RML Rendezvous - Physician Assistants & Information Needs for Clinical Decision Making

Physician Assistants and Information Needs for Clinical Decision-Making RML Rendevous January 13, 2010 Beth Hill, MLS, AHIP Kootenai Medical Center [email_address]

Physician Assistants and Information Needs for Clinical Decision-Making- Outline
History of the profession
Value of the profession to medical practice
IOM Core Competencies and Evidence-based practice
Rural practice challenges
Rochester and University of Wales Studies
Use of clinical information for patient care decision-making- survey results for physician assistants

Physician Assistant- History of the Profession
Nationwide shortage of physicians recognized in the 1960s
Health Professions Assistance Act of 1963
Profession created to relieve shortage and increase access to health care in underserved areas.
First class of PAs organized in 1965
10/6/67- first class of PAs graduates
Work under a physician’s license
Must pass a national certification exam

Physician Assistants- Value of the profession to medical practice
Perform similar tasks to physicians
Have high level of autonomy in clinical decision-making
Relationship with physician allows them to staff satellite clinics, provide on-call services, and deliver care in rural areas

Physician Assistants and Information Needs for Clinical Decision-Making
IOM Core Competencies
Provide patient-centered care
Work in interdisciplinary teams
Apply quality improvement principles
Utilize informatics
Apply clinical decision-making that is evidence-based
Institute of Medicine. (2003). Health professions education: A bridge to quality. Quality Chasm Series. Washington, DC: National Academies Press.

Physician Assistants and Information Needs for Clinical Decision-making
Steps in the EBM Process
Clinical problem arising from patient
Constructing a well-built clinical question
Select appropriate resource and search
Appraise evidence for validity and applicability
Integrate with clinical expertise and patient preferences
Evaluate performance
Schardt, C. & Mayer, J. (2004). Introduction to evidence-based medicine tutorial. Retrieved January 11, 2010, from http://www.hsl.unc.edu/Services/Tutorials/ebm/welcome.htm

Rural Practice Challenges
Struggle to retain qualified physicians
Feelings of isolation- colleagues less accessible
Lower compensation
Limited library resources and services
Fewer practitioners overall choosing family medicine

Rochester Study
Conducted in the early ’90s. Joanne Marshall, PI
Mostly urban physicians and residents, and rural physicians served by circuit librarians
Librarian-mediated searching, results evaluated for clinical usefulness in decision-making
Marshall, J.G. (1992). The impact of the hospital library on clinical decision making: The Rochester study. Bull Med Libr Assoc, 80(2),169–78.
University of Wales Aberystwyth
Conducted in 2005. Spink, Thomas, Urquhart & Weightman
Toolkit development, evaluation of impact of library services on patient care
Participants mostly did their own searching of the literature
Physicians, allied health personnel, nurses, administrators
http://cadair.aber.ac.uk/dspace/bitstream/2160/355/4/NKS_ImpactStudyReport_Nov07.pdf

Results of Rochester Study
Response rate 46.4%- 208 useable surveys
96.9% of physicians reported library-provided information was of clinical value for patient care
71.6% reported a change in the advice given to a patient
59.6% reported a change in choice of other treatments
50.3% reported a change in the choice of tests
49.0% reported avoidance of additional tests and procedures
21.2% reported avoidance of surgery
19.2% reported a reduction in length of stay

Results of University of Wales Study
Response rate was 20.3%- 169 useable surveys
Respondents searched the literature themselves
Nearly half of all searches (46.2%) were related to direct patient care
54.4% stated that information would contribute to advice to colleagues
45% of respondents stated that the information would contribute to advice given to the patient or caregiver
37.9% stated a change to service delivery or practice
23.7% stated that information improved quality of life for patient/family
12.4% stated that information would impact choice of diagnostic test

Current Study
123 critical access hospitals (CAHs)- Washington, Alaska, Montana, and Idaho
Definition of rural- CAHs- 25 beds or less
100 CAH facilitators attempted to distribute surveys
50 final participating CAHs- 852 total practitioners
661 Physicians
109 PAs
82 NPs

Physician Assistants and Information Needs for Clinical Decision-Making Preliminary Survey Outcomes
Response rate 25% - 213 useable surveys overall
125 Physicians (M.D.) (60.1%)
22 Physicians (D.O.) (10.6%)
37 Physician Assistants (17.8%)
24 Nurse Practitioners (11.5%)
All respondents searched for information themselves
56.8% of PAs needed information for a patient
86.5% of PAs needed drug information
100% of PAs chose direct patient care as a reason for needing information
91.7% stated that the information impacted advice given to patient

Physician Assistants and Information Needs for Clinical Decision-Making Preliminary Survey Outcomes- continued
59.5% stated that the information avoided patient misunderstanding of disease
69.4% stated that information avoided additional tests or procedures
70.3% chose print books as their most used resource
54.1% tie between UpToDate ® and print journals, as a resource
86.5% accessed the information from their offices
35.1% accessed the information from a mobile device
54.1% felt completely successful in their search for information
48.6% took less than 10 minutes, 35.1% 10 to 30 minutes to search
55.9% want more access to online journal databases
52.9% want more access to e-books
52.9% want more CME
50% stated access to patient education materials would be helpful to their practice

Preliminary findings re: patient education suggest:
Rural PAs want to be able to access EB information for patient care
They desire to be lifelong learners
They want clinical information to be available online
They use and share new knowledge with their patients and families
They are interested in having more resources for patient education

RML Rendezvous - Physician Assistants & Information Needs for Clinical Decision Making

by National Network of Libraries of Medicine, Pacific Northwest Region on Apr 22, 2010

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