A simple heuristic for Internet-based evidence search in primary care: a randomized controlled trial

BACKGROUND: General practitioners (GPs) are confronted with a wide variety of clinical questions, many of which remain unanswered. METHODS: In order to assist GPs in finding quick, evidence-based answers, we developed a learning program (LP) with a short interactive workshop based on a simple three-step-heuristic to improve their search and appraisal competence (SAC). We evaluated the LP effectiveness with a randomized controlled trial (RCT). Participants (intervention group [IG] n=20; control group [CG] n=31) rated acceptance and satisfaction and also answered 39 knowledge questions to assess their SAC. We controlled for previous knowledge in content areas covered by the test. RESULTS: Main outcome – SAC: within both groups, the pre–post test shows significant (P=0.00) improvements in correctness (IG 15% vs CG 11%) and confidence (32% vs 26%) to find evidence-based answers. However, the SAC difference was not significant in the RCT. OTHER MEASURES: Most workshop participants rated “learning atmosphere” (90%), “skills acquired” (90%), and “relevancy to my practice” (86%) as good or very good. The LP-recommendations were implemented by 67% of the IG, whereas 15% of the CG already conformed to LP recommendations spontaneously (odds ratio 9.6, P=0.00). After literature search, the IG showed a (not significantly) higher satisfaction regarding “time spent” (IG 80% vs CG 65%), “quality of information” (65% vs 54%), and “amount of information” (53% vs 47%). CONCLUSION: Long-standing established GPs have a good SAC. Despite high acceptance, strong learning effects, positive search experience, and significant increase of SAC in the pre–post test, the RCT of our LP showed no significant difference in SAC between IG and CG. However, we suggest that our simple decision heuristic merits further investigation.