Background
Clinicians are increasingly using handheld PDAs during patient care. In addition to pharmacopeias, PDA-based software can also provide readily available up-to-date information for diagnostic and other therapeutic advice and transmit important medical news and alerts. We surveyed users to assess their experience with PDAs and captured practice patterns by measuring PDA software use.
Methods
During a 2-week period in February 2005, 3567 users of Epocrates were asked by email to complete a survey and permit analysis of their usage patterns. Participants were offered discounts on future product purchases as incentives. The software includes a pharmacopeia (Rx Pro), an infectious disease reference (ID), a medical diagnostic and therapeutic reference (Dx) and transmits medical alerts and other notifications during PDA synchronizations. Users may have had all or only some of the software products. Software usage patterns were recorded during synchronization and captured usage history from the prior 4 weeks. Patient information was not collected and physician identifiers were removed before analysis.
Results
The response rate was 42% (n=1501). Participants were predominantly male (86%), had a mean age of 47 years old, had been in practice for 10 or more years (71%) and were most frequently primary care physicians (51%). Physicians reported using PDAs and Epocrates for a mean of 5 and 4 years, respectively and 39% said they used Epocrates during more than half of all patient encounters. Usage patterns for the prior 4-weeks, reported by survey and measured by downloaded data (reported as means for users of each individual reference software) were: unique drug lookups in Rx Pro (204;110), use of the DDI tool in Rx Pro (6;7), drug or disease lookups in ID (3;20) and use of Dx (5;10). Physicians believed that in the prior 4 weeks Rx Pro use prevented adverse drug events or medication errors 3 or more times (61%); 28% believed they improved their patient’s overall care for more than half of their Dx lookups and 26% believed they more expeditiously optimized an antiinfective treatment plan resulting from more than half of ID lookups. Using a 7-point Likert rating scale (1-strongly disagree to 7-strongly agree) physicians believed that alerts/warnings improved patient care if they were public health warnings e.g. influenza immunization guidelines (5.0), FDA drug alert warnings e.g. Vioxx withdrawals (5.0) and new patient safety information e.g. recently published studies (4.8). Regarding future software that integrate patient specific data, physicians believe such technology will improve productivity (5.4), further reduce medical errors (5.7) and improve overall patient outcomes (5.5).
Conclusion
Early adopters of PDA-based medical references use these tools frequently, found them to improve patient care and provide additional value in learning of recent alerts and warnings.