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

Brian S. Alper; David S. White; Bin Ge

doi:10.1370/afm.370

Abstract

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.

Footnotes

Conflicts of interest: Dr Alper is the founding principal of Dynamic Medical Information Systems, LLC, and the Editor-in-Chief of DynaMed. Dr White was employed by Dynamic Medical Information Systems, LLC, to conduct this research with funds from the National Science Foundation award but has not conducted efforts for or received monies from Dynamic Medical Information Systems, LLC, outside this grant award.
Funding support: This material is based on work supported by the National Science Foundation under award 0339256. Any opinion, findings, and conclusions or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the National Science Foundation. The National Science Foundation was not involved in the design, conduct, analysis, or writing of this study, or the decision to submit this paper for publication. The specific award (Small Business Innovation Research) requires the primary investigator to be employed by the small business conducting the research. To avoid commercial influence on data analysis, the coinvestigator (DSW) and statistician (BG) had full access to all the data and veto-level involvement in inclusion and exclusion decisions for all participants and data. Analysis was conducted by the statistician at an academic center.
Versions of this report were displayed as posters at the World Organization of Family Doctors (WONCA) and American Academy of Family Physicians Scientific Assembly, October 2004, Orlando, Fla.