If you were to provide care as per guideline recommendations for the 10 most common chronic conditions to your patient base, it would require 10.6 hours per day. Extending this figure to include preventive services would require another 7.4 hours per day. And what about all the other information that you need to keep on top of? Trawling through hard copies of new guidelines and journals is clearly impractical.
Electronic resources are a fast and effective way to retrieve pertinent information when you require it. You may find that your clinical software has the information that you may need (e.g. drug-drug interaction information), however, often you will need to look beyond this to find the answer to specific patient issues. With near universal Internet access in Australia this solution can be either closer, or further away, than you think.
To be useful, the information you use must be reliable, current, evidence-based and relevant. Think about where the source is located in the information hierarchy.
This hierarchy allows you to distinguish between Level 1 (e.g. a general Google search, Wikipedia) through to robust Level 4 evidence-based guidelines (e.g. RACGP Red Book). Level 5 patient material is the least common and is generally only available on a number of specialised sites. Therefore, once you have defined exactly what you need to know, a good idea is to start with Level 4 information and work down.
When you have successfully retrieved the information, dont forget to ascertain when it was written, what journal it was published in, whether it has been reviewed or whether any endorsing bodies have approved the site (e.g. Health on the Net, a Swiss Foundation who champion the use of high quality medical information via the Internet). This will help you determine the informations currency and validity.
The DISCERN tool is an instrument that can help you assess the validity of this and other consumer health information. This 15 question tool has been designed to gauge the reliability of health information by rating it on separate quality criterion.
My General Practice is also another tool that can be used as an information filter. This desktop tool has been designed by the RACGP and facilitates access to a wide range of online guidelines, patient education materials, journals, Evidence Based Medicine (EBM) resources and learning modules.
Once you are comfortable that you have reliable information, there are a number of other factors to take into account when applying the information to your patient. Participants in research trials are generally homogeneous, in order to successfully observe results without influencing factors. Patients that you treat will often differ from those treated in a study. Co-morbidities are a common problem, especially when looking at a complicated condition such as diabetes. You need to assess the relevance of a clinical trials findings to your patients.
Taking note of the Number Needed to Treat (NNT) is also a useful way to interpret results and apply them in your practice. This epidemiological formula tells you the number of people that you need to treat before a patient benefits from that therapy. This information is useful when discussing treatments and consent. NNT is explored further in the RACGP Green Book (Appendix 3), giving specific examples of preventive care. The recently released Green Book (2nd Edition) is available to download from the RACGP website.
The GPCG Electronic Resources Module
This education module is designed to guide GPs and practice staff through the effective use of electronic resources in retrieving health information. It has a multitude of useful links and delineates the difference between various types of information. It has clear learning objectives, and contains exercises and tips to guide you.
Should you wish to know any more details or get your hands on a copy of the module, you can contact Jane London at the Royal Australian College of General Practitioners. It is also available on the GPCG website.
Posted in Australian eHealth