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Physician Assistants and Information Needs for Clinical Decision-Making RML Rendevous  January 13, 2010 Beth Hill, MLS, AH...
Physician Assistants and Information Needs for Clinical Decision-Making- Outline <ul><li>History of the profession </li></...
Physician Assistant- History of the Profession <ul><li>Nationwide shortage of physicians recognized in the 1960s </li></ul...
Physician Assistants- Value of the profession to medical practice <ul><li>Perform similar tasks to physicians </li></ul><u...
Physician Assistants and Information Needs for Clinical Decision-Making <ul><li>IOM Core Competencies  </li></ul><ul><li>P...
Physician Assistants and Information Needs for Clinical Decision-making <ul><li>Steps in the EBM Process </li></ul><ul><li...
Physician Assistants and Information Needs for Clinical Decision-Making <ul><li>Rural Practice Challenges </li></ul><ul><l...
Physician Assistants and Information Needs for Clinical Decision-Making <ul><li>Rochester Study </li></ul><ul><li>Conducte...
Results of Rochester Study <ul><li>Response rate 46.4%- 208 useable surveys </li></ul><ul><li>96.9% of physicians reported...
Results of University of Wales Study <ul><li>Response rate was 20.3%- 169 useable surveys </li></ul><ul><li>Respondents se...
Physician Assistants and Information Needs for Clinical Decision-Making <ul><li>Current Study </li></ul><ul><li>123 critic...
Physician Assistants and Information Needs for Clinical Decision-Making Preliminary Survey Outcomes <ul><li>Response rate ...
Physician Assistants and Information Needs for Clinical Decision-Making Preliminary Survey Outcomes- continued <ul><li>59....
Physician Assistants and Information Needs for Clinical Decision-Making <ul><li>Preliminary findings re: patient education...
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RML Rendezvous - Physician Assistants & Information Needs for Clinical Decision Making

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January 13, 2010 RML Rendezvous webcast, part two.

