Article Figures & Data
Figures
- Figure 1.
Information needs and information-seeking behavior of 112 Spanish primary care physicians during 3,511 consultations.
Tables
- Table 1.
Clinical Topics of the 635 Clinical Questions Asked by 112 Spanish Primary Care Physicians During 3,511 Consultations
Topic No. (%) 95% CI CI = confidence interval. Pharmacology or prescribing information 61 (9.6) 7.2–12 Diagnostic process 59 (9.3) 7–12.7 Dermatology 53 (8.3) 6.1–10.6 Orthopedics 50 (7.9) 5.7–10 Administration 34 (5.4) 3.5–7.2 Adult gastroenterology 32 (5.0) 3.3–6.8 Obstetrics and gynecology 28 (4.4) 2.7–6.1 Otolaryngology 28 (4.4) 2.7–6.1 Pediatric infectious disease 21 (3.3) 1.8–4.8 Adult respiratory disease 20 (3.1) 1.7–4.6 Adult psychiatry 17 (2.7) 1.3–4.0 Adult dermatology 16 (2.5) 1.2–3.8 Ophthalmology 16 (2.5) 1.2–3.8 General surgery 15 (2.4) 1.1–3.6 Adult neurology 15 (2.4) 1.1–3.6 Adult cardiovascular disease 14 (2.2) 0.9–3.4 Medical ethics 13 (2.0) 0.9–3.2 Family practice 13 (2.0) 0.9–3.2 Urology 11 (1.7) 0.6–2.8 Clinical interview 10 (1.6) 0.5–2.6 Adult endocrinology 10 (1.6) 0.5–2.6 Preventive medicine and screening 9 (1.4) 0.4–2.4 Adult infectious disease 9 (1.4) 0.4–2.4 Symptoms, signs, and ill-defined conditions 7 (1.1) 0.2–1.9 Pediatric respiratory disease 7 (1.1) 0.2–1.9 Radiology 6 (0.9) 0.1–1.8 Legal issues 5 (0.8) 0.3–1.8 Patient education 5 (0.8) 0.3–1.8 Pediatric rheumatology 4 (0.6) 0.2–1.6 Adult allergy and immunology 4 (0.6) 0.2–1.6 Adult hematology 4 (0.6) 0.2–1.6 Pediatric gastroenterology 3 (0.5) 0.09–1.4 Geriatrics 3 (0.5) 0.09–1.4 Laboratory medicine 3 (0.5) 0.09–1.4 Neurosurgery 3 (0.5) 0.09–1.4 Adult oncology 3 (0.5) 0.09–1.4 Child psychiatry 3 (0.5) 0.09–1.4 Occupational medicine 2 (0.3) 0.04–1.1 Dentistry 2 (0.3) 0.04–1.1 General pediatrics 2 (0.3) 0.04–1.1 Pediatric allergy and immunology 2 (0.3) 0.04–1.1 Pediatric endocrinology 2 (0.3) 0.04–1.1 Pediatric neurology 2 (0.3) 0.04–1.1 General internal medicine 1 (0.2) 0.004–0.9 Anesthesiology 1 (0.2) 0.004–0.9 Adult nephrology 1 (0.2) 0.004–0.9 Nutrition 1 (0.2) 0.004–0.9 Alternative medicine 1 (0.2) 0.004–0.9 Thoracic surgery 1 (0.2) 0.004–0.9 Vascular surgery 1 (0.2) 0.004–0.9 Therapeutic process 1 (0.2) 0.004–0.9 Physical medicine and rehabilitation 1 (0.2) 0.004–0.9 - Table 2.
