摘要：Objective The research determined the usage and satisfaction levels with one of two point-of-care (PoC) resources among health care providers in a rural state. Methods In this randomized controlled trial, twenty-eight health care providers in rural areas were stratified by occupation and region, then randomized into either the DynaMed or the AccessMedicine study arm. Study participants were physicians, physician assistants, and nurses. A pre- and post-study survey measured participants' attitudes toward different information resources and their information-seeking activities. Medical student investigators provided training and technical support for participants. Data analyses consisted of analysis of variance (ANOVA), paired t tests, and Cohen's d statistic to compare pre- and post-study effects sizes. Results Participants in both the DynaMed and the AccessMedicine arms of the study reported increased satisfaction with their respective PoC resource, as expected. Participants in both arms also reported that they saved time in finding needed information. At baseline, both arms reported too little information available, which increased to “about right amounts of information” at the completion of the study. DynaMed users reported a Cohen's d increase of +1.50 compared to AccessMedicine users' reported use of 0.82. DynaMed users reported d2 satisfaction increases of 9.48 versus AccessMedicine satisfaction increases of 0.59 using a Cohen's d . Conclusion Participants in the DynaMed arm of the study used this clinically oriented PoC more heavily than the users of the textbook-based AccessMedicine. In terms of user satisfaction, DynaMed users reported higher levels of satisfaction than the users of AccessMedicine. Keywords and Medical Subject Headings (MeSH) Clinical Decision Support Systems, Computer-Assisted Decision Making, Decision Making, Evidence-Based Library and Information Practice, Evidence-Based Practice, Health Status Disparities, Health Care Disparities, Information Divide, Information-Seeking Behavior, Medically Underserved Area, Nurse Practitioners, Nurses, Physician Assistants, Physicians, Public Health Nurses, Randomized Controlled Trial as Topic, Service Learning, Vulnerable Populations Health care practitioners regularly seek to incorporate valid information into their evidence-based decisions. Electronic information resources now provide easy access to current health information and summarized forms of evidence to support clinical decision making. Access effects on health care Health care providers who are affiliated with well-funded institutions benefit from access to a variety of high-quality information resources to support their evidence-based practices. Practitioners who are not affiliated with academic health sciences centers rarely have access to these same resources due to prohibitively high licensing costs. Ely et al. report that not having access to easy-to-use, high-quality, current information can negatively affect sound clinical decision making. [ 1 ]. Patients in Isaac et al.'s study who were admitted to hospitals that had access to an electronic evidence-based resource experienced reduced length of stay and lower risk-adjusted mortality rates for prespecified conditions [ 2 ]. That study was validated on a broader scale by a multicenter investigation on the utilization of information resources by practitioners [ 3 ]. Primary health care practitioners who are not affiliated with academic health sciences centers, particularly those who practice in rural or remote areas, often articulate the need for increased access to health information resources. The authors' literature search and review of 114 of the most relevant research articles about the information needs and information-seeking behavior of health care practitioners suggested that these professionals most value speed and accuracy. For example, they likely would prefer to use point-of-care (PoC) resources for quickly and accurately answering their clinical questions. Desirability of point of care PoC resources quickly guide physicians through the diagnosis, treatment, and management of commonly encountered clinical conditions. PoC resources can present compilations of highly authoritative, often evidence-based, information. Physicians can answer more questions and revise clinical decisions more often using these PoC resources [ 4 ]. Meanwhile, many health care practitioners still rely on textbooks familiar to them from their professional training programs, despite their potentially dated contents [ 5 – 14 ]. Limited access in rural New Mexico A randomized controlled trial involving public health practitioners across the rural state of New Mexico reported many barriers in accessing valued information resources [ 15 , 16 ]. In another study, researchers in New Mexico set out to determine and analyze information needs of health care practitioners who were not affiliated with an academic center. Fifty-one interviews of rural physicians, nurses, physician assistants, and nurse practitioners showed both a need and desire for access to information resources [ 17 ]. Goals and hypothesis This study sought to determine which rural health care providers found more useful in answering everyday clinical questions: electronic PoC DynaMed, which is more clinically oriented, or electronic PoC AccessMedicine, which consists primarily of a health sciences textbook collection. We hypothesized that free access to the explicitly clinical format of the PoC resource DynaMed would result in more extensive use than a baseline of zero over a six-month period than the electronic PoC textbook collection AccessMedicine. We felt this would be due to greater utility of DynaMed in clinical practice. We also predicted that clinicians using the clinically oriented PoC would express higher levels of satisfaction than those using the textbook-based PoC and that clinicians using these PoC resources would prefer using them over other information resources.
关键词：Keywords and Medical Subject Headings (MeSH) Clinical Decision Support Systems; Computer-Assisted Decision Making; Decision Making; Evidence-Based Library and Information Practice; Evidence-Based Practice; Health Status Disparities; Health Care Disparities; Information Divide; Information-Seeking Behavior; Medically Underserved Area; Nurse Practitioners; Nurses; Physician Assistants; Physicians; Public Health Nurses; Randomized Controlled Trial as Topic; Service Learning; Vulnerable Populations
