Background: Clinicians use information regularly in clinical care. New electronic information resources provided in push, pull, and prompting formats have potential to improve information support but have not been designed for individualization. Physicians with differing risk status use healthcare resources differently often without an improvement in outcomes.
Questions: Do physicians who are risk seeking or risk avoiding and comfortable or uncomfortable with uncertainty use or prefer electronic information resources differently when answering simulated clinical questions and can the processes be modeled with existing theoretical models?
Design: Cohort study.
Methods: Primary care physicians in Canada and the United States were screened for risk status. Those with high and low scores on 2 validated scales answered 23 multiple-choice questions and searched for information using their own electronic resources for 2 of these questions. They also answered 2 other questions using information from 2 electronic information sources: PIER© and Clinical Evidence© .
Results: The physicians did not differ for number of correct answers according to risk status although the number of correct answers was low and not substantially higher than chance. Their searching process was consistent with 2 information-seeking models from information science (modified Wilson Problem Solving and Card/Pirolli Information Foraging/Information Scent models). Few differences were seen for any electronic searching or information use outcome based on risk status although those physicians who were comfortable with uncertainty used more searching heuristics and spent less effort on direct searching. More than 20% of answers were changed after searchingalmost the same number going from incorrect to correct and from correct to incorrect. These changes from a correct to incorrect answer indicate that some electronic information resources may not be ideal for direct clinical care or integration into electronic medical record systems.
Conclusions: Risk status may not be a major factor in the design of electronic information resources for primary care physicians. More research needs to be done to determine which computerized information resources and which features of these resources are associated with obtaining and maintaining correct answers to clinical questions.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-08052005-075912 |
| Date | 30 September 2005 |
| Creators | McKibbon, Kathleen Ann |
| Contributors | Rebecca S. Crowley, Ellen G. Detlefsen, PhD, Charles P. Friedman, PhD, R. Brian Haynes, MD, PhD, Douglas B. Fridsma, MD, PhD |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-08052005-075912/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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