RML Rendezvous - Physician Assistants & Information Needs for Clinical Decision Making
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  • 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. 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
  • 3. 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
  • 4. 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
  • 5. 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.
  • 6. 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
  • 7. 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
  • 8. 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
  • 9. 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
  • 10. 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
  • 11. 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
  • 12. 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
  • 13. 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
  • 14. 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