Article type
Year
Abstract
Background: Application of the best current knowledge to decisions in individual patients is the key to evidence-based medicine practice. Research of relevant scientific information through direct consultation of textbooks or journals or online resources is a different way to answer the questions that occur during the visit of the patients. Different studies highlight that the ideal information source must be directly relevant, contain valid information and can be accessed with a minimum amount of work for physicians, but only a few studies address, as objective, the impact of literature assistance on clinical outcome.
Objectives: To assess and quantify the impact of literature in diagnostic decisions and treatment of patients admitted to an internal medicine service, using evidence-based medicine methodology.
Methods: From November 2012 to February 2013, patients who were hospitalised in the internal medicine service and generated questions about medical care, were randomly assigned to two groups: an intervention group (supported by literature research) and a control group. The information obtained from literature was submitted by email to all the medical team within 12 hours of asking the question. Eight-hundred and sixty-six patients were hospitalised in the analysed period; 201 of these generated questions, and were divided into intervention (n = 101) and control (n = 100) groups. In the intervention group, bibliographical research was possible for 98 subjects. The medical team accepted the results and implemented the research for 90.8% of these subjects (89/98). Statistical analyses were carried out on the intention to treat (ITT) and on the per-protocol populations.
Results: Bibliographical research had a significant protective effect on transfer to an intensive care unit (RR = 0.30; 95% CI 0.10 to 0.90; X2 = 5.3, P = 0.02) and hospital readmissions were also influenced by bibliographical research (RR = 0.42; 95% CI, 0.17 to 1.0; X2 = 3.36, P =0.05) in the ITT population.
Conclusions: Our results point out the importance of bibliographical support on the quality of medical care. In particular, they show its possible impact on clinical outcome.
Objectives: To assess and quantify the impact of literature in diagnostic decisions and treatment of patients admitted to an internal medicine service, using evidence-based medicine methodology.
Methods: From November 2012 to February 2013, patients who were hospitalised in the internal medicine service and generated questions about medical care, were randomly assigned to two groups: an intervention group (supported by literature research) and a control group. The information obtained from literature was submitted by email to all the medical team within 12 hours of asking the question. Eight-hundred and sixty-six patients were hospitalised in the analysed period; 201 of these generated questions, and were divided into intervention (n = 101) and control (n = 100) groups. In the intervention group, bibliographical research was possible for 98 subjects. The medical team accepted the results and implemented the research for 90.8% of these subjects (89/98). Statistical analyses were carried out on the intention to treat (ITT) and on the per-protocol populations.
Results: Bibliographical research had a significant protective effect on transfer to an intensive care unit (RR = 0.30; 95% CI 0.10 to 0.90; X2 = 5.3, P = 0.02) and hospital readmissions were also influenced by bibliographical research (RR = 0.42; 95% CI, 0.17 to 1.0; X2 = 3.36, P =0.05) in the ITT population.
Conclusions: Our results point out the importance of bibliographical support on the quality of medical care. In particular, they show its possible impact on clinical outcome.