Improving information management in primary care: the proof is in the pudding.
ABSTRACT 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: Information and communications technology (ICT) is increasingly being used in management of chronic illness to facilitate shared services (virtual health networks and electronic health records), knowledge management (care rules and protocols, scheduling, information directories), as well as consumer-based health education and evidence-based clinical protocols. Common applications of ICT include home monitoring of vital signs for patients with chronic disease, as well as replacing home visits by nurses in person with telemedicine videophone consultations. A patient-managed Home Telecare System with integrated clinical signs monitoring, automated scheduling and medication reminders, as well as access to health education and daily logs, is presented as an example of ICT use for chronic disease self-management. A clinical case study demonstrates how early identification of adverse trends in clinical signs recorded in the home can either avoid hospital readmission or reduce the length of hospital stay.The Medical journal of Australia 10/2003; 179(5):242-6. · 3.79 Impact Factor
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ABSTRACT: To examine the current levels of information technology (IT) use in a primary care practice-based research network (PBRN) in order to inform future development of its infrastructure. Every primary care practitioner who is a member of the Kentucky Ambulatory Network (KAN),as well as the office managers of each practice. Practitioners included family practitioners, general practitioners, nurse practitioners and physician assistants. A cross-sectional study using two survey instruments: one for office managers and one for practitioners. The office manager survey included questions related to the current state of IT within the practice, plans for enhancement and general IT issues from the perspective of managing a practice. The practitioner survey was designed to measure current IT use and attitudes of primary care practitioners. Response rates for the surveys were 46% (n = 68) for the office managers and 51% (n = 116) for practitioners. All but one practice had internet access; however, 43% had only dial-up service. Only 21% of practitioners use an electronic medical record (EMR), with dollar cost being the barrier reported most frequently (58%). More than half of the office managers were either 'somewhat interested' (45%) or 'very interested' (17%) in a low-cost, standardised EMR that was, at the time, to be sponsored by the American Academy of Family Physicians. For practitioners, 71% were either 'somewhat' or 'very' interested in such a system. Responses to other IT issues are reported. While interest in enabling information technologies was high in KAN, adoption was variable, with use of several key technologies reported as low.The results suggest that research in this network that would be dependent on or enhanced by IT might be impeded and, generally, greater attention should be given to enhancing the IT infrastructure in primary care.Informatics in primary care 02/2004; 12(1):11-8. DOI:10.14236/jhi.v12i1.103
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ABSTRACT: Medical education experts have called for improved training in evidence-based medicine (EBM) and the increased use of e-learning technologies in medical education. In response, we developed an interactive, Web-based curriculum on key aspects of EBM in family medicine. Students participating in a 6-week family medicine clerkship (n=238) were randomly assigned to intervention (n=134) or control (n=104) groups. Both groups participated in the traditional clerkship experience, but intervention group students received additional training via an on-line curriculum that included learning modules in MEDLINE searching skills, EBM skills, and the calculation of the number needed to treat (NNT) statistic. The on-line curriculum was evaluated using a case-control design with a test case at the clerkship's end. Results suggested that the on-line curriculum was effective, with experimental group students outperforming control group participants on a variety of measures, including the number of MEDLINE searches conducted during the clerkship (13 searches versus 3 searches) and the quality of literature search strategies on an evaluation patient case study (2.9 versus 2.1 on a 1=poor to 4=excellent scale). Intervention group students reported greater confidence and enjoyment in searching the biomedical journal literature via MEDLINE and were more likely to identify the best articles (randomized controlled trials or meta-analyses) for the evaluation case from among those retrieved (60% versus 34%). In addition, intervention group students' abilities to correctly calculate the NNT were significantly higher than those of control group participants (73% versus 27%). Intervention group students were more likely than control subjects to report learning from other students during the clerkship. This study demonstrates that an e-learning approach to educating medical students to effectively search MEDLINE for articles meeting the criteria for evidence-based practice can result in higher-quality literature search strategies, identification of higher-quality evidence, and improved confidence in information retrieval and analysis skills.Family medicine 03/2006; 38(2):126-32. · 0.85 Impact Factor