad
- Department of Family Medicine; McGill University; 517 Pine Avenue West; Montreal; Quebec; Canada; H2W 1S4
| | - Carol Repchinsky
- Canadian Pharmacists Association; 1785 Alta Vista Drive; Ottawa; Ontario; Canada; K1G 3Y6
| | - Barbara Jovaisas
- Canadian Pharmacists Association; 1785 Alta Vista Drive; Ottawa; Ontario; Canada; K1G 3Y6
| | - Janique Johnson-Lafleur
- Information Technology Primary Care Research Group (ITPCRG); McGill University; 517 Pine Avenue West; Montreal; Quebec; Canada; H2W 1S4
| | - Marie-Eve Carrier
- Information Technology Primary Care Research Group (ITPCRG); McGill University; 517 Pine Avenue West; Montreal; Quebec; Canada; H2W 1S4
| | - Vera Granikov
- Information Technology Primary Care Research Group (ITPCRG); McGill University; 517 Pine Avenue West; Montreal; Quebec; Canada; H2W 1S4
| | - Barbara Farrell
- Department of Family Medicine; University of Ottawa; 43 Bruyère Street (Floor 3JB); Ottawa; ON; Canada; K1N 5C8
| | - Charo Rodriguez
- Department of Family Medicine; McGill University; 517 Pine Avenue West; Montreal; Quebec; Canada; H2W 1S4
| | - Gillian Bartlett
- Department of Family Medicine; McGill University; 517 Pine Avenue West; Montreal; Quebec; Canada; H2W 1S4
| | - Carmen Loiselle
- School of Nursing; McGill University; Wilson Hall, 3506 University Street; Montreal; Quebec; Canada; H3A 2A7
| | - France Légaré
- Department of Family and Emergency Medicine, Université Laval, Centre de Recherche du CHUQ, Hôpital Saint-François d'Assise; Unité de Recherche Évaluative; local D6-727, 10, rue de l'Espinay; Québec; Québec; Canada; G1L 3L5
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Abstract
Evidence-based medicine is a relatively new and sometimes controversial concept when applied to pediatric orthopaedics. This article provides pediatric orthopaedists with some basics to help them understand and apply evidence-based medicine to their clinical practice.
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Lasserre K. Expert searching in health librarianship: a literature review to identify international issues and Australian concerns. Health Info Libr J 2012; 29:3-15. [PMID: 22335285 DOI: 10.1111/j.1471-1842.2011.00974.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The traditional role of health librarians as expert searchers is under challenge. OBJECTIVES The purpose of this review is to establish health librarians' views, practices and educational processes on expert searching. METHODS The search strategy was developed in LISTA and then customised for ten other databases: ALISA, PubMed, Embase, Scopus, Web of Science, CINAHL, ERIC, PsycINFO, Cochrane Library and Google Scholar. The search terms were (expert search* OR expert retriev* OR mediated search* OR information retriev*) AND librar*. The searches, completed in December 2010 and repeated in May 2011, were limited to English language publications from 2000 to 2011 (unless seminal works). RESULTS Expert searching remains a key role for health librarians, especially for those supporting systematic reviews or employed as clinical librarians answering clinical questions. CONCLUSIONS Although clients tend to be satisfied with searches carried out for them, improvements are required to effectively position the profession. Evidence-based guidelines, adherence to transparent standards, review of entry-level education requirements and a commitment to accredited, rigorous, ongoing professional development will ensure best practice.
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Affiliation(s)
- Kaye Lasserre
- Hargrave-Andrew Library, Monash University, Melbourne, Victoria, Australia.
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A cost-consequences analysis of a primary care librarian question and answering service. PLoS One 2012; 7:e33837. [PMID: 22442727 PMCID: PMC3307768 DOI: 10.1371/journal.pone.0033837] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 02/17/2012] [Indexed: 12/02/2022] Open
Abstract
Background Cost consequences analysis was completed from randomized controlled trial (RCT) data for the Just-in-time (JIT) librarian consultation service in primary care that ran from October 2005 to April 2006. The service was aimed at providing answers to clinical questions arising during the clinical encounter while the patient waits. Cost saving and cost avoidance were also analyzed. The data comes from eighty-eight primary care providers in the Ottawa area working in Family Health Networks (FHNs) and Family Health Groups (FHGs). Methods We conducted a cost consequences analysis based on data from the JIT project [1]. We also estimated the potential economic benefit of JIT librarian consultation service to the health care system. Results The results show that the cost per question for the JIT service was $38.20. The cost could be as low as $5.70 per question for a regular service. Nationally, if this service was implemented and if family physicians saw additional patients when the JIT service saved them time, up to 61,100 extra patients could be seen annually. A conservative estimate of the cost savings and cost avoidance per question for JIT was $11.55. Conclusions The cost per question, if the librarian service was used at full capacity, is quite low. Financial savings to the health care system might exceed the cost of the service. Saving physician's time during their day could potentially lead to better access to family physicians by patients. Implementing a librarian consultation service can happen quickly as the time required to train professional librarians to do this service is short.
