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Physicians Answer More Clinical Questions and Change Clinical Decisions More Often With Synthesized Evidence: A Randomized Trial in Primary Care

¹ DynaMed, Columbia, Mo
² Department of Family and Community Medicine, University of Missouri-Columbia School of Medicine, Columbia, Mo
³ A private practice, Columbia, Mo
⁴ Medical Research Office, University of Missouri-Columbia Health Sciences Center, Columbia, Mo

CORRESPONDING AUTHOR: Brian S. Alper, MD, MSPH, Clinical Reference Products, EBSCO Publishing, Inc, 10 Estes ST, Ipswich, MA 01938, editor{at}dynamicmedical.com

PURPOSE Clinicians need evidence in a format that rapidly answers their questions. DynaMed is a database of synthesized evidence. We investigated whether primary care clinicians would answer more clinical questions, change clinical decision making, and alter search time using DynaMed in addition to their usual information sources.

METHODS Fifty-two primary care clinicians naïve to DynaMed searched for answers to 698 of their own clinical questions using the Internet. On a per-question basis, participants were randomized to have access to DynaMed (A) or not (N) in addition to their usual information sources. Outcomes included proportions of questions answered, proportions of questions with answers that changed clinical decision making, and median search times. The statistical approach of per-participant analyses of clinicians who asked questions in both A and N states was decided before data collection.

RESULTS Among 46 clinicians in per-participant analyses, 23 (50%) answered a greater proportion of questions during A than N, and 13 (28.3%) answered more questions during N than A (P = .05). Finding answers that changed clinical decision making occurred more often during A (25 clinicians, 54.3%) than during N (13 clinicians, 28.3%) (P = .01). Search times did not differ significantly. Overall, participants found answers for 263 (75.8%) of 347 A questions and 250 (71.2%) of 351 N questions. Answers changed clinical decision making for 224 (64.6%) of the A questions and 209 (59.5%) of the N questions.

CONCLUSIONS Using DynaMed, primary care clinicians answered more questions and changed clinical decisions more often, without increasing overall search time. Synthesizing results of systematic evidence surveillance is a feasible method for meeting clinical information needs in primary care.

Key Words: Evidence-based medicine • answering clinical questions • databases • systematic literature surveillance • clinical reference • medical decision making • medical informatics

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