Information Seeking Behavior of Physicians

1. Information Seeking Behavior of Physicians Patti Reynolds Director, Bishopric Medical LibrarySarasota Memorial Hospital

2. Critical Skills • “Using technology to access clinical information has become a critical skill for family physicians.” • “Family physicians information seeking behaviors: a survey comparison with other specialties”2005 • BMC Medical Information and Decision Making 2005

3. Family Physicians Needs • Timely access to wide variety of clinical information sources • Specific questions on patient management: • 3.2 questions for every 10 patients seen • Drug questions most often • Pursuing answers occurs only about a third of the time

4. Pursuing an answer • Motivation: • Belief that a definitive answer exists • The patient’s problem is urgent • What happens when personal bias or negative attitudes enters the picture?

5. Where are the answers? • Half the questions may be readily answered by information in a clinical record • One quarter of questions require traditional resources – books, journals • One quarter of the questions require synthesis of information about a specific patient with a biomedical knowledge base

6. Success Needs… • Essential to find accurate information quickly • Family MD’s spend on average less than 2 minutes finding an answer in a text book or journal • MD’s found drug info in a palm pilot in 20 seconds • One study – PDA’s used in 64% of outpatient facilities, with 69% looking up drug info

7. Results • Care may be fragmented or diminished and less evidence-based when access is not readily available or available only through specialists

8. Study results • 457 family physicians • 72.7% male • 27.4% female • 39.6% practiced in rural areas • 44.8% graduated from medical school more than 20 years earlier

9. Results • 59% regularly use the internet daily or weekly for clinical information • Also use for personal email • 47% report access by modem • Journals were rated first in importance • 73% believed that the Internet was useful and important to physicians

10. Results • 54% of md’s were confident in using the internet • 14% not confident at all • Family md’s look for info on a specific patient problem • Diagnosis/management – 73% • Patient education - 58% • Guideline summaries – 49% • Specialists were similar but 37% looked for patient education material

11. Credibility and relevance • Credibility was ranked as the most important characteristic of the internet related to clinical informationby all types of md’s. • Family md’s said “too much information to scan” – barrier • Relevance considered very important

13. Results • Because of the broad scope of family practice and exponential increase in medical knowledge, mastery of technology is a core skill. • Family md’s are driven by questions regarding specific patients rather than new research findings.

14. Specialist vs Family MD • Family • Current best practices and clinical guidelines most important • Specialists • In-depth knowledge in relatively narrow area • Access to cutting edge research and journals • Contact with more limited population of colleagues – many far away

15. Problems for all • Navigation • Lack of speed • Extensive amount of information to scan • Lack of specificity for available information • Obstacles greater for family md’s

16. Handheld devices –PDA’s • Family md’s more like to use these • 80% of internists use PDA’s to access drug information • Other uses: • textbooks • Journals • Medical calculators • Patient tracking programs • Billing and coding software • Word processing • Internet access and more……

17. PDA’s • Drug prescribing most common medical error • PDA’s • save time in information retrieval, • easily incorporated into their workflow • Reduced rate of preventable adverse drug events

18. Results • Family md’s deal with broadest clinical knowledge bases BUT • 2/3 of questions go unanswered • Only pursue urgent needs or high probability of finding an answer • MD’s have access to the internet and are using it • Consider it important • Confident in their ability to use it(?)

19. Results • They direct more attention to patient care issues • Overwhelmed by amount of clinical information • Lack of confidence that they will be able to find an answer • PDA’s will grow in use

20. Other studies • The most commonly reported obstacle to the pursuit of an answer was the physician's doubt that an answer existed

22. The PDR • What is the PDR?

23. Adverse Drug Events • 76.2% ADE’s are dose relatedusing standard methods of care • Large number of serious ADEs even when drugs are properly prescribed and administered • 1985 – 37,000 ADE reports to FDA 71% “involved toxic reactions to usual doses” Lazarou J, et al Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998;279:1200-1205

24. Usual Dose of Drug • Doses recommended by manufacturers package inserts • This is what is found in the PDR • Manufacturer-recommended doses of medications are usually selected during phase 1 • After drug is introduced or general use – and the package insert is written and codified in the PDR – THEN Phase 4 starts

25. Phase 4 • Risks become apparent • New uses for drugs • Independent research reveals effectiveness of doses that differ from the manufacturers recommendations • This information does not get to the physician.

26. PDR • 82-90% md’s consider PDR single most useful reference(“publishing company source”) • Average md consults 8 times a week • FREE - underwritten by the pharmaceutical industry

27. PDR information • PDR info rarely updated • PDR drug descriptions are not dated • There is no requirement for drug companies to update their package inserts • No dosing adjustments for elderly • Data regarding lower doses often omitted (NSAIDS)

28. Good Data • NSAIDS • Dose related ADEs from NSAIDS hae prompted more reports to the FDA than any other drug group • Most NSAID ADE’s are dose related • Annually, 8000-16,000 deaths and 70,000-107,000 hospitalizations related to NSAID use • Using lowest dose is critical

30. “The most common therapeutic intervention in medicine is writing a prescription” Inadequate dosing information affects everyone

31. Needs • New constantly updated PDR • Another drug reference with adequate information • Entirely new reference created from joint contributions of government, pharmaceutical industry, foundations and phsyicians

32. SMH Access statistics – 1 year • Mar 2004-Feb 2005, 4,554 articles downloaded from NEJM. • 378 searches performed • ProQuest – 7,598 articles downloaded in 12 months • UpToDate – more than 300 time per week • JAMA – 12,000+ articles downloaded • 831 articles borrowed • 1,900+ requests to library

33. What does this mean? • Physicians need information • Consistent, fast access • Valid resources to fit exact needs • Proper education in use of technology • Time • An administration that supports the financing of good information