Computer resources help doctors answer patient care questions

You bring questions to your physician, but if your doctor has questions about how to best provide care for you, where does he or she go for answers? Physicians still use paper-based resources, however, a University of Iowa Health Care study focused on pediatricians shows that, in comparison, it takes less than one-third of the time to use the computer to find an answer.

The study, which also shows the effectiveness of training physicians to use computer resources for patient care questions, appears in the January 2004 issue of the journal Pediatrics. A related study on pediatricians’ most common types of clinical questions appears in the January 2004 issue of the journal Ambulatory Pediatrics. That study shows resources should better take into account the types of questions doctors have about their young patients. The two studies were based on the participation of faculty and resident pediatricians at Children’s Hospital of Iowa.

“There has been little research on how physicians seek answers to clinical care questions and, of that, virtually nothing focuses on pediatricians,” said Donna D’Alessandro, M.D., associate professor of pediatrics in the UI Roy J. and Lucille A. Carver College of Medicine.

“We tried to characterize what pediatricians did when they had questions and also what those questions were. The underlying goal is ultimately to make different information resources available,” she said. “If we can develop better resources for physicians to use when they have questions, then hopefully we can improve patient care.”

Previous studies show that roughly one patient care question per physician goes unanswered in any given day, and the most common reason is lack of time. In addition, resources either are not available, not up-to-date, or do not provide information in a way that answers the specific question about a specific patient.

The study published in Pediatrics focused on types of resources — paper-based or online/digital. First, a control group of 41 pediatricians used the paper-based resources for in-patient and out-patient questions. Nearly a year later, an “intervention” group of 31 pediatricians received a 10-minute training session on how best to use computer resources. While both groups were equally successful in finding correct answers (overall, 94.4 percent of the time), after the computer training, physicians spent an average of eight minutes seeking answers compared to nearly 20 minutes previously. In addition, after training, the physicians used the computers significantly more often.

“Physicians generally use paper-based resources because that’s generally what we have available. If computers will save time, we need to shift physicians’ behaviors from using paper to using computer-based resources,” D’Alessandro said. “We don’t know if the 10-minute interventions alone can make all the difference, but it made pediatricians very aware of what types of resources are available to them and how they could go about using computers.”

In her own practice, D’Alessandro increasingly uses the Internet to get the most current information about topics such as SARS, anthrax or influenza. She also finds more and more information that is available only online, such as traveler health information issued by the Centers for Disease Control and Prevention (CDC).

“Previously, the CDC’s travel ’yellow’ book used to be printed once a year and quickly got outdated. Now it’s on the Web and if they make a change based on something that’s happened in the world, I know about it right away. I don’t have to rely on two-year-old data,” she said.

D’Alessandro added that remotely using online or digital resources also provides an advantage over paper resources when physicians are on call, for example.

The study published in Ambulatory Pediatrics revealed the most common question is “What is the dose of drug X?” that should be given to a particular patient. That type of question is fairly straightforward, and a resource such as the Physician’s Desk Reference, available both in print and online, can provide an accurate answer. However, other questions were not as easily answered, such as “What’s the treatment for condition X?” because it is difficult to apply to a patient with other medical problems.

D’Alessandro said that medical educators need to think about these issues and develop answers so that physicians can not only find the information quickly but also use it for their specific clinical case.

“Physicians use what is convenient to them and what they know,” D’Alessandro said. “Our two studies may help more physicians start to believe that computers will make a difference — then we can start to change their behaviors.”

Both studies included grant support from a Robert Wood Johnson General Faculty Scholars Grant awarded to D’Alessandro. Other collaborators on both studies were Clarence Kreiter, Ph.D., assistant professor in the UI Office of Consultation and Research in Medicine and UI Department of Family Medicine, and Michael Peterson, M.D., a former UI faculty member now at the University of California in Fresno. In addition, Peggy Kingsley and Jill Johnson-West, both in the UI Department of Pediatrics, contributed to the question analysis study.

STORY SOURCE:
University of Iowa Health Science Relations,
5137 Westlawn,
Iowa City, Iowa 52242-1178

News releases describing previous computer-related research by D’Alessandro can be found online:
Readability of information about children’s health care:
http://www.uiowa.edu/~ournews/2001/july/0713peds-internet.html
Physician response to unsolicited online requests for help:
http://www.uiowa.edu/~ournews/1999/april/0430online.html
Creation of generalpediatrics.com digital library:
http://www.uiowa.edu/~ournews/2000/may/0508digital_library.html

University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide.