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

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

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January 13, 2010 RML Rendezvous webcast, part two.

January 13, 2010 RML Rendezvous webcast, part two.

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

    • 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
    • Physician Assistants and Information Needs for Clinical Decision-Making
      • 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
    • Physician Assistants and Information Needs for Clinical Decision-Making
      • 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
    • Physician Assistants and Information Needs for Clinical Decision-Making
      • 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
    • Physician Assistants and Information Needs for Clinical Decision-Making
      • 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