PDA Use by Clinicians has a Positive Impact on Clinical Decision Making

Suzanne Pamela Lewis

摘要

A review of: Dee, Cheryl R., Marilyn Teolis, and Andrew D. Todd. “Physicians’ use of the personal digital assistant (PDA) in clinical decision making.” Journal of the Medical Library Association 93.4 (October 2005): 480-6. Objective – To examine how frequently attending physicians and physicians in training (medical students, interns and residents) used PDAs for patient care and to explore physicians’ perceptions of the impact of PDA use on several aspects of clinical care. Design – User study via a questionnaire. Setting – Teaching hospitals in Tennessee, Florida, Alabama, Kentucky, and Pennsylvania in the United States. Subjects – A convenience sample of fifty-nine attending physicians and forty-nine physicians in training (108 total), spread unevenly across the five states. Methods – Subjects were recruited by librarians at teaching hospitals to answer a questionnaire which was distributed and collected at medical meetings, as well as by email, mail, and fax. The subjects were required to have and use a PDA, but prior training on PDA use was not a requirement, nor was it offered to the subjects before the study. Most of the questions required the respondent to choose from five Likert scale answers regarding frequency of PDA use: almost always, often, a few times, rarely, or never. In the reporting of results, the options ‘almost always’ and ‘often’ were combined and reported as ‘frequent’, and the options ‘a few times’ and ‘rarely’, were combined and reported as ‘occasional’. Subjects could also record comments for each question, but only for affirmative responses. Subjects were asked about their frequency of PDA use before, during, or after a patient encounter. They were also asked if PDA use had influenced one or more of five aspects of clinical care – decision making, diagnosis, treatment, test ordering, and in-patient hospital length of stay. Data analysis included chi square tests to assess differences between attending physicians and physicians in training regarding frequency of PDA use and the influence of PDA use on the five aspects of clinical care. The subject population was also divided into frequent and occasional users of PDAs, and chi square testing was used to assess differences between these two groups regarding the influence of PDA use on clinical care. A significance value of P Main results – Ninety-four (87%) of the 108 respondents used PDAs for patient encounters. Of this group, 59 were frequent users and 35 were occasional users. There were no significant differences between attending physicians and physicians in training with regard to frequency of PDA use in patient encounters. Sixty-seven percent of the 108 respondents reported that using a PDA had influenced their clinical decision making; over 50% reported that PDA use had influenced changes in patient treatment; 16% reported that PDA use had helped avoid unnecessary tests; 10% reported that PDA use had helped change a patient’s diagnosis; and 6% reported that PDA use had helped shorten a patient’s length of stay. Within these results, there were no statistically significant differences between the attending physicians and the physicians in training. More than 85% of the frequent PDA users (n=59), and 60% of the occasional PDA users (n=35), reported that PDA use had influenced their clinical decision making. The difference between these two groups was statistically significant (P Fifty-six percent of respondents recorded comments on the survey. More than 75% of the comments included using PDAs to access drug-related information for clinical decision making. Conclusion – PDA use has a positive impact on clinical decision making and patient care. Frequency of PDA use appears to be a factor in determining the perceived impact of PDAs on clinical decision making. However, even those physicians who used PDAs only occasionally reported a positive impact of PDA use on clinical decision making. The status of physicians (attending or in training) does not appear to be a determining factor in the frequency of PDA use for patient encounters. Health sciences librarians are well positioned to provide resources and training for PDA use by clinicians.

机译：评论：Dee，Cheryl R.，Marilyn Teolis和Andrew D. Todd。 “医师在临床决策中使用个人数字助理（PDA）。”医学图书馆协会杂志93.4（2005年10月）：480-6。目的–研究参加培训的医师和医师（医学生，实习生和住院医师）使用PDA进行患者护理的频率，并探讨医师对PDA使用对临床护理几个方面的影响的看法。设计–通过问卷调查进行用户研究。设置–在美国田纳西州，佛罗里达州，阿拉巴马州，肯塔基州和宾夕法尼亚州的教学医院。受试者–接受培训的59位主治医师和49位医师（共108名）的便利性样本在五个州中分布不均。方法–由教学医院的图书馆员招募受试者来回答在医学会议上分发并收集的问卷，以及通过电子邮件，邮件和传真进行。要求受试者具有并使用PDA，但是并不需要事先进行PDA使用培训，也没有在研究之前向受试者提供PDA。大多数问题要求受访者从五个Likert量表答案中选择关于PDA使用的频率：几乎总是，经常，几次，很少或永远不会。在结果报告中，“几乎总是”和“经常”选项被组合并报告为“频繁”，而“几次”和“很少”选项被组合并报告为“偶然”。主题还可以记录每个问题的评论，但只能记录肯定的回答。在患者接触之前，期间或之后，询问受试者有关PDA使用的频率。他们还被问到PDA的使用是否影响了临床护理五个方面中的一个或多个–决策，诊断，治疗，测试顺序和住院病人的住院时间。数据分析包括卡方检验，以评估主治医师和内科医师之间在PDA使用频率以及PDA使用对临床护理五个方面的影响方面的差异。受试者人群也分为经常使用和不经常使用PDA的人群，卡方检验用于评估两组之间在PDA使用对临床护理的影响方面的差异。 P主要结果的显着性值– 108位被调查者中有94位（87％）使用PDA进行患者就诊。在该组中，有59个是频繁用户，而35个是偶尔用户。在主治医生和内科医师之间的培训中，患者接触中使用PDA的频率没有显着差异。在108位受访者中，有67％的受访者表示使用PDA影响了他们的临床决策。超过50％的人报告说PDA的使用影响了患者治疗的变化; 16％的人报告说PDA的使用有助于避免不必要的测试; 10％的人报告说PDA的使用有助于改变患者的诊断;有6％的人报告说，使用PDA可以帮助缩短患者的住院时间。在这些结果中，主治医师与受训医师之间没有统计学上的显着差异。超过85％的PDA频繁用户（n = 59）和60％的PDA偶尔用户（n = 35）表示使用PDA影响了他们的临床决策。两组之间的差异具有统计学意义（P. 56％的受访者在调查中记录了评论。超过75％的评论包括使用PDA访问药物相关信息以进行临床决策。结论– PDA的使用具有一定的意义。对PDA的使用频率似乎是确定PDA对临床决策的感知影响的一个因素，但是，即使是那些使用PDA的医生也偶尔会报告PDA对临床决策的积极影响决策（医师的状态（就诊或正在接受培训）似乎不是决定患者使用PDA的频率的决定因素，健康科学馆员可以为临床医生使用PDA提供资源和培训。

PDA Use by Clinicians has a Positive Impact on Clinical Decision Making

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