OBJECTIVE:Personal digital assistants (PDAs) are popular with physicians: in 2003, 33% of Canadian doctors reported using them in their practices. We do not know, however, whether using a PDA changes the behaviour of practising physicians. We studied the effectiveness of a PDA software application to help family physicians diagnose angina among patients with chest pain. DESIGN: Prospective randomized controlled pilot trial using a cluster design. SETTING: Primary care practices in the Toronto area. PARTICIPANTS: Eighteen family physicians belonging to the North Toronto Primary Care Research Network (Nortren) or recruited from a local hospital. INTERVENTIONS: We randomized physicians to receive a Palm PDA (which included the angina diagnosis software) or to continue conventional care. Physicians prospectively recorded the process of care for patients aged 30 to 75 presenting with suspected angina, over 7 months. MAIN OUTCOME MEASURES: Did the process of care for patients with suspected angina improve when their physicians had PDAs and software? The primary outcomes we looked at were frequency of cardiac stress test orders for suspected angina, and the appropriateness of referral for cardiac stress testing at presentation and for nuclear cardiology testing after cardiac stress testing. Secondary outcome was referrals to cardiologists. RESULTS: The software led to more overall use of cardiac stress testing (81% vs 50%). The absolute increase was 31% (P = .007, 95% confidence interval [CI] 8% to 58%). There was a trend toward more appropriate use of stress testing (48.6% with the PDA vs 28.6% control), an increase of 20% (P = .284, 95% CI -11.54% to 51.4%). There was also a trend toward more appropriate use of nuclear cardiology following cardiac stress testing (63.0% vs 45.5%), an absolute increase of 17.5% (P =.400, 95% CI -13.9% to 48.9%). Referrals to cardiologists did not increase (38.2% with the PDA vs 40.9%, P =.869). CONCLUSION: A PDA-based software application can lead to improved care for patients with suspected angina seen in family practices; this finding requires confirmation in a larger study.
RCT Entities:
OBJECTIVE: Personal digital assistants (PDAs) are popular with physicians: in 2003, 33% of Canadian doctors reported using them in their practices. We do not know, however, whether using a PDA changes the behaviour of practising physicians. We studied the effectiveness of a PDA software application to help family physicians diagnose angina among patients with chest pain. DESIGN: Prospective randomized controlled pilot trial using a cluster design. SETTING: Primary care practices in the Toronto area. PARTICIPANTS: Eighteen family physicians belonging to the North Toronto Primary Care Research Network (Nortren) or recruited from a local hospital. INTERVENTIONS: We randomized physicians to receive a Palm PDA (which included the angina diagnosis software) or to continue conventional care. Physicians prospectively recorded the process of care for patients aged 30 to 75 presenting with suspected angina, over 7 months. MAIN OUTCOME MEASURES: Did the process of care for patients with suspected angina improve when their physicians had PDAs and software? The primary outcomes we looked at were frequency of cardiac stress test orders for suspected angina, and the appropriateness of referral for cardiac stress testing at presentation and for nuclear cardiology testing after cardiac stress testing. Secondary outcome was referrals to cardiologists. RESULTS: The software led to more overall use of cardiac stress testing (81% vs 50%). The absolute increase was 31% (P = .007, 95% confidence interval [CI] 8% to 58%). There was a trend toward more appropriate use of stress testing (48.6% with the PDA vs 28.6% control), an increase of 20% (P = .284, 95% CI -11.54% to 51.4%). There was also a trend toward more appropriate use of nuclear cardiology following cardiac stress testing (63.0% vs 45.5%), an absolute increase of 17.5% (P =.400, 95% CI -13.9% to 48.9%). Referrals to cardiologists did not increase (38.2% with the PDA vs 40.9%, P =.869). CONCLUSION: A PDA-based software application can lead to improved care for patients with suspected angina seen in family practices; this finding requires confirmation in a larger study.
Authors: R J Gibbons; K Chatterjee; J Daley; J S Douglas; S D Fihn; J M Gardin; M A Grunwald; D Levy; B W Lytle; R A O'Rourke; W P Schafer; S V Williams Journal: Circulation Date: 1999-06-01 Impact factor: 29.690
Authors: D B Mark; L Shaw; F E Harrell; M A Hlatky; K L Lee; J R Bengtson; C B McCants; R M Califf; D B Pryor Journal: N Engl J Med Date: 1991-09-19 Impact factor: 91.245
Authors: Lindsay Blank; Susan Baxter; Helen Buckley Woods; Elizabeth Goyder; Andrew Lee; Nick Payne; Melanie Rimmer Journal: Br J Gen Pract Date: 2014-12 Impact factor: 5.386
Authors: Lauren A Maggio; Christopher A Aakre; Guilherme Del Fiol; Jane Shellum; David A Cook Journal: J Med Internet Res Date: 2019-07-25 Impact factor: 5.428
Authors: Anna M Lindquist; Pauline E Johansson; Göran I Petersson; Britt-Inger Saveman; Gunilla C Nilsson Journal: J Med Internet Res Date: 2008-10-28 Impact factor: 5.428