FIRSTConsult

FIRSTConsult (formerly PDxMD) is part of the MD Consult Clinical Knowledge System. This evidence-based, electronic primary care clinical information system is designed to enhance the decision making of health care professionals by providing specialized diagnostic tools and continuously updated thinking on the latest in evaluation and diagnosis, management options, and patient outcomes. It is specifically designed for use at the point and time of care. According to the product information, it “fosters efficient decision making by combining a ‘best practice’ approach with the flexibility necessary to account for individual patient differences and physician preferences; expedites work-ups and optimizes outcomes by offering evidence-based treatment planning and improving time and resource utilization; and reduces risk of errors and improves clinical documentation by providing comprehensive and continuously updated information.”

FIRSTConsult is available in three formats: online, handheld, and print. FIRSTConsult Online is updated weekly and is composed of an Interactive Differential Diagnosis tool, evidence-based Medical Condition Files, Patient Information Files, Reference Centers, and Procedure Files. FIRSTConsult Handheld includes the Interactive Differential Diagnosis tool and the Medical Condition Files updated quarterly. FIRSTConsult Books is a series of fifteen books including Differential Diagnosis with Clinical Benchmarks and the FIRSTConsult Medical Condition Series published by specialty. Physician writers guided by the editorial advisory board (national figures in their specialties and in primary care) and clinical reviewers (practicing clinicians and experts in their fields) synthesize materials from respected journals, evidence databases, and position papers and guidelines from professional organizations.

The Medical Condition Files cover more than 450 medical conditions that are most commonly seen by primary care physicians. Each condition includes a summary of the most pertinent information from the other sections; background information including ICD 9 codes and epidemiology; diagnosis including differential diagnosis, signs and symptoms, clinical pearls, suggested questions for the patient history, links to references to guide the provider's decision making, and tests that may be performed; therapy with a summary of therapeutic options, full drug details, and patient and caregiver issues; outcomes including efficacy of therapy, prognosis, and complications; prevention indicating risk factors, lifestyle and wellness suggestions, and screening; resources including key references and a link to information for the patient; and evidence linking to the bibliographic references and clinical guidelines. Contributors are listed at the end of the information provided.

The Differential Diagnosis Files allow users to see a diagnostic pathway table listing potential diagnoses sorted by age and prevalence for more than 330 signs and symptoms. Potential emergencies are shown in red. Clicking on a diagnosis brings up a brief summary including onset, male-to-female ratio, ethnicity, character, location, clinical course, and co-morbidities along with a link to the Medical Condition Files.

The Patient Information Files provide patient handouts written in a question-and-answer format. The handouts, many of which are written at the fifth-to-sixth-grade reading level, are linked to the Medical Condition file and can be customized for a specific patient. Handouts are available in a choice of Spanish or English and in a choice of format, for the patient who has been diagnosed with the condition or for general information only.

The Reference Centers and Procedure Files are relatively new additions to the database. Reference Centers discuss topics that are not disease specific. At the time of review, only bioterrorism, pregnancy, and contraception were available, though several others were in production. The Procedure Files section describes, in detail, twenty-five procedures commonly performed in the office setting. Most of the descriptions include video clips that demonstrate the procedure. At the time of review, nine other procedures were in production.

Because the product is designed for quick lookup at the point of care, the primary audience for FIRSTConsult would appear to be primary health care providers; physician extenders, such as physician assistants and nurse practitioners; and house staff. It lends itself to use in primary care offices, clinics, or emergent and urgent care settings. Special pricing is available for residents and students, as well as individual subscribers to MD Consult.

The interface for FIRSTConsult is easy to use. Users can access information in each section by choosing a subject from the alphabetical list or entering a term in the search box. In the Medical Conditions section, a structured template provides concise information and recommendations that allow the clinician to make decisions based on accurate and clinically relevant information from respected sources such as the Cochrane database and the National Guidelines Clearinghouse, as well as peer-reviewed articles. A new feature for users who have a subscription to MD Consult is the capability to link directly to that service. This enhancement gives users the ability to access the reference and current awareness resources available in MDConsult.

In a comparison with another popular evidence-based medicine resource, UpToDate, the following observations were made

• FIRSTConsult focuses on the most common medical conditions and diseases. UpToDate covers a greater number of diseases and conditions.

• FIRSTConsult is targeted to primary care providers. UpToDate is targeted to practitioners in internal medicine and subspecialties.

• FIRSTConsult is designed for quick lookup at the point of care. UpToDate has more in-depth coverage of the topics covered.

• The material in FIRSTConsult is divided into separate sections (differential diagnosis, medical conditions, etc.). Topic reviews in UpToDate are presented in a narrative format that is linked to supplementary material via a table of contents sidebar for quick access to specific aspects of the disease or condition.

• The patient information in FIRST Consult is written at a lower grade level and in a style that is easier to read than that of UpToDate. This makes the information much more accessible to the average patient.

• Primary care providers, house staff, less experienced clinicians, and other care providers—such as physician assistants, nurse practitioners, or clinical nurse specialists—may prefer the scope of topics and presentation style of FIRSTConsult with its “cut-to-the-chase” synthesis of topics. More experienced clinicians and specialists may find the information provided in FIRSTConsult too basic for their needs.