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Abstract
BACKGROUND In the recent times of recession and budget cuts, it is more important than ever for library and information services to deliver cost-effective services. OBJECTIVES This rapid review aims to examine the evidence for the most cost-effective ways of delivering enquiry services. METHODS A literature search was conducted on LISA (Library and Information Sciences Abstracts) and MEDLINE. Searches were limited to 2007 onwards. RESULTS Eight studies met the inclusion criteria. The studies covered hospital and academic libraries in the USA and Canada. Services analysed were 'point-of-care' librarian consultations, staffing models for reference desks and virtual/digital reference services. CONCLUSIONS Transferable lessons, relevant to health library and information services generally, can be drawn from this rapid review. These suggest that 'point-of-care' librarians for primary care practitioners are a cost-effective way of answering questions. Reference desks can be cost-effectively staffed by student employees or general reference staff, although librarian referral must be provided for more complex and subject-specific enquiries. However, it is not possible to draw any conclusions on virtual/digital reference services because of the limited literature available. Further case analysis studies measuring specific services, particularly enquiry services within a health library and information context, are required.
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Affiliation(s)
- Anthea Sutton
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK.
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Augestad KM, Berntsen G, Lassen K, Bellika JG, Wootton R, Lindsetmo RO. Standards for reporting randomized controlled trials in medical informatics: a systematic review of CONSORT adherence in RCTs on clinical decision support. J Am Med Inform Assoc 2012; 19:13-21. [PMID: 21803926 PMCID: PMC3240766 DOI: 10.1136/amiajnl-2011-000411] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 06/29/2011] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The Consolidated Standards for Reporting Trials (CONSORT) were published to standardize reporting and improve the quality of clinical trials. The objective of this study is to assess CONSORT adherence in randomized clinical trials (RCT) of disease specific clinical decision support (CDS). METHODS A systematic search was conducted of the Medline, EMBASE, and Cochrane databases. RCTs on CDS were assessed against CONSORT guidelines and the Jadad score. RESULT 32 of 3784 papers identified in the primary search were included in the final review. 181 702 patients and 7315 physicians participated in the selected trials. Most trials were performed in primary care (22), including 897 general practitioner offices. RCTs assessing CDS for asthma (4), diabetes (4), and hyperlipidemia (3) were the most common. Thirteen CDS systems (40%) were implemented in electronic medical records, and 14 (43%) provided automatic alerts. CONSORT and Jadad scores were generally low; the mean CONSORT score was 30.75 (95% CI 27.0 to 34.5), median score 32, range 21-38. Fourteen trials (43%) did not clearly define the study objective, and 11 studies (34%) did not include a sample size calculation. Outcome measures were adequately identified and defined in 23 (71%) trials; adverse events or side effects were not reported in 20 trials (62%). Thirteen trials (40%) were of superior quality according to the Jadad score (≥3 points). Six trials (18%) reported on long-term implementation of CDS. CONCLUSION The overall quality of reporting RCTs was low. There is a need to develop standards for reporting RCTs in medical informatics.
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Affiliation(s)
- K M Augestad
- Department of Telemedicine and Integrated Care, University Hospital North Norway, Tromsø, Norway
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Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Légaré F, Thomson R. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2011:CD001431. [PMID: 21975733 DOI: 10.1002/14651858.cd001431.pub3] [Citation(s) in RCA: 550] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Decision aids prepare people to participate in decisions that involve weighing benefits, harms, and scientific uncertainty. OBJECTIVES To evaluate the effectiveness of decision aids for people facing treatment or screening decisions. SEARCH STRATEGY For this update, we searched from January 2006 to December 2009 in MEDLINE (Ovid); Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, issue 4 2009); CINAHL (Ovid) (to September 2008 only); EMBASE (Ovid); PsycINFO (Ovid); and grey literature. Cumulatively, we have searched each database since its start date. SELECTION CRITERIA We included published randomised controlled trials (RCTs) of decision aids, which are interventions designed to support patients' decision making by providing information about treatment or screening options and their associated outcomes, compared to usual care and/or alternative interventions. We excluded studies in which participants were not making an active treatment or screening decision. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts for inclusion, extracted data, and assessed potential risk of bias. The primary outcomes, based on the International Patient Decision Aid Standards, were:A) decision attributes;B) decision making process attributes.Secondary outcomes were behavioral, health, and health system effects. We pooled results of RCTs using mean differences (MD) and relative risks (RR), applying a random effects model. MAIN RESULTS Of 34,316 unique citations, 86 studies involving 20,209 participants met the eligibility criteria and were included. Thirty-one of these studies are new in this update. Twenty-nine trials are ongoing. There was variability in potential risk of bias across studies. The two criteria that were most problematic were lack of blinding and the potential for selective outcome reporting, given that most of the earlier trials were not registered.Of 86 included studies, 63 (73%) used at least one measure that mapped onto an IPDAS effectiveness criterion: A) criteria involving decision