Answering family physicians' clinical questions using electronic medical databases.
OBJECTIVE
We studied the ability of electronic medical databases to provide adequate answers to the clinical questions of family physicians.


METHODS
Two family physicians attempted to answer 20 questions with each of the databases evaluated. The adequacy of the answers was determined by the 2 physician searchers, and an arbitration panel of 3 family physicians was used if there was disagreement.


METHODS
We identified 38 databases through nominations from national groups of family physicians, medical informaticians, and medical librarians; 14 met predetermined eligibility criteria.


METHODS
The primary outcome was the proportion of questions adequately answered by each database and by combinations of databases. We also measured mean and median times to obtain adequate answers for individual databases.


RESULTS
The agreement between family physician searchers regarding the adequacy of answers was excellent (k=0.94). Five individual databases (STAT!Ref, MDConsult, DynaMed, MAXX, and MDChoice.com) answered at least half of the clinical questions. Some combinations of databases answered 75% or more. The average time to obtain an adequate answer ranged from 2.4 to 6.5 minutes.


CONCLUSIONS
Several current electronic medical databases could answer most of a group of 20 clinical questions derived from family physicians during office practice. However, point-of-care searching is not yet fast enough to address most clinical questions identified during routine clinical practice.
Alper
B S
BS
Department of Family and Community Medicine, University of Missouri-Columbia, MU School of Medicine, Columbia, MO, 65212, USA. alperB@health.missouri.edu
Stevermer
J J
JJ
White
D S
DS
Ewigman
B G
BG
D002983:Clinical Competence / Q000592:standards; D003200:Computer User Training; D019992:Databases as Topic / Q000191:economics / Q000592:standards*; D019317:Evidence-Based Medicine / Q000592:standards*; D005194:Family Practice / Q000193:education / Q000592:standards*; D006801:Humans; D007255:Information Services / Q000592:standards*; D016247:Information Storage and Retrieval / Q000592:standards*; D020407:Internet / Q000592:standards*; D010821:Physicians, Family / Q000193:education / Q000523:psychology; D017410:Practice Guidelines as Topic / Q000592:standards; D013997:Time Factors