Description of 635 Questions Asked by 112 Spanish Primary Care Physicians During 3,511 Consultations, Using the Taxonomy of Ely et al13
Code Primary Secondary Description No. (%) 95% CI ECG = elecrocardiogram; CI = confidence interval. 1.1.1.1 Diagnosis Cause/interpretation of clinical finding What is the cause of symptom x? 130 (20.5) 17.3–23.7 1.1.2.1 Diagnosis Cause/interpretation of clinical finding What is the cause of physical finding x? 95 (15.0) 12.1–17.8 1.1.3.1 Diagnosis Cause/interpretation of clinical finding What is the cause of test finding x? 19 (3.0) 1.6–4.4 1.1.4.1 Diagnosis Cause/interpretation of clinical finding Could this patient have condition y given findings x1, x2, …, xn? 39 (6.1) 4.2–8.1 1.2.1.1 Diagnosis Criteria/manifestations What are the manifestations (findings) of condition y? 6 (0.9) 0.1–1.8 1.3.1.1 Diagnosis Test (laboratory, ECG, imaging, biopsy, skin test, element of physical examination, etc) Is test x indicated in situation y? 20 (3.1) 1.7–4.6 1.3.2.1 Diagnosis Test (laboratory, ECG, imaging, biopsy, skin test, element of physical examination, etc) How good is test x in situation y? 3 (0.5) 0.09–1.4 1.3.3.1 Diagnosis Test (laboratory, ECG, imaging, biopsy, skin test, element of physical examination, etc) When (timing, not indications) should I do test x? 11 (1.7) 0.6–2.8 1.3.4.1 Diagnosis Test (laboratory, ECG, imaging, biopsy, skin test, element of physical examination, etc) What is the preparation for test x? 2 (0.3) 0.04–1.1 1.3.5.1 Diagnosis Test (laboratory, ECG, imaging, biopsy, skin test, element of physical examination, etc) How do you do test x? 7 (1.1) 0.2–1.9 1.4.1.1 Diagnosis Name finding — — — 1.4.2.1 Diagnosis Name finding — — — 1.4.3.1 Diagnosis Name finding — — — 1.5.1.1 Diagnosis Orientation — — — 1.5.2.1 Diagnosis Orientation — — — 1.6.1.1 Diagnosis Inconsistencies Why were this patient’s findings (or course) inconsistent with usual expectations? 1 (0.2) 0.004–0.9 1.7.1.1 Diagnosis Cost — — — 1.8.1.1 Diagnosis Not elsewhere classified Diagnosis, generic type, varies 3 (0.5) 0.09–1.4 2.1.1.1 Treatment Drug prescribing How do you prescribe/administer drug x (in situation y)? 3 (0.5) 0.09–1.4 2.1.1.2 Treatment Drug prescribing What is the dose of drug x? 18 (2.8) 1.5–4.2 2.1.1.3 Treatment Drug prescribing When (timing, not indication) or how should I start/stop drug x? 13 (2.0) 0.9–3.2 2.1.2.1 Treatment Drug prescribing Is drug x (or drug class x) indicated in situation y or for condition y? 47 (7.4) 5.5–9.7 2.1.2.2 Treatment Drug prescribing — — — 2.1.3.1 Treatment Drug prescribing Could finding y be caused by drug x? 9 (1.4) 0.4–2.4 2.1.3.2 Treatment Drug prescribing How can drug x be administered without causing adverse effect y or minimizing adverse effect y or in spite of adverse effect y? 2 (0.3) 0.04–1.1 2.1.3.3 Treatment Drug prescribing Is drug x safe to use in situation y? 11 (1.7) 0.6–2.8 2.1.4.1 Treatment Drug prescribing Is it OK to use drug x with drug y? 11 (1.7) 0.6–2.8 2.1.5.1 Treatment Drug prescribing What is the name of that drug? 12 (1.9) 0.8–3.0 2.1.6.1 Treatment Drug prescribing What is drug x? 7 (1.1) 0.2–1.9 2.1.7.1 Treatment Drug prescribing What are the physical characteristics (dosage forms, tablet/liquid characteristics, container characteristics) of drug x? 9 (1.4) 0.4–2.4 2.1.8.1 Treatment Drug prescribing — — — 2.1.9.1 Treatment Drug prescribing — — — 2.1.10.1 Treatment Drug prescribing — — — 2.1.11.1 Treatment Drug prescribing — — — 2.1.12.1 Treatment Drug prescribing — — — 2.2.1.1 Treatment Not limited to but may include drug prescribing How should I treat finding/condition y (given situation z)? 15 (2.4) 1.1–3.6 2.2.1.2 Treatment Not limited to but may include drug prescribing Should this kind of patient get prophylactic treatment (intervention) x to prevent condition y? 9 (0.2) 0.004–0.9 2.2.2.1 Treatment Not limited to but may include drug prescribing When (or how) should I start/stop treatment x? 3 (0.5) 0.09–1.4 2.2.3.1 Treatment Not limited to but may include drug prescribing How do you do treatment/procedure x? 3 (0.5) 0.09–1.4 2.2.4.1 Treatment Not limited to but may include drug prescribing — — — 2.3.1.1 Treatment Not elsewhere classified Why is drug x not effective in condition y? 1 (0.2) 0.004–0.9 3.1.1.1 Management (not specifying diagnostic or therapeutic) Condition/finding How should I manage condition/finding/ situation y (not specifying diagnostic or therapeutic management)? 29 (4.6) 2.9–6.3 3.2.1.1 Management (not specifying diagnostic or therapeutic) Other clinicians — — — 3.2.2.1 Management (not specifying diagnostic or therapeutic) Other clinicians When should you refer in situation y? 5 (0.8) 0.3–1.8 3.2.3.1 Management (not specifying diagnostic or therapeutic) Other clinicians — — — 3.3.1.1 Management (not specifying diagnostic or therapeutic) Physician-patient communication How should I advise the patient/family in situation y? 1 (0.2) 0.004–0.9 3.3.2.1 Management (not specifying diagnostic or therapeutic) Physician-patient communication What is the best way to discuss or approach discussion of difficult issue x? 5 (0.8) 0.3–1.8 3.3.3.1 Management (not specifying diagnostic or therapeutic) Physician-patient communication How can I get the patient/family to comply with my recommendations or agree with my assessment? 