attributes: knowledge scores (51 studies); accurate risk perceptions (16 studies); and informed value-based choice (12 studies); and B) criteria involving decision process attributes: feeling informed (30 studies) and feeling clear about values (18 studies).A) Criteria involving decision attributes:Decision aids performed better than usual care interventions by increasing knowledge (MD 13.77 out of 100; 95% confidence interval (CI) 11.40 to 16.15; n = 26). When more detailed decision aids were compared to simpler decision aids, the relative improvement in knowledge was significant (MD 4.97 out of 100; 95% CI 3.22 to 6.72; n = 15). Exposure to a decision aid with expressed probabilities resulted in a higher proportion of people with accurate risk perceptions (RR 1.74; 95% CI 1.46 to 2.08; n = 14). The effect was stronger when probabilities were expressed in numbers (RR 1.93; 95% CI 1.58 to 2.37; n = 11) rather than words (RR 1.27; 95% CI 1.09 to 1.48; n = 3). Exposure to a decision aid with explicit values clarification compared to those without explicit values clarification resulted in a higher proportion of patients achieving decisions that were informed and consistent with their values (RR 1.25; 95% CI 1.03 to 1.52; n = 8).B) Criteria involving decision process attributes:Decision aids compared to usual care interventions resulted in: a) lower decisional conflict related to feeling uninformed (MD -6.43 of 100; 95% CI -9.16 to -3.70; n = 17); b) lower decisional conflict related to feeling unclear about personal values (MD -4.81; 95% CI -7.23 to -2.40; n = 14); c) reduced the proportions of people who were passive in decision making (RR 0.61; 95% CI 0.49 to 0.77; n = 11); and d) reduced proportions of people who remained undecided post-intervention (RR 0.57; 95% CI 0.44 to 0.74; n = 9). Decision aids appear to have a positive effect on patient-practitioner communication in the four studies that measured this outcome. For satisfaction with the decision (n = 12) and/or the decision making process (n = 12), those exposed to a decision aid were either more satisfied or there was no difference between the decision aid versus comparison interventions. There were no studies evaluating the decision process attributes relating to helping patients to recognize that a decision needs to be made or understand that values affect the choice.C) Secondary outcomesExposure to decision aids compared to usual care continued to demonstrate reduced choice of: major elective invasive surgery in favour of conservative options (RR 0.80; 95% CI 0.64 to 1.00; n = 11). Exposure to decision aids compared to usual care also resulted in reduced choice of PSA screening (RR 0.85; 95% CI 0.74 to 0.98; n = 7). When detailed compared to simple decision aids were used, there was reduced choice of menopausal hormones (RR 0.73; 95% CI 0.55 to 0.98; n = 3). For other decisions, the effect on choices was variable. The effect of decision aids on length of consultation varied from -8 minutes to +23 minutes (median 2.5 minutes). Decision aids do not appear to be different from comparisons in terms of anxiety (n = 20), and general health outcomes (n = 7), and condition specific health outcomes (n = 9). The effects of decision aids on other outcomes (adherence to the decision, costs/resource use) were inconclusive. AUTHORS' CONCLUSIONS New for this updated review is evidence that: decision aids with explicit values clarification exercises improve informed values-based choices; decision aids appear to have a positive effect on patient-practitioner communication; and decision aids have a variable effect on length of consultation.Consistent with findings from the previous review, which had included studies up to 2006: decision aids increase people's involvement, and improve knowledge and realistic perception of outcomes; however, the size of the effect varies across studies. Decision aids have a variable effect on choices. They reduce the choice of discretionary surgery and have no apparent adverse effects on health outcomes or satisfaction. The effects on adherence with the chosen option, patient-practitioner communication, cost-effectiveness, and use with developing and/or lower literacy populations need further evaluation. Little is known about the degree of detail that decision aids need in order to have positive effects on attributes of the decision or decision-making process.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada
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Gardois P, Calabrese R, Colombi N, Deplano A, Lingua C, Longo F, Villanacci MC, Miniero R, Piga A. Effectiveness of bibliographic searches performed by paediatric residents and interns assisted by librarians. A randomised controlled trial. Health Info Libr J 2011; 28:273-84. [PMID: 22051126 DOI: 10.1111/j.1471-1842.2011.00957.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Considerable barriers still prevent paediatricians from successfully using information retrieval technology. OBJECTIVES To verify whether the assistance of biomedical librarians significantly improves the outcomes of searches performed by paediatricians in biomedical databases using real-life clinical scenarios. METHODS In a controlled trial at a paediatric teaching hospital, nine residents and interns were randomly allocated to an assisted search group and nine to a non-assisted (control) group. Each participant searched PubMed and other online sources, performing pre-determined tasks including the formulation of a clinical question, retrieval and selection of bibliographic records. In the assisted group, participants were supported by a librarian with ≥5 years of experience. The primary outcome was the success of search sessions, scored against a specific assessment tool. RESULTS The median score of the assisted group was 73.6 points interquartile range (IQR = 13.4) vs. 50.4 (IQR = 17.1) of the control group. The difference between median values in the results was 23.2 points (95% CI 4.8-33.2), in favour of the assisted group (P-value, Mann-Whitney U test: 0.013). CONCLUSIONS The study has found quantitative evidence of a significant difference in search performance between paediatric residents or interns assisted by a librarian and those searching the literature alone.
