Staying afloat in a sea of information: Point-of-care resources

Rebecca Andrews; Neil Mehta; Jack Maypole; Stephen A. Martin

doi:10.3949/ccjm.84a.15087

Article Figures & Data

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TABLE 1

Toolbox essentials

Type of sources	Examples	Comments	Funding source
Primary sources	PubMed	Article searches are needed to find answers to questions May be difficult to use at the point of care in a busy practice Workflow reminders to look up this information at the end of each day promote lifelong learning	Federal government
Pharmaco-therapy	Lexicomp, ePocrates	Practical information about medications such as indications, dosage, adverse reactions, and drug interactions	Advertising, subscription, data sharing
Medical calculators	MDCalc	Tools to calculate cardiovascular risk, medication dosage adjustment in renal insufficiency, sodium replacement in hyponatremia, more	Unclear
Guidelines databases	National Guideline Clearing House, USPSTF	A searchable collection of guidelines developed by various government-funded or professional societies which allow side-by-side comparisons and ratings for strength of evidence for individual recommendations	Federal government
Systematic reviews of medical evidence	Cochrane Collaboration, Centre for Reviews and Dissemination	Provide high-quality up-to-date syntheses of research evidence Robust and unbiased information to help clinicians make decisions	Subscription, university
Evidence search tools	PubMed	Clinical queries provide busy clinicians fast access to reliable clinical studies using preset research methodology filters Designed to find those few “good” articles that can help us make decisions at the point of care	Federal government
Online textbooks	Access Medicine, Harrison’s Principles of Internal Medicine	Easily accessible and updated more frequently than their print versions Additional features such as multimedia materials, search capabilities, and ability to share notes turn these into excellent resources, especially for questions that often come up when working with residents or students	Subscription
Online texts and summary sources	Dynamed, UpToDate, Clinical Evidence	Fast clinical answers at the point of care Can be accessed from desktop or mobile devices	Subscription
Internet search	Wikipedia, Google	An Internet search not directly in a medical reference can provide more information including that from patients and industry, but reliability and validity can limit use without discrimination of results Google searches can replicate findings from summary sources in speed and accuracy⁹	Donations (Wikipedia), advertising (Google)

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TABLE 2

Point-of-care resources compared

Resource	Cost	CME credit	Add-on features	Key features
Clinical Evidence	$36 for 48 hours of access for 1 review $53 for 30 days of viewing all content	No	Large major reviews of conditions and treatments with graded evidence Drug and safety alerts Links to full-text major guidelines	Easily navigated Intuitive organization Personalized notes, bookmarks Identifies evidence, lack of evidence
Dynamed	Physicians: $395/year Residents: $150/year Students: $100/year	Yes	Drug database update alerts Links to articles Practice-changing updates Electronic health record integration Patient information	Synthesized summary from primary data directed at primary care physicians All evidence-based findings Most frequently updated Bulleted information
Evidence Essentials	$85/year	Yes	Medical calculators	Ability to filter results Likelihood and odds ratio calculators “Overall bottom line” Bulleted information
First Consult	Based on packages, eg, $499 for internal medicine (8 journals and 11 books), $998 for extended internal medicine (45 journals and 23 books)	Yes	White papers such as “Best time management tips for physicians”	Extensive free trial Access to original articles and books through Elsevier Presentation assistance
Medscape	Free with registration	Yes	Drug database Patient information Pill identifier Visual images and videos	Medication checking “In the news” Care algorithms
UpToDate	Physicians: $499/year, $53 for a 30-day recurring subscription Residents, fellows, and students: $199/year, $19 for a 30-day recurring subscription	Yes	Drug database Update alerts Links to articles Practice-changing updates Electronic health record integration Patient information	Summary information written by experts in narrative form for a complete disease process review for any clinical staff Narrative information Largest compilation of topics Quickest search results Offline access