4 (0.6) 0.2–1.6 3.4.1.1 Management (not specifying diagnostic or therapeutic) Not elsewhere classified Management, generic type, varies 3 (0.5) 0.09–1.4 4.1.1.1 Epidemiology Prevalence/incidence What is the incidence/prevalence of condition y (in situation z)? 1 (0.2) 0.004–0.9 4.2.1.1 Epidemiology Etiology Is x a risk factor for condition y? – or – Is x associated with condition y? 4 (0.6) 0.2–1.6 4.2.1.2 Epidemiology Etiology Is condition y hereditary? 1 (0.2) 0.004–0.9 4.3.1.1 Epidemiology Course/prognosis What is the usual course (or natural history) of condition y? 1 (0.2) 0.004–0.9 4.4.1.1 Epidemiology Not elsewhere classified — — — 5.1.1.1 Nonclinical Education I need to learn more about topic x. 18 (2.8) 1.5–4.2 5.1.1.2 Nonclinical Education Where can I find or how can I get information about topic x? 3 (0.5) 0.09–1.4 5.1.1.3 Nonclinical Education — — — 5.1.2.1 Nonclinical Education — — — 5.2.1.1 Nonclinical Administration What are the administrative rules/considerations in situation y? 35 (5.5) 3.3–6.8 5.3.1.1 Nonclinical Ethics What are the ethical considerations in situation y? 13 (2.0) 0.9–3.2 5.4.1.1 Nonclinical Legal What are the legal considerations in situation y? 5 (0.8) 0.3–1.8 5.5.1.1 Nonclinical Frustration Generic type, varies. Not a true question, but rather an expression of frustration or an unanswerable dilemma. 3 (0.5) 0.09–1.4 5.6.1.1 Nonclinical Not elsewhere classified In a broad sense, the question is nonclinical, but it does not fit any other nonclinical category. 6 (0.9) 0.1–1.8 6.1.1.1 Unclassified — — — — - Table 3.
Ten Most Frequent Questions Asked by 112 Spanish Primary Care Physicians During 3,511 Consultations
Rank Code of Ely et al13 Category Description Frequency % 1 1.1.1.1 Diagnosis What is the cause of symptom x? 20.5 2 1.1.2.1 Diagnosis What is the cause of physical finding x? 15.0 3 2.1.2.1 Treatment Is drug x (or drug class x) indicated in situation y or for condition y? 7.4 4 1.1.4.1 Diagnosis Could this patient have condition y given findings x1, x2, … , xn? 6.1 5 5.2.1.1 Nonclinical What are the administrative rules/considerations in situation y? 5.0 6 3.1.1.1 Management (not specifying diagnostic or therapeutic) How should I manage condition/finding/situation y (not specifying diagnostic or therapeutic management)? 4.6 7 1.3.1.1 Diagnosis Is test x indicated in situation y? 3.1 8 1.1.3.1 Diagnosis What is the cause of test finding x? 3.0 9 2.1.1.2 Treatment What is the dose of drug x? 2.8 10 5.1.1.1 Nonclinical I need to learn more about topic x. 2.8 - Table 4.
Resources Used by 112 Spanish Primary Care Physicians in Seeking Answers to Clinical Questions
Resource Used for Searching Total No. (%) Searched During Consultation* No. (%) Searched After Consultation No. (%) Answers Found After Consultation No. (%) * Answers were found for all questions for which physicians searched for answers during the consultation. Drug compendium 61 (39.6) 40 (65.6) 11 (13.1) 8 (12.7) Colleagues 19 (12.3) 12 (19.7) 7 (8.3) 6 (9.5) Others 10 (6.5) 6 (9.8) 4 (4.8) 4 (6.3) Pharmacist 3 (1.9) 3 (4.9) 1 (1.2) 0 (0) Books 26 (16.9) — 26 (31) 17 (27) Journals 15 (9.7) — 15 (17.9) 9 (14.3) Specialist 8 (5.2) — 8 (9.5) 8 (12.7) Pharmaceutical representative 7 (4.5) — 7 (8.3) 6 (9.5) Databases on Internet 5 (3.2) — 5 (6.0) 5 (7.9) Total 154 61 84 63
The Article in Brief
Information Needs and Information-Seeking Behavior of Primary Care Physicians
Ana I. Gonzales-Gonzales, MD, and colleagues
Background Primary care clinicians, on average, address more than 500 clinical topics in their practices and so have very broad information needs. The aim of this study is to determine the information needs and information-seeking patterns among primary care physicians in Spain.
What This Study Found In this study, the most frequent questions asked by doctors relate to diagnosis and treatment of patients� conditions. The most frequent generic type of question was �what is the cause of symptom X?� Doctors searched for answers to 23% of questions, most often finding answers in a summary of drug information, a textbook, or from a colleague.
Implications
- Primary care doctors� questions cover a wide range of topics, reflecting the broad scope of primary care practice. These questions are often complex and patient-specific.
- Doctors in this study had short patient visits, allowing time to answer only 1 in 5 of their questions. Better methods are needed to provide answers to questions that arise in short visits.
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