Point of care decision-making tools - Overview

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Contents

Introduction

See also Filters (ie. hedges), How to appraise POC tools, TRIP Database and SumSearch

Physicians at the frontlines of care do not have time to search biomedical databases methodically or to browse Google scholar and Bing for answers. However, several appraised sources are available to liberate doctors from the difficult task of locating reliable information and expert summaries of the evidence. Many physicians are accustomed to reading digested, summaries of evidence to guide them in their clinical thinking and decision-making processes. The point-of-care sources below aim to synthesize all available evidence for major clinical topics (especially the top layers of the evidence-based pyramid). By summarizing medical knowledge, it is easier to apply the best evidence within the context of providing patient care. (See 2009 UofA POC tools handout).

Features of POC tools

  • syntheses of current evidence for diagnosis, tests and treatments
  • designed for rapid consultation at the point of patient care
  • evidence-based and frequently updated, with links to relevant literature
  • include drug information, ICD coding, information for patients, PDA application, and provision for links to electronic health records

Access and navigation issues

Point-of-care decision-making tools make a physician's retrieval of evidence easier. However, many of these tools are accessed by keyword or textword searching (ie. no MeSH searching). They also rely on point-and-click findability, browsing and scanning of web pages to find what is needed. That said, some POC tools are easier to navigate than others due to the use of structured abstracts and well-designed interfaces. Keep in mind that POC tools tend to answer very broad clinical questions and are not as helpful for specific foreground questions.

Point-of-care tools are small in size compared to millions of citations in MEDLINE, or EMBASE; and tiny compared to the mammoth Web or Google scholar. In addition, as proprietary tools, they are owned by commercial vendors and are generally marketed as tools that synthesize medical evidence from the major medical databases.

Background vs. foreground clinical questions

Some health librarians view point-of-care tools as tertiary synthesized sources of information ie. syntheses of primary and secondary research articles, and evidence, from major biomedical journals. An example of a primary research article is a recently published clinical trial of a drug indexed in MEDLINE; an example of secondary research is a review of recent clinical trials in a specific area of medicine. See systematic review, for examples. Finding answers to clinical questions may require searches for general, background information about the who, what, where, when or why about a disease, or its processes. Examples of background questions include What is Down's syndrome? and What is trisomy 21? Background questions are simple questions about the facts of a disease, and some point-of-care tools provide excellent context (or background) for these questions. Two tools strong in providing background are UpToDate and BMJ's Clinical Evidence. Guyatt et al suggest that background questions are most often asked by medical students. As medical training continues through residency and practice, clinical questions get more and more specific - the foreground of medical evidence. Many research studies indexed in MEDLINE answer specific foreground questions whereas textbooks answer background questions.

ACP Journal Club

ACP Journal Club 's general purpose is to select from the biomedical literature articles that report original studies and systematic reviews that warrant immediate attention by physicians attempting to keep pace with important advances in internal medicine. These articles are summarized in value-added abstracts and commented on by clinical experts. ACP Journal Club is available via OVID EBM Reviews.

ACP PIER (Physicians' Information and Education Resource)

ACP PIER is an evidence-based point-of-care decision tool, available through Stat!Ref. In keeping with PIER's motto, "Clinical Guidance from ACP", each entry contains practice guidelines developed from evidence found in peer-reviewed journal articles and traditional textbooks. More...

BMJ 'Point-of-Care'

BMJ Point of Care is developed by the BMJ Evidence and Epocrates -- a U.S.-based leader in technology and high-quality drug information. BMJPOC was created to meet the challenging information demands of the clinical care setting and offers:

  • Disease monographs that include diagnoses, treatment options, tests to order, guidelines etc.
  • patient-centered approach to information with treatment organized by patient group
  • Embedded links to drug dosing and best available evidence from Clinical Evidence (with paid subscription)
  • Information on 3,300 drugs and 400 alternative medicines; comprehensive drug interaction checking tool
  • Up-to-date, detailed formulary for top national and regional healthcare insurance plans
  • Embedded links to ePocrates; referenced with links to Pubmed abstracts
  • A useful pill identifier tool plus hundreds of helpful medical tables and calculators.

For more information see: http://group.bmj.com/products/evidence-centre/bmj-point-of-care-1 or demo http://group.bmj.com/media/movies/poc/

High quality POC tools such as BMJ Clinical Evidence support evidence-based decision and BMJ Point of Care is similar overall. It blends clear, concise expert opinion with medical evidence and provides authoritative concise answers to clinical questions through its hierarchical browsing structure. Monographs with embedded links to references and BMJ Clinical Evidence cover 29 specialties and include diagnoses, symptom evaluation, drug dosing, tests to order, relevant images (MRI, angiograms) and patient handouts. BMJ POC is a direct competitor to DynaMed and UpToDate.

