Improving information management in primary care: the proof is in the pudding
Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA.The Journal of Innovations in Health Informatics 02/2008; 16(3):213-20. DOI: 10.14236/jhi.v16i3.696
Generalists in both the USA and UK have been at the forefront of improving information management skills, defined here as the abilities required to locate and utilise synthesised information for patient care that is accessible, current, relevant and valid. Over the past decade, a variety of interventions designed to improve knowledge and skills relative to information management has been implemented. The goals of training are for learners to demonstrate long-term retention of knowledge and skills gained and to be able to transfer this learning from the context of training into different situations and contexts, such as those encountered in the workplace. Thus, to conclude that learning has taken place, it is essential to study performance after learners have acquired knowledge and skills to see how well those have been retained and generalised. The current study builds on previous work conducted by the authors that described and evaluated an intervention designed to improve information management knowledge, skills and use of Web-based resources by participants from generalist primary care practices. This cross-over study found that both groups of participants--those who received training initially and those who received training later--showed the same improvements when assessed 15 months and three months, respectively, after training. Given the definition of learning as 'relatively permanent', we wondered if these improvements would last. Participants in the original three phases of the study completed questionnaires during each phase; for the current study they were asked to complete a fourth questionnaire administered 27 and 15 months, respectively, after their original training. All variables showed non-significant differences between participants' scores at the end of the original study, where learning was assessed as having occurred, and the current administration of the questionnaire. Demonstrated long-term retention of knowledge and skills and generalisation to the workplace show that the goals of training have been met.
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ABSTRACT: Primary-care physicians feel pressure to be knowledgeable, efficient, comprehensive, and compassionate while delivering evidence-based medical care. Incorporating evidence-based medicine into practice requires training in the skills of finding and applying good evidence to patients, and, increasingly, infrastructure that supports the incorporation of evidence into electronic health records. Physicians cite many barriers to the use of evidence-based medicine in practice. In this review, we examine evidence of the value of evidence-based medicine in clinical practice, discuss the interface of evidence and shared decision-making, suggest tools and approaches for incorporating evidence-based medicine into practice, and discuss the impact of recent health insurance reform on expectations and incentives for physicians with respect to evidence-based practice. Mt Sinai J Med 79:545-554, 2012. © 2012 Mount Sinai School of Medicine.Mount Sinai Journal of Medicine A Journal of Translational and Personalized Medicine 09/2012; 79(5):545-54. DOI:10.1002/msj.21337 · 1.62 Impact Factor
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