RML Rendezvous - Physician Assistants & Information Needs for Clinical Decision Making

Physician Assistants and Information Needs for Clinical Decision-Making

RML Rendevous January 13, 2010

Beth Hill, MLS, AHIPKootenai Medical [email protected]

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

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

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

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.

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

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

Physician Assistants and Information Needs for Clinical Decision-Making

Rochester StudyConducted in the early ’90s. Joanne Marshall, PIMostly urban physicians and residents, and rural physicians served by circuit

librariansLibrarian-mediated searching, results evaluated for clinical usefulness in

decision-makingMarshall, 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 AberystwythConducted in 2005. Spink, Thomas, Urquhart & WeightmanToolkit development, evaluation of impact of library services on patient careParticipants mostly did their own searching of the literaturePhysicians, allied health personnel, nurses, administratorshttp://cadair.aber.ac.uk/dspace/bitstream/2160/355/4/NKS_ImpactStudyReport_Nov07.pdf

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

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

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

Physician Assistants and Information Needs for Clinical Decision-MakingPreliminary 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

Physician Assistants and Information Needs for Clinical Decision-MakingPreliminary 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

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