Moving medical research into clinical practice: Helping physicians sort the forest from the trees

Canadian researchers study how family physicians use e-learning tools to stay on top of the clinical practice information their patients' need.

Dr. Roland Grad

  • Associate Professor, Department of Family Medicine, McGill University
  • Family doctor at the Herzl Clinic, Montréal, Québec

Dr. Pierre Pluye

  • CIHR New Investigator
  • Associate Professor, Department of Family Medicine McGill University, Montréal, Quebe

Associates and partners

Issue

Medical and clinical practice research is moving at lightening speed these days, generating new insights into patient care on a constant basis.

For busy physicians, staying abreast of the latest thinking in clinical practice and retrieving the best possible clinical information to help their patients with medical problems and to support healthy lifestyles is a major challenge.

“Clinical information becomes the updated knowledge doctors’ use in their day-to-day practice,” says Roland Grad, a family physician and Knowledge Translation researcher at McGill University. “Physicians eventually hear about the information they need most, but it takes too long for it to get to them.”

Electronic knowledge resources that contain clinical information like InfoPOEMs® and e-Therapeutics+Highlights®, aim to make it easier for physicians and other health care practitioners to keep their professional knowledge up-to-date. Developed by the College of Family Physicians of Canada, MD Physician Services (a company owned by the Canadian Medical Association) and the Canadian Pharmacists Association, e-learning programs deliver summaries of the latest clinical information right to the desktops of doctors, pharmacists and others making health care decisions. The hope is that by getting timely, relevant information directly into the hands of practitioners in primary health care, individual patients will enjoy better health outcomes and the health care system will save on unnecessary testing or referrals to specialists.

“We want to know more about how physicians are actually using these e-summaries,” explains Dr. Pierre Pluye, also from McGill University. “Are they changing the way doctors look for information and work with their patients? How can we improve their design to help physicians absorb and easily recall information when it is needed?”

Research

Tracking what doctors do on an everyday basis isn’t easy. However, Drs. Grad and Pluye have come up with an interactive Knowledge Translation tool—known as the Information Assessment Method or IAM—that is making a difference.

Since 2006, over 10,000 health professionals have used the IAM to provide feedback on a variety of e-learning programs. Participants use the IAM to reflect on clinical information they received, by rating and commenting on this information.

This kind of integrated Knowledge Translation process leads to a double gain: end-users can improve their knowledge while researchers and information providers can incorporate feedback from the practitioners, to improve the impact of their information packages.

“We’ve gained a lot from the long-term support and involvement of the College of Family Physicians, the Canadian Pharmacists Association and MD Physician Services,” says Dr. Grad. For instance, Drs. Bernard Marlow and Jamie Meuser have worked with us at all stages, bringing a Continuing Medical Education perspective to the team and helping to channel the team’s findings back into their organization’s e-learning programs.

With support from a CIHR Knowledge-to-Action grant, Drs. Grad and Pluye have conducted new research to strengthen the IAM.

“This study allowed us to test our theoretical model on how individuals remember and choose to use clinical practice knowledge,” says Dr. Pluye. “We also explored whether it really works to enable doctors to access and retrieve this information on mobile devices like smart phones or Personal Digital Assistants (PDAs).”

Study participants received InfoPOEMs® over the course of a year. Using their PDAs, participants rated the information they received and chose to retrieve it at a later date, if needed in their practice. Follow-up interviews sought to understand what motivated doctors to search again for the InfoPOEM® and to apply the information to their patient care.

Results

The study shines a clear light on what shapes behaviour and translates knowledge into action in today’s dense digital universe.

With regard to the retrieval of information when needed, “we found that 1 in 14 searches yielded information that was applied in practice to the benefit of the patient,” observes Dr. Pluye. “We also confirmed that a positive result or an experience that reinforces the physician’s prior knowledge encourages subsequent searches.”

From Canada to the EU and Brazil, other organizations are turning to the IAM—and its ability to support robust KT research—to strengthen their information sharing exercises. Librarians, health care administrators and pharmacists have all expressed interest in using the IAM to promote lifelong learning and engage end-users in systems design and other research efforts.

Based on an adapted version of IAM (called IAM4all), Dr. Pluye is currently designing a study in partnership with information providers such as clinical editors. The idea is to gather consumer feedback on the value information from their perspective. In the long run, Drs. Grad and Pluye can envision health care professionals of various kinds using the IAM to work collaboratively with patients to find the information they need to make personal health and lifestyle decisions—a style of decision-making that the next generation of consumers are likely to demand.

Links

An article on The Information Assessment Method (IAM).
From the search function in the left-hand menu, type in Pluye or Grad to bring up the article ‘Assessing and Improving Clinical Information”.