PDA Use by Clinicians has a Positive Impact on Clinical Decision Making

Suzanne Pamela Lewis

Abstract


A review of:


Dee, Cheryl R., Marilyn Teolis, and Andrew D. Todd. “Physicians’ use of the personal digital assistant (PDA) in clinical decision making.” Journal of the Medical Library Association 93.4 (October 2005): 480-6.

Objective – To examine how frequently attending physicians and physicians in training (medical students, interns and residents) used PDAs for patient care and to explore physicians’ perceptions of the impact of PDA use on several aspects of clinical care.

Design – User study via a questionnaire.

Setting – Teaching hospitals in Tennessee, Florida, Alabama, Kentucky, and Pennsylvania in the United States.

Subjects – A convenience sample of fifty-nine attending physicians and forty-nine physicians in training (108 total), spread unevenly across the five states.

Methods – Subjects were recruited by librarians at teaching hospitals to answer a questionnaire which was distributed and collected at medical meetings, as well as by email, mail, and fax. The subjects were required to have and use a PDA, but prior training on PDA use was not a requirement, nor was it offered to the subjects before the study. Most of the questions required the respondent to choose from five Likert scale answers regarding frequency of PDA use: almost always, often, a few times, rarely, or never. In the reporting of results, the options ‘almost always’ and ‘often’ were combined and reported as ‘frequent’, and the options ‘a few times’ and ‘rarely’, were combined and reported as ‘occasional’. Subjects could also record comments for each question, but only for affirmative responses.

Subjects were asked about their frequency of PDA use before, during, or after a patient encounter. They were also asked if PDA use had influenced one or more of five aspects of clinical care – decision making, diagnosis, treatment, test ordering, and in-patient hospital length of stay.

Data analysis included chi square tests to assess differences between attending physicians and physicians in training regarding frequency of PDA use and the influence of PDA use on the five aspects of clinical care. The subject population was also divided into frequent and occasional users of PDAs, and chi square testing was used to assess differences between these two groups regarding the influence of PDA use on clinical care. A significance value of P<0.05 was considered statistically significant.

Main results – Ninety-four (87%) of the 108 respondents used PDAs for patient encounters. Of this group, 59 were frequent users and 35 were occasional users. There were no significant differences between attending physicians and physicians in training with regard to frequency of PDA use in patient encounters.

Sixty-seven percent of the 108 respondents reported that using a PDA had influenced their clinical decision making; over 50% reported that PDA use had influenced changes in patient treatment; 16% reported that PDA use had helped avoid unnecessary tests; 10% reported that PDA use had helped change a patient’s diagnosis; and 6% reported that PDA use had helped shorten a patient’s length of stay. Within these results, there were no statistically significant differences between the attending physicians and the physicians in training.

More than 85% of the frequent PDA users (n=59), and 60% of the occasional PDA users (n=35), reported that PDA use had influenced their clinical decision making. The difference between these two groups was statistically significant (P<0.007) with regard to the influence of PDA use.

Fifty-six percent of respondents recorded comments on the survey. More than 75% of the comments included using PDAs to access drug-related information for clinical decision making.

Conclusion – PDA use has a positive impact on clinical decision making and patient care. Frequency of PDA use appears to be a factor in determining the perceived impact of PDAs on clinical decision making. However, even those physicians who used PDAs only occasionally reported a positive impact of PDA use on clinical decision making. The status of physicians (attending or in training) does not appear to be a determining factor in the frequency of PDA use for patient encounters. Health sciences librarians are well positioned to provide resources and training for PDA use by clinicians.


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