Pediatric Informatics: Computer Applications in Child Health (Health ...

10 Evidence-Based Medicine and Pediatrics 135
barriers to access. In one sample of pediatricians, only 33% said they accessed the
Internet at work and the majority (44%) had slow (modem) connections. 6,8,11,12
10.3.3 Understanding Clinical Information Needs
Primary care physicians’ information needs have been well documented 7,13–23
in adult medicine, but pediatrician’s information needs have been less well studied.
12, 19, 24, 25 The first primary study of pediatric clinical information needs in
2004 26 found that pediatricians articulated needs for clear definitions for medical
conditions, physical findings and laboratory testing information. It also found that
pediatricians may pursue clinical questions at a higher rate than other physicians. 8,26
Of particular importance to general pediatricians is the need for pharmacology
( especially drug-dosing) and infectious disease information. 12,25
10.3.4 Finding and Using Evidence Efficiently
To answer many questions, physicians may use convenient resources such as textbooks
(which may be outdated) and colleagues (who may not have appropriate or
current knowledge). 8,12,13,23,25 To use published evidence, a framework for asking
clinical questions when searching primary literature has been suggested (PICO), in
which a question is defined by:
Patient population
Intervention or exposure
Comparison
Outcome of interest
A pediatric example is: “In 3–5 year olds with recurrent otitis media, does insertion
of pressure-equalizing tubes decrease the number of infections when compared to
children treated with prophylactic antibiotics?”
It takes time and experience to formulate an effective question and to search the
primary literature. A more time-efficient method is to use abstractions of evidence:
clinical guidelines, systematic reviews, evidence-linked textbooks on a topic.
However, unfamiliarity with specific knowledge resources within a domain and
uncertainty of their accuracy may increase the time needed to find an appropriate
resource. For example, general pediatricians usually use the AAP Red Book ® as
the authority on pediatric infectious diseases, but may not be as familiar with other
infectious disease texts. While the use of abstracted EBM resources may be more
efficient for clinicians, the costs associated with access (commercial information
sources) may be prohibitive to small practices that are not affiliated with hospitals
or academic centers.