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Affiliation(s)
- Paolo Gardois
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
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Davies K. Evidence-based medicine: is the evidence out there for primary care clinicians? Health Info Libr J 2011; 28:285-93. [PMID: 22051127 DOI: 10.1111/j.1471-1842.2011.00954.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Finding evidence to answer clinical questions is essential to the practice of evidence-based medicine (EBM). However, practising EBM in primary care is thought to be problematic because of concerns about whether evidence exists to answer specific questions. OBJECTIVES To determine the highest level of evidence per question; to ascertain the number of questions unanswered because of a lack of evidence; to establish the frequency with which guidelines answered questions; and to determine the domain of websites used to answer questions. METHODS Clinical questions were identified from two primary care answering services: ATTRACT and National Library for Health (NLH) Primary Care Answering Service. The types of evidence used to answer the question were noted, including whether this was from systematic reviews or meta-analyses (level one evidence) or from randomised controlled trials (level two). The data were collected from March to June 2008. RESULTS Level 1 or level 2 evidence answered 11% of questions. Sixteen per cent were unanswered because of a lack of evidence. Over 40% of questions were answered using guidelines. Forty-three per cent of questions were answered with one type of evidence and 24% with two. CONCLUSION Guidelines are useful resources for primary care clinicians, answering two-fifths of questions.
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Affiliation(s)
- Karen Davies
- School of Information Studies, University of Wisconsin Milwaukee (UW-M), Milwaukee, WI, USA.
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Karari C, Tittle R, Penner J, Kulzer J, Bukusi EA, Marima R, Cohen CR. Evaluating the Uptake, Acceptability, and Effectiveness of Uliza! Clinicians' HIV Hotline: A Telephone Consultation Service in Kenya. Telemed J E Health 2011; 17:420-6. [DOI: 10.1089/tmj.2010.0220] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Charles Karari
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Robin Tittle
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Jeremy Penner
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Jayne Kulzer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Elizabeth A. Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Reson Marima
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
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Tews M, Brennan K, Begaz T, Treat R. Medical student case presentation performance and perception when using mobile learning technology in the emergency department. MEDICAL EDUCATION ONLINE 2011; 16:MEO-16-7327. [PMID: 22013378 PMCID: PMC3195427 DOI: 10.3402/meo.v16i0.7327] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/28/2011] [Accepted: 08/05/2011] [Indexed: 05/10/2023]
Abstract
BACKGROUND Hand-held mobile learning technology provides opportunities for clinically relevant self-instructional modules to augment traditional bedside teaching. Using this technology as a teaching tool has not been well studied. We sought to evaluate medical students' case presentation performance and perception when viewing short, just-in-time mobile learning videos using the iPod touch prior to patient encounters. METHODS Twenty-two fourth-year medical students were randomized to receive or not to receive instruction by video, using the iPod Touch, prior to patient encounters. After seeing a patient, they presented the case to their faculty, who completed a standard data collection sheet. Students were surveyed on their perceived confidence and effectiveness after using these videos. RESULTS Twenty-two students completed a total of 67 patient encounters. There was a statistically significant improvement in presentations when the videos were viewed for the first time (p=0.032). There was no difference when the presentations were summed for the entire rotation (p=0.671). The reliable (alpha=0.97) survey indicated that the videos were a useful teaching tool and gave students more confidence in their presentations. CONCLUSIONS Medical student patient presentations were improved with the use of mobile instructional videos following first time use, suggesting mobile learning videos may be useful in medical student education. Clinical educators should consider whether, in an instance where live bedside or direct interactive teaching is unavailable, using just-in-time educational videos on a handheld device might be useful as a supplemental instructional strategy.
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Affiliation(s)
- Matthew Tews
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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