Angina on the Palm: randomized controlled pilot trial of Palm PDA software for referrals for cardiac testing.
OBJECTIVE
Personal digital assistants (PDAs) are popular with physicians: in 2003, 33% of Canadian doctors reported using them in their practices. We do not know, however, whether using a PDA changes the behaviour of practising physicians. We studied the effectiveness of a PDA software application to help family physicians diagnose angina among patients with chest pain.


METHODS
Prospective randomized controlled pilot trial using a cluster design.


METHODS
Primary care practices in the Toronto area.


METHODS
Eighteen family physicians belonging to the North Toronto Primary Care Research Network (Nortren) or recruited from a local hospital.


METHODS
We randomized physicians to receive a Palm PDA (which included the angina diagnosis software) or to continue conventional care. Physicians prospectively recorded the process of care for patients aged 30 to 75 presenting with suspected angina, over 7 months.


METHODS
Did the process of care for patients with suspected angina improve when their physicians had PDAs and software? The primary outcomes we looked at were frequency of cardiac stress test orders for suspected angina, and the appropriateness of referral for cardiac stress testing at presentation and for nuclear cardiology testing after cardiac stress testing. Secondary outcome was referrals to cardiologists.


RESULTS
The software led to more overall use of cardiac stress testing (81% vs 50%). The absolute increase was 31% (P = .007, 95% confidence interval [CI] 8% to 58%). There was a trend toward more appropriate use of stress testing (48.6% with the PDA vs 28.6% control), an increase of 20% (P = .284, 95% CI -11.54% to 51.4%). There was also a trend toward more appropriate use of nuclear cardiology following cardiac stress testing (63.0% vs 45.5%), an absolute increase of 17.5% (P =.400, 95% CI -13.9% to 48.9%). Referrals to cardiologists did not increase (38.2% with the PDA vs 40.9%, P =.869).


CONCLUSIONS
A PDA-based software application can lead to improved care for patients with suspected angina seen in family practices; this finding requires confirmation in a larger study.
Greiver
Michelle
M
Department of Family and Community Medicine, University of Toronto. mgreiver@rogers.com
Drummond
Neil
N
White
David
D
Weshler
Jason
J
Moineddin
Rahim
R
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis*; D034201:Computers, Handheld; D005080:Exercise Test / Q000706:statistics & numerical data*; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012017:Referral and Consultation; D012984:Software