Information needs in office practice: are they being met?

Covell, DG, Uman, GC, Manning, PR, Information Needs in Office Practice: Are They Being Met? Ann Intern Med 1985;103(4):596-9.

The study examined the self-reported needs of 47 physicians during a half day of typical office practice.

  • Physicians self-report that they need answers, on average, once per week.
  • Physicians have about two questions for every three patients seen.
  • Only 30% of clinical questions were answered, usually by another physician or other health care professional.

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Information seeking in primary care: How physicians choose which clinical questions to pursue and which to leave unanswered

Gorman PN, Helfand M. Information seeking in primary care: how physicians choose which clinical questions to pursue and which to leave unanswered. Med Decis Making. 1995 Apr-Jun;15(2):113-9.

  • Primary care physicians have many clinical questions while they are seeing patients, but they pursue only about 30% of their questions.
  • Two primary factors determined which questions were pursued: the physician’s belief that a definitive answer existed, and the urgency of the patient’s problem.

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Information in practice: Analysis of questions asked by family doctors regarding patient care

Ely JW, Osheroff JA, Ebell MH, Bergus GR, Levy BT, Chambliss ML, Evans ER. Analysis of questions asked by family doctors regarding patient care. BMJ. 1999 Aug 7;319(7206):358-61.

  • Family doctors frequently had questions about patient care (about 3 questions per 10 patients or 8 questions per day) but pursued answers to only 40 percent of them. Of those pursued, 80% were answered.
  • An answer was pursued when the problem was perceived as urgent and when a definitive answer was thought to exist.

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Residents’ medical information needs in clinic: are they being met?

Green ML, Ciampi MA, Ellis PJ. Residents’ medical information needs in clinic: are they being met? Am J Med. 2000 Aug 15;109(3):218-23.

  • Residents identified 2 questions for every 3 patients they saw and pursued answers to 29% of the questions.
  • The primary reason for not pursuing answers was lack of time (60%).

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Answering physicians’ clinical questions: Obstacles and potential solutions

Ely JW, Osheroff JA, Chambliss ML, Ebell MH, Rosenbaum ME. Answering physicians’ clinical questions: obstacles and potential solutions. J Am Med Inform Assoc. 2005 Mar-Apr;12(2):217-24.

A study of generalist physicians in Iowa investigated the obstacles preventing physicians from answering their patient care questions. Physicians asked 5.5 questions per half-day but pursued answers to just 55% of them. Of the 55% of questions pursued, UpToDate was used the most (41%) out of over 10 information resources consulted during the study. Other resources on the list included Epocrates (25%), MICROMEDEX (15%), and the Sanford Guide to Antimicrobial Therapy (14%).

  • The typical primary care physician has approximately 11 questions a day. While they pursue answers to 55% of questions, only 40% get answered.
  • Answering all questions would change up to 5 management decisions per day.
  • The most common reason for not pursuing an answer was that they doubted that an answer existed.

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Clinical questions raised by clinicians at the point of care: a systematic review

Del Fiol G, Workman TE, Gorman PN. Systematic review: the relationship between clinical experience and quality of health care. JAMA Intern Med. 2014 May;174(5):710-8. doi: 10.1001/jamainternmed.2014.368.

Clinicians frequently raise questions about patient care in their practice. Although they are effective at finding answers to questions they pursue, roughly half of the questions are never pursued. This picture has been fairly stable over time despite the broad availability of online evidence resources that can answer these questions. Technology-based solutions should enable clinicians to track their questions and provide just-in-time access to high-quality evidence in the context of patient care decision making. Opportunities for improvement include the recent adoption of electronic health record systems and maintenance of certification requirements.

  • In 11 studies, 7012 questions were elicited through short interviews with clinicians after each patient visit.
  • The mean frequency of questions raised was 0.57 (95% CI, 0.38-0.77) per patient seen, and clinicians pursued 51% (36%-66%) of questions and found answers to 78% (67%-88%) of those they pursued.
  • Overall, 34% of questions concerned drug treatment, and 24% concerned potential causes of a symptom, physical finding, or diagnostic test finding.
  • Clinicians’ lack of time and doubt that a useful answer exists were the main barriers to information seeking.

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