Point-of-Care Clinical Evidence: The Essential “Hunting Tool” for Answering Questions in Real-Time

Dr. Alper and his colleagues have significantly contributed to the discourse on point-of-care clinical evidence utilization through their insightful manuscript. Their work underscores the importance of readily accessible databases and technologies in enhancing patient care. This study aligns with existing point-of-care literature demonstrating the positive impact of computer decision support across various clinical settings. Notably, handheld computers have emerged as a particularly effective hardware platform in these environments.

Research conducted in a critical care unit revealed that decision support systems on handheld computers not only decreased patient lengths of stay but also reduced antibiotic prescriptions (1). Similarly, office-based studies employing handheld computers have shown improved adherence to asthma guidelines (2), potential reductions in adverse drug events (3), enhanced antibiotic prescribing for otitis media in children (4), and decreased inappropriate antibiotic use for upper respiratory infections (5). The Robert Wood Johnson Foundation’s Prescription for Health Project further highlights the potential of innovative approaches and technologies in improving patient care, with pilot projects demonstrating promising results in areas like tobacco use, diet, exercise, and alcohol misuse (6).

Beyond a robust “hunting tool” for efficient clinical evidence retrieval when questions arise, a complementary “foraging tool” is crucial. This “foraging tool” would proactively update physicians on the latest medical advancements and setbacks, ensuring they are informed when critical information becomes available. These dual information tools are indispensable for contemporary medical practice in the Information Age. The ideal system incorporates: 1) a “foraging” mechanism to sift through vast amounts of new data, identifying relevant and valid information; and 2) a “hunting” mechanism for rapid database searches to answer immediate clinical questions. Both tools are essential; neither alone is sufficient to ensure timely awareness and accessibility of vital medical information (7).

The next logical progression for synthesized evidence studies, utilizing databases such as Dynamed, InfoRetriever, and UpToDate, is to evaluate patient outcomes in settings where these resources are actively used. Furthermore, integrating these databases with electronic medical records and optimizing the display of pertinent evidence warrants thorough exploration. Continuous evaluation of database content is paramount to guarantee the validity and relevance of included information, the exclusive use of patient-oriented evidence, appropriate evidence level assignment, objectivity, and comprehensive information coverage.

Scott M. Strayer, MD, MPH
Assistant Professor of Family Medicine
University of Virginia
Department of Family Medicine
Charlottesville, Virginia

David C. Slawson, MD
B. Lewis Barnett, Jr. Professor of Family Medicine
University of Virginia
Department of Family Medicine
Charlottesville, Virginia

Allen F. Shaughnessy, PharmD
Adjunct Professor of Public Health and Family Medicine
Tufts University Family Medicine Residency
Tufts University School of Medicine
Boston, Massachusetts

References

1. Sintchenko V, Iredell JR, Gilbert GL, Coiera E. Handheld computer-based decision support reduces patient length of stay and antibiotic prescribing in critical care. J Am Med Inform Assoc. 2005 Jul- Aug;12(4):398-402. Epub 2005 Mar 31.
2. Shiffman RN, Freudigman M, Brandt CA, Liaw Y, Navedo DD. A guideline implementation system using handheld computers for office management of asthma: effects on adherence and patient outcomes. Pediatrics. 2000 Apr;105(4 Pt 1):767-73.
3. Rothschild JM, Lee TH, Bae T, Bates DW. Clinician use of a palmtop drug reference guide. J Am Med Inform Assoc. 2002 May- Jun;9(3):223-9.
4. Christakis DA, Zimmerman FJ, Wright JA, Garrison MM, Rivara FP, Davis RL. A randomized controlled trial of point-of-care evidence to improve the antibiotic prescribing practices for otitis media in children. Pediatrics. 2001 Feb;107(2):E15.
5. Samore MH, Bateman K, Alder SC, Hannah E, Donnelly S, Stoddard GJ, Haddadin B, Rubin MA, Williamson J, Stults B, Rupper R, Stevenson K. Clinical decision support and appropriateness of antimicrobial prescribing: a randomized trial. JAMA. 2005 Nov 9;294(18):2305-14.
6. Green LA, et. al. Prescription for Health: Changing Primary Care Practice to Foster Healthy Behaviors. Ann Fam Med. 2005 Jul/Aug 3;supp:S1-S68.
7. Shaughnessy AF, Slawson DC. Are we providing doctors with the training and tools for lifelong learning? BMJ 1999; 319:1280.

Competing interests: Drs. Shaughnessy and Slawson are consultants for InfoPOEM, Inc., publisher of the InfoPOEMs, The Clinical Awareness System(tm) and originators of the Information Mastery(tm) process.