Use of Computers and Medical Databases
in Family Practice in Niagara Falls, Ontario

Teresa Petrella, Mel Krass, and John Dunn.

Journal Contents

Dr. T. Petrella is currently a first year Internal Medicine resident at McMaster University.
Dr. M. Krass is a Family Physician in Niagara Falls.
John Dunn is the librarian at the Greater Niagara General Hospital.

SUMMARY

Objective:
To identify the computer knowledge, skills, use of medical databases and perceived need in Family Practitioners in Niagara Falls.

Design:
Survey of 33 Family Practitioners practicing in Niagara Falls during September 1995.

Results:
Of the physicians surveyed, 64% (21/33) responded. All of the participants had access to a computer, but very few used them for database searches (8/21 or 28%). The two most common barriers to computer use were lack of training and lack of time, 13/21 (62%).

Conclusion:
An understanding of computers and medical databases should be an integral part of medical practice. Lack of time, lack of training and lack of awareness may be preventing physicians from accessing information. Several categories of resources are described and information needed to access various databases is provided.

INTRODUCTION

The rapid expansion of scientific and medical knowledge has provided physicians with numerous therapeutic and diagnostic options. In order for a physician to select appropriate and current management for an individual patient, he/she must access and appraise the knowledge available. Management decisions should be made not only from clinical experience and pathophysiologic rationale, but also from evidence from clinical research. Processing this large amount of information can be difficult and time consuming. Difficulty obtaining access to useful information seems to be more pronounced in a nonacademic setting ⁽¹⁾.

Medical information on computer software is widely available and easily accessible through a personal computer. Software like GRATEFUL MED, MEDLINE, CANCERLIT, PDQ, PSYCHLIT, SCIENTIFIC AMERICAN, and the COCHRANE DATABASE OF SYSTEMATIC REVIEW, to name a few, provide current medical information. With the use of the INTERNET, the possibilities are endless.

In a recent survey involving first year Family Medicine residents in Canada ⁽²⁾, it was found that only 13% felt very comfortable with computer use and the majority wanted more computer training. It was concluded that computer training become an integral part of Family Medicine training in Canada ⁽²⁾. Other studies document the difficulty experienced by physicians in answering clinical questions. One such study involved allowing participants to use medical software for a two week period to answer questions arising in their practice ⁽³⁾. Some of the problems they encountered were retrieval of incomplete information, difficulty navigating the software and difficulty translating clinical problems into questions ⁽³⁾.

In this small pilot study we wanted to determine computer availability, knowledge, skills and barriers to computer use and use of medical information systems. We also wanted to determine the need and desire for further training.

METHODS

All Family Practitioners in Niagara Falls were asked to participate. Thirty-three physicians were sent surveys in September 1995. The survey was made up of 8 closed questions, 2 of which had multiple parts (see Appendix A). The response to the questions was either Yes or No. The survey was specifically designed for this study. The 33 physicians were contacted by mail and a cover letter was included explaining the questionnaire. The physicians were surveyed within a 2 week time period. There was no attempt to contact those who did not respond.

RESULTS

We sent questionnaires to 33 Family Practitioners, of whom 21 (64%) responded.

Table 1 outlines the results for the questions assessing knowledge, skills and need. All our participants had access to a computer (21/21). However, only 8/21 (38%) had access to medical databases such as MEDLINE. The majority saw a need for further computer training (16/21) and would attend training sessions if they were available.

Table 2 shows the results of computer use. When asked what their computer was used for, only 7/21 (33%) used the computer for database searches and only 4/21 (19%) used it for research purposes. The majority used their computers for billing and word-processing, 20/21 (95%) and 16/21 (76%) respectively.

Table 3 describes the barriers to computer use. Lack of time and lack of training were the most significant barriers, both identified by 13/21 (62%) of the physicians. Lack of hardware and cost were not identified by many as hindrances, 3/21 (14%) and 4/21 (19%) respectively.

TABLE 1:

TABLE 2:

TABLE 3:

DISCUSSION

Computers are an integral part of the practice of medicine and with the shift towards Evidence-based Medicine ⁽⁴⁾, physicians will be expected to retrieve and appraise clinically relevant information in order to provide the best management for their patient. Computer software is a potentially powerful resource for physicians if they are properly trained in its use. To access most databases you would need a computer, a monitor, a printer, a modem and potentially a CD-ROM drive. CD-ROMS offer one of the simplest options when considering resources for your computer system. All major publishers now offer many of their medical texts and journals in a CD-ROM version. Many of the texts are available for a free trial period prior to purchase. There are also many patient education and medical continuing education CD-ROM products on the market.

