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.

Adult↗

PubMed2005

Using cognitive behavioural therapy in practice: qualitative study of family physicians' experiences.

OBJECTIVE: To investigate whether family physicians thought they could use cognitive behavioural therapy (CBT) in their practices, and if so, how, and to discover what the barriers to implementation might be. DESIGN: Qualitative study using taped interviews. SETTING: British Columbia and Ontario. PARTICIPANTS: Physicians practising family medicine in a variety of settings who attended an educational session on CBT. METHOD: Six months after participating in a 5-hour seminar on CBT, consenting physicians were interviewed to determine their experiences with using CBT in their practices. The interviews used a semistructured guide and were audiotaped and transcribed verbatim. The constant comparative method of data analysis was used to identify key words and themes. MAIN FINDINGS: Most participants (34 of 42) reported using elements of CBT in their practices. Barriers mentioned by physicians to offering CBT to patients were lack of time, practice distractions and interruptions, and the perception that some patients were not good candidates for CBT. Barriers to patients' accepting or using CBT were preferences for pharmacotherapy and lack of motivation or interest. Physicians could overcome some barriers by using CBT's structure; this reduced the amount of in-office time required and helped them cope with interruptions. They selected specific CBT methods that fit their practices and patients. CONCLUSION: Most participants saw CBT as a useful part of practice and reported implementing it successfully. There were, however, barriers to implementation in primary care. These barriers need to be addressed if CBT is to be taught to primary care physicians and offered in their practices.

Adult↗

PubMed2004