Clin-eguide (Wolters-Kluwer-Ovid)

Clin-eguide (Wolters-Kluwer Ovid) is a Wolters-Kluwer-OVID product that presents a synthesis of the best available evidence on diagnosis, management, and treatment of high-cost problems occuring in inpatient, outpatient and emergency department settings. For more information, see Clin-eguide (Wolters-Kluwer Ovid)

Clinical Evidence (BMJ)

Clinical Evidence, published by the BMJ Publishing Group, draws on the evidence from systematic reviews to address broad, clinical questions - for example, what is effective in treating common cold? As an international source of the best available evidence for effective health care, CE promotes informed decision-making by summarizing what's known -- and not known -- about 200 medical conditions and 2000 treatments. CE is based on questions that clinicians and patients want answered. This may be the right starting place for a search for relevant evidence on major topics. For more information, see Clinical Evidence (BMJ)

Clinical pharmacology

Clinical pharmacology provides up-to-date, peer-reviewed, clinically-relevant information on all U.S. prescription drugs, as well as off-label uses and dosage, herbal supplements, nutritional and over-the-counter products and new and investigational drugs.

Cochrane Library

See The Cochrane Library

Cochrane Database of Systematic Reviews (Cochrane Reviews)

Database of Abstracts of Reviews of Effects (DARE)

Cochrane Central Register of Controlled Trials (Clinical Trials)

The Cochrane Methodology Register (Methods Studies)

Health Technology Assessment Database (Technology Assessments)

NHS Economic Evaluation Database (Economic Evaluations)

Cochrane Database of Systematic Reviews

Since 1996, systematic reviews prepared and maintained by the Cochrane Collaboration have been published in The Cochrane Database of Systematic Reviews. CDSRs are regularly updated as more information becomes available and in response to comments from physicians. Systematic reviews are now widely regarded as being of better quality, on average, than their counterparts in print journals.

Cochrane Database of Systematic Reviews is one of the most important databases in evidence-based medicine. It is on par with MEDLINE in the view of many and provides quick access to the systematic reviews of randomized controlled trials (RCTs) undertaken by the international Cochrane Collaboration. Its strength is providing easy access to RCTs that deal with drugs, interventions and therapies. For more information, see Cochrane Library.

Database of Abstracts of Reviews of Effects (DARE)

DARE is the only database to contain abstracts of systematic reviews that have been quality assessed. Each abstract includes a summary of the review together with a critical commentary about the overall quality. The database is a key resource for busy decision makers and can be used for answering questions about the effects of specific interventions, whether such questions arise from practice or when making policy. DARE covers a broad range of health related interventions and includes over 3000 abstracts of reviews in fields as diverse as diagnostic tests, public health, health promotion, pharmacology, surgery, psychology and the organization and delivery of healthcare. DARE complements the Cochrane Database of Systematic Reviews by quality-assessing and summarizing reviews that have not yet been completed by the Cochrane Collaboration. DARE is produced by the Centre for Reviews and Dissemination (CRD), University of York, UK.

DynaMed (EBSCO)

DynaMed (EBSCO) is a just-in-time reference tool integrating evidence-based and practical information for clinical practice. As a point-­of-­care tool, it is easy to use and offers clinically oranized summaries to more than 3000 tpoics and covers more than 500 journals. Content is updated daily. Dynamed does not offer all evidence on topics but rather the best evidence. Summaries are listed alphabetically and are searchable. Dynamed also offers handy calculators, decision trees, clinical criteria, and unit and dose converters. For more information, see DynaMed_(EBSCO)...

eMedicine

eMedicine comprises the largest and most current Clinical Knowledge Base available freely to physicians and other healthcare professionals. eMedicine's subscription site for point-of-care use for institutions is iMedicine. Nearly 10,000 physician authors and editors contribute to the eMedicine multimedia Clinical Knowledge Base, which contains articles on 7,000 diseases and disorders. The evidence-based content, updated regularly, provides the latest practice guidelines in 59 medical specialties. eMedicine's professional content undergoes 4 levels of physician peer review plus an additional review by a PharmD prior to publication.

Essential Evidence Plus - formerly 'InfoPOEMs/InfoRetriever'

Essential Evidence Plus, formerly 'InfoPOEMs/InfoRetriever', is the only database system of filtered, synopsized, evidence-based information. InfoRetriever searches a full spectrum of evidence-based content, tools and POEMs - or, Patient-Oriented Evidence that Matters™. POEMs meet three criteria: 1) they address a question that we face as clinicians 2) they measure outcomes that we and our patients care about: symptoms, morbidity, quality of life, and mortality; 3) they have the potential to change the way we practice. As POEMs are valid, they improve important patient outcomes and change what physicians do.