One of the primary tools for physicians is the MEDLINE database. Created by the National Library of Medicine, in Betheseda, Maryland, this database contains references to literally hundreds of thousand of articles from world-wide health care publications. MEDLINE can be accessed several ways. Fortunately, a very convenient program called GRATEFUL MED was developed for physicians. The greatest feature of this program is that it enables you to input your search strategy prior to going online. When you are satisfied with your strategy and prompt the program, it automatically connects to the database, performs the search, downloads the results, and disconnects. You are then able, at your leisure, to view the results. GRATEFUL MED also offers you the option of ordering a photocopy of an article that is referenced in your search results using a sub program called Loansome Doc. Both of these services are administered in Canada by the Canada Institute for Scientific and Technical Information (CISTI) in Ottawa, and are available for a nominal fee. MEDLINE is also available in CD-ROM or through on-line access.

In the past few years, the INTERNET has gone from a theory to a reality. Unfortunately accompanying this new reality has been a deluge of "buzzwords" and hype, such as "Information Superhighway". While it may sound intimidating, access to the "Infobahn" is actually simple. Access to the INTERNET can be obtained through an INTERNET provider. These businesses have already secured all of the necessary technical specifications, and allow you to access the INTERNET through them. Their service is generally provided on a monthly fee basis, following an initial start-up fee. It is mandatory that you investigate each provider and their services agreement. Although their rates are usually competitive, their customer service may vary significantly. Of particular interest to physicians is the instantaneous and direct access that the INTERNET provides to:

a) federal, provincial and municipal governments
b) medical and hospital associations
c) professional affiliations
d) consumer health organizations
e) clinical information and research
f) patient teaching resources

AU of these can be accessed utilizing various functions such as E-Mail, Listservs, Newsgroups, and Worldwide Web sites. Introductory and advanced instruction is readily available from many sources, such as your INTERNET provider, and library staff.

Our results show that all the participants have access to a computer, but very few of them use it for searching databases or research, The participants identified that few of them have access to medical databases, yet cost was not an issue. Part of the difficulty may be lack of awareness of what is available due to lack of training. In this study the most frequently cited barriers to computer use were lack of training and lack of time. The majority of participants would like further training and would be willing to attend training sessions because they saw a need for computer literacy in their practice.

Not addressed in this survey , but an important consideration, is physician awareness of the resources available. It is difficult to assess a need for medical databases and INTERNET if their capabilities are unknown. This small pilot study was raised mainly out of interest to assess computer and medical database use in Niagara Falls and hence the survey was not validated nor tested on a previous group. This would be a consideration for a future more involved, validated study.

CONCLUSION

The results obtained in this study highlight that though all the physicians had computer access very few accessed medical databases. Lack of training and lack of time were identified as barriers, but lack of awareness of what is available may also be a factor. More computer training is recommended for physicians who wish to improve their information access. Physicians who are interested in further training may contact local libraries, Universities and private courses. In this article information of what databases are available and how to access them is provided in the hope of increasing awareness. Access to Medical Databases can be a great asset and ensures that information essential for proper patient care would be easily accessible in the realm of a non- academic based practice.

APPENDIX A

SURVEY:
USING THE INFORMATION HIGHWAY

Please check the appropriate answer:

REFERENCES

1. Williamson JW, German PS, Weiss R. Health Science Information Management and continuing Education of Physicians: A Survey of U.S. Primary Care Practitioners and Their Opinion Leaders. Ann Intern Med 1989; 110: 151-160.

2. Rowe BH, Ryan DT, Therrien S, Mulloy JV. First year Family Medicine Residents' Use of Computers: Knowledge, Skills and Attitudes. Can Med Assoc J 1995 Aug. 1; 153(3): 267-72.

3. Osheroff JA, Bankowitz RA. Physicians' Use of Computer Software in Answering Clinical Questions. BullMed Libr Assoc 1993 Jan; 81(l): 11-19.

4. Guyatt G. Evidence-based Medicine: A New Approach to Teaching the Practice of Medicine. JAMA 1992, 268: 2420-2425.

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