Answering Family Physicians’ Clinical Questions Using Electronic Medical Databases

Context

Family physicians and other primary care providers treat patients who have a wide variety of syndromes and symptoms. Because of the scope and breadth of primary care, it is nearly impossible for a clinician to keep up with rapidly changing medical information.¹⁰

Connelly and colleagues¹¹ surveyed 126 family physicians and found they used the Physicians’ Desk Reference and colleagues much more often than Index Medicus or computer-based bibliographic retrieval systems. Research literature was used infrequently and rated among the lowest in terms of credibility, availability, searchability, understandability, and applicability. Physicians preferred sources that had low cost and were relevant to specific patient problems over sources that had higher quality.

Conclusions

Current databases can answer a considerable proportion of clinical questions but have not reached their potential for efficiency. It is our hope that as electronic medical databases mature, they will be able to bridge this gap and bring the research literature to the point of care in useful and practical ways. This study provides a snapshot of how far we have come and how far we need to go to meet these needs.

Acknowledgments

Funding for our study was provided by a grant from the American Academy of Family Physicians to support the Center for Family Medicine Science and from 2 Bureau of Health Professions Awards (DHHS 1-D14-HP-00029-01, DHHS 5 T32 HP10038) from the Health Resources and Services Administration to the Department of Family and Community Medicine at University of Missouri-Columbia. The authors would like to acknowledge Erik Lindbloom, MD, MSPH, for assisting with the database testing as a substitute searcher for B.A.; E. Diane Johnson, MLS, for assisting with the selection of databases for study inclusion; Robert Phillips, Jr., MD, MSPH, for arbitration of questions and answers for which the searchers did not reach agreement along with B.E. and J.S.; David Cravens, Erik Lindbloom, Kevin Kane, Jim Brillhart, and Mark Ebell for proofreading the questions for clarity, answerability, and clinical relevance; John Ely and Lee Chambliss for providing clinical questions from their observations; Mark Ebell, John Ely, Erik Lindbloom, Jerry Osheroff, Lee Chambliss, David Mehr, Robin Kruse, John Smucny, and many others for constructive criticism in the design of this study; and Steve Zweig for editorial review.