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10,000 questions, 10,000 answers - what have we learnt?

10,000 questions, 10,000 answers - what have we learnt?. Jon Brassey ATTRACT October 2011. About me. Worked in information support for nearly 15 years, started and continue to run ATTRACT. ATTRACT answers clinical questions for primary care health professionals within Wales.

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10,000 questions, 10,000 answers - what have we learnt?

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  1. 10,000 questions, 10,000 answers - what have we learnt? Jon Brassey ATTRACT October 2011

  2. About me • Worked in information support for nearly 15 years, started and continue to run ATTRACT. • ATTRACT answers clinical questions for primary care health professionals within Wales. • Also worked on other, non-Welsh Q&A services and between them have answered 10,000+ Qs. • Also run the TRIP Database (www.tripdatabase.com) a global clinical search engine, > 55 million searches. • Users indicate high levels of support for patient care ?affected millions of consultations.

  3. Is clinical research useful? • My interest is in getting robust answers to genuine clinical questions. • Unfortunately, clinical research (both primary and secondary) does not appear focussed on supporting clinical practice. • Usefulness medical information = (relevance x validity)/ work (Slawson & Shaughnessy, 1999)

  4. Relevance • Primary research • HIRU’s EvidenceUpdates. • Critical appraisal >50,000 articles from 110 ‘premier’ clinical journals. • Those that pass the critical appraisal stage are passed to a network of clinicians to assess for clinical relevance and newsworthiness. • How many ‘pass’?

  5. Relevance • Secondary research • Analysis of 358 dermatology Q&As. • 3 answered by a single SR. • 20% answered exclusively by secondary evidence. • Acne better, with 45% answered by secondary sources. • Psoriasis most frequently asked about, yet 10th most common consultation, yet <10% answered with secondary evidence.

  6. Relevance – summary • Lots of answers looking for questions.

  7. Work (or Findability) • Lots of research. • Relatively little high quality, clinically relevant content. • How to find high quality, relevant content? • Problem compounded by noise of poor quality research. • Search is problematic: • 100 clinicians • Pain

  8. Search – 100 Clinicians • Information seeking defined by the Google generation • Ask 100 clinicians the support they’d want, how many would say – ‘Give me a search box where I add terms and then return 10 results which I need to read in the hope that they will answer my question’?

  9. Search - pain • Search isn’t good at knowing you (and clinicians typically don’t like telling us). • So, a search for ‘pain’ gives the same results irrespective of if the searcher is an oncologist, GP, paediatrician etc.

  10. Search – not answering questions • 300 million consultations by GPs per year • Approximately 100m questions • Combine TRIP and NHS Evidence usage and you answer less than 0.5% of these Qs, clinician’s prefer other sources. • “Despite attempts to evolve search into something more human friendly, there's still a big hole there. As useful as Google is, it doesn't answer questions very well” TechCrunch blog

  11. Search - Summary • Search is defined by Google. • Search is unintelligent. • Search isn’t the answer, it’s part of it but there’s little debate. • Literature search for an American Agency for Healthcare Research and Quality research grant (in conjunction with University of South Florida) has highlighted the lack of research around clinical search.

  12. The way forward - Relevance • DUETs & Iain Chalmers • “there should be a moratorium on all new research until we have found out what we know and what we don’t know from research that has already been done – and that includes the 50%+of clinical trials that have never been reported.” • Estimates 85% waste, tens of billions of investment ‘lost’. • Prioritise effectively and reduce avoidable waste in the production and reporting of research evidence.

  13. The way forward - Findability • Move away from the search paradigm. • Look at better ways of improving information support for clinicians. • If using search make it as intelligent as possible e.g. TRIP is developing an adaptive search. • Q&A is one possible way forward. After all clinicians want answers to their clinical questions – why not ‘spoon feed’ them?

  14. In summary • To date the ‘evidence based’ world has spent lots of time on methodology, let’s redress the balance and make relevancy and findability an equal part of the triangle. • Ultimately, it’s giving robust answers to real clinical questions.

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