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. 2016 Aug 4:7:433-41.
doi: 10.2147/AMEP.S78385. eCollection 2016.

A simple heuristic for Internet-based evidence search in primary care: a randomized controlled trial

Affiliations

A simple heuristic for Internet-based evidence search in primary care: a randomized controlled trial

Andreas Eberbach et al. Adv Med Educ Pract. .

Abstract

Background: General practitioners (GPs) are confronted with a wide variety of clinical questions, many of which remain unanswered.

Methods: In order to assist GPs in finding quick, evidence-based answers, we developed a learning program (LP) with a short interactive workshop based on a simple three-step-heuristic to improve their search and appraisal competence (SAC). We evaluated the LP effectiveness with a randomized controlled trial (RCT). Participants (intervention group [IG] n=20; control group [CG] n=31) rated acceptance and satisfaction and also answered 39 knowledge questions to assess their SAC. We controlled for previous knowledge in content areas covered by the test.

Results: Main outcome - SAC: within both groups, the pre-post test shows significant (P=0.00) improvements in correctness (IG 15% vs CG 11%) and confidence (32% vs 26%) to find evidence-based answers. However, the SAC difference was not significant in the RCT.

Other measures: Most workshop participants rated "learning atmosphere" (90%), "skills acquired" (90%), and "relevancy to my practice" (86%) as good or very good. The LP-recommendations were implemented by 67% of the IG, whereas 15% of the CG already conformed to LP recommendations spontaneously (odds ratio 9.6, P=0.00). After literature search, the IG showed a (not significantly) higher satisfaction regarding "time spent" (IG 80% vs CG 65%), "quality of information" (65% vs 54%), and "amount of information" (53% vs 47%).

Conclusion: Long-standing established GPs have a good SAC. Despite high acceptance, strong learning effects, positive search experience, and significant increase of SAC in the pre-post test, the RCT of our LP showed no significant difference in SAC between IG and CG. However, we suggest that our simple decision heuristic merits further investigation.

Keywords: continuing medical education; decision making; evidence-based practice; medical informatics.

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Figures

Figure 1
Figure 1
The three-step heuristic of decision making.
Figure 2
Figure 2
Workshop table of contents. Abbreviations: ARR, absolute risk reduction; RRR, relative risk reduction; NNT, number needed to treat.
Figure 3
Figure 3
Flowchart of general practitioners’ participation, and dropout. Abbreviation: WS, workshop.
Figure 4
Figure 4
Participants’ workshop evaluation. Notes: (N=51, 1= very good, 6= deficient). Please note that GPs in the control group are included in this process evaluation. Abbreviations: IG, intervention group; GPs, general practitioners; CG, control group.
Figure 5
Figure 5
Commitment to change at the end of the workshop (n=48). Note: Please note that GPs in the control group are included in this process evaluation. Abbreviation: GPs, general practitioners.

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