Evidence-Based Medicine Reviews (EBMR) - OVID

See The Cochrane Library

  1. Cochrane Database of Systematic Reviews (Cochrane Reviews)
  2. Database of Abstracts of Reviews of Effects (DARE)
  3. Cochrane Central Register of Controlled Trials (Clinical Trials)
  4. The Cochrane Methodology Register (Methods Studies)
  5. Health Technology Assessment Database (Technology Assessments)
  6. NHS Economic Evaluation Database (Economic Evaluations)

Evidence Matters

Evidence Matters (EM) is a user-friendly clinical knowledge management system to help support the use of research in decision-making. It answers questions on the effectiveness, safety, and costs of therapy options for a particular patient, in an evidence-based manner. Designed by clinicians, users of EM include clinicians, decision-makers, managers, medical librarians, and those who create guidelines, careplans, and formularies. EM creates patient-customized answers via summarized, instant meta-analyses (more accurately a "meta-graph") of all current research and best practices from thousands of peer-reviewed journals. More...

FirstConsult (Elsevier)

FIRSTConsult - used in conjunction with Elsevier's MDConsult - is a relatively new, evidence-based primary care clinical information system that provides continuously updated thinking on the latest in evaluation, diagnosis, therapeutics, patient management and outcomes. Designed to give you rapid access to concise point-of-care information, FIRSTConsult provides both practical information and diagnostic tools. It is both Web, and PDA-based. FIRSTConsult provides information to ~20,000 disease-specific topics, presented in a concise, accessible format.

  • Differential Diagnoses provides rapid evaluation of a patient's chief complaint with access to lists of ~1,800 diagnoses sorted by age and prevalence
  • Medical Topics is FIRSTConsult's comprehensive database of weekly updated information on patient evaluation, diagnosis, treatment, tests and prevention
  • Patient Education provides handouts for patients in English and Spanish
  • Procedures provide clear guidance, including videos of procedures integral to medical practice

FIRSTConsult is edited by practicing physicians who ensure that content is accurate and relevant. They work to ensure that content is updated with the latest recommendations supported by evidence-based medicine. Access to FIRSTConsult through a computer or handheld is via the web, local area network or intranet on an annual basis. FIRSTConsult can be embedded in other applications and programs such as patient health records via iCONSULT. More...

JBI COnNECT

JBI COnNECT (Clinical Online Network of Evidence for Care and Therapeutics) is a charitable, not for profit organization, and COnNECT is its online repository of pre-appraised evidence and resources to facilitate getting that evidence used in practice.

NHS Clinical Knowledge Summaries

NHS Clinical Knowledge Summaries (formerly Prodigy): U.K. National Health Service product designed to provide "a reliable source of evidence-based information and practical ‘knowhow’ about the common conditions managed in primary care. CKS provides quick answers to real-life questions that arise in the consultation, linking to detailed answers that clearly outline the evidence on which they are based”. Searchable by topic or alphabetically or by clinical topic, includes patient information, drug data, links to Cochrane and Dynamed. ‘My CKS’ allows storage of CKS content and web links. Simple, easy-to-use interface.

Nursing Reference Centre (EBSCO)

Nursing Reference Centre is a comprehensive reference tool designed to provide relevant clinical resources to nurses and other health care professionals. NRC covers conditions and diseases, drug information, patient education , diagnostic details, best practice guidelines, point-of-care reference books and evidence-based care sheets (as in CINAHL).

Thomson Clinical Xpert

Thomson Clinical Xpert powers your handheld device with a wealth of clinical knowledge from Thomson Healthcare, the industry’s leading provider of evidence-based decision support. It is available for download to any handheld device running on the Palm OS® or Pocket PC Operating System, and is updated instantly at each sync with the latest information. Your download gives you access to: disease and laboratory test information.

Plus free access to information about:

  • drugs
  • interactions
  • alternative medicine
  • toxicology
  • news & alerts
  • convenient calculators

UpToDate

UpToDate (UTD) is one of the most popular POC tools in clinical medicine. It offers comprehensive "evidence-based clinical information" via the web, desktop and mobile device, for a variety of health professionals though targeted to internal medicine and related specialists. UTD is designed to provide concise, practical answers to clinicians (almost recommendations with its listing of evidence grades) when they need them most and viewed as an essential point-of-care tool by some. Topics (~7700) are written exclusively for clinicians, and more than 4,000 clinicians serve as authors. UTD has an extensive peer review process to ensure that the information and recommendations are accurate and reliable. While considered an electronic text by some health librarians, UTD is described as a "practical clinical reference tool designed to provide quick access to synthesized medical information in an easy-to-use format". It is comprised of topic reviews written by recognized experts who address specific topics, synthesize research and make recommendations for treatment. To write entries, 430 medical journals are searched regularly along with the biomedical databases and hand-searching of the literature. More...

References

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  9. How to Answer Your Clinical Questions More Efficiently
  10. Ketchum A, Saleh A. The evidence behind Point of Care products. HSLS Update. Pittsburgh: Health Sciences Library System Serving the University of Pittsburgh and UPMC 2009.
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