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

  1. 1. Physician Assistants and Information Needs for Clinical Decision-Making RML Rendevous January 13, 2010 Beth Hill, MLS, AHIP Kootenai Medical Center [email_address]
  2. 2. Physician Assistants and Information Needs for Clinical Decision-Making- Outline <ul><li>History of the profession </li></ul><ul><li>Value of the profession to medical practice </li></ul><ul><li>IOM Core Competencies and Evidence-based practice </li></ul><ul><li>Rural practice challenges </li></ul><ul><li>Rochester and University of Wales Studies </li></ul><ul><li>Use of clinical information for patient care decision-making- survey results for physician assistants </li></ul>
  3. 3. Physician Assistant- History of the Profession <ul><li>Nationwide shortage of physicians recognized in the 1960s </li></ul><ul><li>Health Professions Assistance Act of 1963 </li></ul><ul><li>Profession created to relieve shortage and increase access to health care in underserved areas. </li></ul><ul><li>First class of PAs organized in 1965 </li></ul><ul><li>10/6/67- first class of PAs graduates </li></ul><ul><li>Work under a physician’s license </li></ul><ul><li>Must pass a national certification exam </li></ul>
  4. 4. Physician Assistants- Value of the profession to medical practice <ul><li>Perform similar tasks to physicians </li></ul><ul><li>Have high level of autonomy in clinical decision-making </li></ul><ul><li>Relationship with physician allows them to staff satellite clinics, provide on-call services, and deliver care in rural areas </li></ul>
  5. 5. Physician Assistants and Information Needs for Clinical Decision-Making <ul><li>IOM Core Competencies </li></ul><ul><li>Provide patient-centered care </li></ul><ul><li>Work in interdisciplinary teams </li></ul><ul><li>Apply quality improvement principles </li></ul><ul><li>Utilize informatics </li></ul><ul><li>Apply clinical decision-making that is evidence-based </li></ul><ul><li>Institute of Medicine. (2003). Health professions education: A bridge to quality. Quality Chasm Series. Washington, DC: National Academies Press. </li></ul>
  6. 6. Physician Assistants and Information Needs for Clinical Decision-making <ul><li>Steps in the EBM Process </li></ul><ul><li>Clinical problem arising from patient </li></ul><ul><li>Constructing a well-built clinical question </li></ul><ul><li>Select appropriate resource and search </li></ul><ul><li>Appraise evidence for validity and applicability </li></ul><ul><li>Integrate with clinical expertise and patient preferences </li></ul><ul><li>Evaluate performance </li></ul><ul><li>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 </li></ul>
  7. 7. Physician Assistants and Information Needs for Clinical Decision-Making <ul><li>Rural Practice Challenges </li></ul><ul><li>Struggle to retain qualified physicians </li></ul><ul><li>Feelings of isolation- colleagues less accessible </li></ul><ul><li>Lower compensation </li></ul><ul><li>Limited library resources and services </li></ul><ul><li>Fewer practitioners overall choosing family medicine </li></ul>
  8. 8. Physician Assistants and Information Needs for Clinical Decision-Making <ul><li>Rochester Study </li></ul><ul><li>Conducted in the early ’90s. Joanne Marshall, PI </li></ul><ul><li>Mostly urban physicians and residents, and rural physicians served by circuit librarians </li></ul><ul><li>Librarian-mediated searching, results evaluated for clinical usefulness in decision-making </li></ul><ul><li>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. </li></ul><ul><li>University of Wales Aberystwyth </li></ul><ul><li>Conducted in 2005. Spink, Thomas, Urquhart & Weightman </li></ul><ul><li>Toolkit development, evaluation of impact of library services on patient care </li></ul><ul><li>Participants mostly did their own searching of the literature </li></ul><ul><li>Physicians, allied health personnel, nurses, administrators </li></ul><ul><li>http://cadair.aber.ac.uk/dspace/bitstream/2160/355/4/NKS_ImpactStudyReport_Nov07.pdf </li></ul>
  9. 9. Results of Rochester Study <ul><li>Response rate 46.4%- 208 useable surveys </li></ul><ul><li>96.9% of physicians reported library-provided information was of clinical value for patient care </li></ul><ul><li>71.6% reported a change in the advice given to a patient </li></ul><ul><li>59.6% reported a change in choice of other treatments </li></ul><ul><li>50.3% reported a change in the choice of tests </li></ul><ul><li>49.0% reported avoidance of additional tests and procedures </li></ul><ul><li>21.2% reported avoidance of surgery </li></ul><ul><li>19.2% reported a reduction in length of stay </li></ul>
  10. 10. Results of University of Wales Study <ul><li>Response rate was 20.3%- 169 useable surveys </li></ul><ul><li>Respondents searched the literature themselves </li></ul><ul><li>Nearly half of all searches (46.2%) were related to direct patient care </li></ul><ul><li>54.4% stated that information would contribute to advice to colleagues </li></ul><ul><li>45% of respondents stated that the information would contribute to advice given to the patient or caregiver </li></ul><ul><li>37.9% stated a change to service delivery or practice </li></ul><ul><li>23.7% stated that information improved quality of life for patient/family </li></ul><ul><li>12.4% stated that information would impact choice of diagnostic test </li></ul>
  11. 11. Physician Assistants and Information Needs for Clinical Decision-Making <ul><li>Current Study </li></ul><ul><li>123 critical access hospitals (CAHs)- Washington, Alaska, Montana, and Idaho </li></ul><ul><li>Definition of rural- CAHs- 25 beds or less </li></ul><ul><li>100 CAH facilitators attempted to distribute surveys </li></ul><ul><li>50 final participating CAHs- 852 total practitioners </li></ul><ul><li>661 Physicians </li></ul><ul><li>109 PAs </li></ul><ul><li>82 NPs </li></ul>
  12. 12. Physician Assistants and Information Needs for Clinical Decision-Making Preliminary Survey Outcomes <ul><li>Response rate 25% - 213 useable surveys overall </li></ul><ul><li>125 Physicians (M.D.) (60.1%) </li></ul><ul><li>22 Physicians (D.O.) (10.6%) </li></ul><ul><li>37 Physician Assistants (17.8%) </li></ul><ul><li>24 Nurse Practitioners (11.5%) </li></ul><ul><li>All respondents searched for information themselves </li></ul><ul><li>56.8% of PAs needed information for a patient </li></ul><ul><li>86.5% of PAs needed drug information </li></ul><ul><li>100% of PAs chose direct patient care as a reason for needing information </li></ul><ul><li>91.7% stated that the information impacted advice given to patient </li></ul>
  13. 13. Physician Assistants and Information Needs for Clinical Decision-Making Preliminary Survey Outcomes- continued <ul><li>59.5% stated that the information avoided patient misunderstanding of disease </li></ul><ul><li>69.4% stated that information avoided additional tests or procedures </li></ul><ul><li>70.3% chose print books as their most used resource </li></ul><ul><li>54.1% tie between UpToDate ® and print journals, as a resource </li></ul><ul><li>86.5% accessed the information from their offices </li></ul><ul><li>35.1% accessed the information from a mobile device </li></ul><ul><li>54.1% felt completely successful in their search for information </li></ul><ul><li>48.6% took less than 10 minutes, 35.1% 10 to 30 minutes to search </li></ul><ul><li>55.9% want more access to online journal databases </li></ul><ul><li>52.9% want more access to e-books </li></ul><ul><li>52.9% want more CME </li></ul><ul><li>50% stated access to patient education materials would be helpful to their practice </li></ul>
  14. 14. Physician Assistants and Information Needs for Clinical Decision-Making <ul><li>Preliminary findings re: patient education suggest: </li></ul><ul><li>Rural PAs want to be able to access EB information for patient care </li></ul><ul><li>They desire to be lifelong learners </li></ul><ul><li>They want clinical information to be available online </li></ul><ul><li>They use and share new knowledge with their patients and families </li></ul><ul><li>They are interested in having more resources for patient education </li></ul>
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