Technology may hold the key to helping physicians and other medical professionals stay on top of the rapidly growing literature in the health-care field – and thus provide better care for their patients. There are an estimated 20,000 medical journals offering updates on various medical specialties. University of Washington researchers have been looking for a way to help physicians and other health care providers keep track of the most important findings. The researchers chose specific new ideas and findings that they wanted to teach to doctors. The researchers found that the best way to make a difference in the clinic was through a computer screen that popped up with the latest relevant information when the physician began the prescription process.
"The information in this program does not overwhelm the physician. What it does do is take the latest research, and then get it into practice," says Dr. Dimitri Christakis, an assistant professor of pediatrics at the UW School of Medicine and associate director of UW's Child Health Institute in Seattle. The results of the research are in the February issue of Pediatrics, a publication of the American Academy of Pediatrics.
It's been said that a doctor who read journals for two hours a day would be eight years behind in his or her reading at the end of a year. This may explain why studies have shown that physicians often fail to prescribe the most appropriate or optimal medications for their patients, Christakis says. It’s likely that partly because of the overload of information, most physicians rely on what was current during their own education for what they do.
The UW team tried different approaches before settling on the high-tech answer. They tried accompanying doctors in the clinic and personally offering to do research on the latest treatments, but found this to be a cumbersome process that provided information too late to be effective. The team also discussed setting up a Web site for the latest research, but found that the resulting process required the physician to spend too much time looking up information. Plus, not every possible topic was covered on the Web site, so physicians eventually seemed to give up on it.
The team then developed a computer program to run on computers that doctors use for prescribing. The team has spent 40 hours a week poring over journals to keep the program current for about 100 of the most frequently prescribed medications and conditions. What they chose to measure for the Pediatrics article was a change in behavior toward prescribing antibiotics for middle ear infections (otitis media). A year before the project began, an article in the Journal of the American Medical Association said that an antibiotic course of five days was as effective as the more commonly prescribed 10-day course. This is considered important because overuse of antibiotics can contribute to microbial resistance, and add to the expense of treatment.
In order to change the behavior of doctors to reflect this development, the team programmed a computer screen to come up when the doctor began to prescribe a course of antibiotics for 10 days. The screen said, "At eight to 19 days after the initiation of therapy, only one child out of 19 would show additional benefit from a 10-day course of antibiotics beyond what would be expected from a 5-day course. At 30 days, there is no difference in the success of 10-day versus 5-day courses of antibiotics. To read more about this, click the information button below."
Doctors found this bite-sized information useful, and prescription of antibiotics decreased by 34 percent, according to the research.
Christakis predicts that this sort of electronic information during the prescription process will become common. The system is now being tested in a rural practice in Mount Vernon, Wash., and urban and family practice clinics in Seattle.
The work was supported by a grant from the Packard Foundation.
Other authors of the paper, "A Randomized Controlled Trial of Point-of-Care Evidence to Improve the Antibiotic Prescribing Practices for Otitis Media in Children," include Dr. Robert Davis, assistant professor of pediatrics; Dr. Frederick Rivara, professor of pediatrics and adjunct professor of epidemiology; Michelle Garrison, research consultant, Child Health Institute; Dr. Jeffrey Wright, associate professor, department of pediatrics; and Dr. Frederick Zimmerman, acting assistant professor, department of health services, UW School of Public Health and Community Medicine.
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