No abstract

Further research is warranted to assess how to create accurate and reliable health information sources for both Internet and non-Internet users.

Background: The increase in the adoption of electronic health records (EHR) has contributed to physicians and nurses experiencing information overload. To address the problem of information overload, an assessment of the information needs of physicians and nurses will assist in understanding what they view as useful information to make patient care more efficient. Objective: To analyse studies that assessed the information needs and information-seeking behaviour of physicians and nurses in a primary care setting to develop a better understanding of what information to present to physicians when they making clinical decisions. Method: A literature review of studies was conducted with a comprehensive search in PubMed, CINAHL, SCOPUS, as well as examination of references from relevant papers and hand-searched articles to identify articles applicable to this review. Results: Of the papers reviewed the most common information needs found among physicians and nurses were related to diagnoses, drug(s) and treatment/therapy. Colleagues remain a preferred information source among physicians and nurses; however, a rise in Internet usage is apparent. Conclusion: Physicians and nurses need access to the Internet and job-specific resources to find practitioneroriented information. In addition, effective usage of resources is important for improving patient care.

PURPOSEThe prevalence of diabetes in the United States is increasing. There is also concern that diabetes may be occurring at a greater frequency in youth and in young adults. We describe US population trends in self-reported age at diagnosis of type 2 diabetes mellitus. METHODSWe undertook a secondary analysis of data from the National Health and Nutrition Examination Survey (NHANES) 1999 and NHANES III (1988-1994. Both surveys are stratifi ed, multistage probability samples targeting the civilian, noninstitutionalized US population, which allow calculation of population estimates. We included adults aged 20 years and older. We compared selfreported age at diagnosis of type 2 diabetes between the 2 survey periods. RESULTSThe mean age at diagnosis decreased from 52.0 to 46.0 years (P <.05). Racial and ethnic differences in age at diagnosis found in 1988 to 1994 are no longer found in 1999 to 2000.CONCLUSIONS The age at diagnosis of type 2 diabetes mellitus has decreased with time. This fi nding likely represents a combination of changing diagnostic criteria, improved physician recognition of diabetes, and increased public awareness. Younger age at diagnosis may also refl ect a true population trend of earlier onset of type 2 diabetes. INTRODUCTIONT he prevalence of diagnosed diabetes in the United States is increasing, coincident with increases in the prevalence of obesity and sedentary lifestyle. 1-3 Among adults in the United States, population estimates of the prevalence of diagnosed diabetes increased from 3. 4% in 1976 to 1980, to 5.1% in 1988 to 1994, to 5.9% in 1999 to 2000. 4-6 Rates of diagnosed diabetes for racial and ethnic minorities generally exceeded that of non-Hispanic whites. [4][5][6] There has been concern that child and adolescent age-groups have also been affected by rising trends in type 2 diabetes mellitus. 7,8 The prevalence of overweight children and adolescents is increasing in the United States. 9,10 Although there have not been US population estimates of the prevalence of type 2 diabetes in youth, an increase in type 2 diabetes has been noted in pediatric diabetes referral centers, as well as in Pima Indians. 11,12 Additionally, there have not been estimates of population trends in age of onset of type 2 diabetes among adults in the United States.Given the increasing prevalence of diabetes in the United States and the evidence that type 2 diabetes is being diagnosed in younger populations, the onset of type 2 diabetes may be occurring at a much younger age in the US population as a whole. help defi ne the magnitude of this health problem. We report the mean self-reported age at diagnosis of type 2 diabetes and make comparisons between the most recently available population data from the National Health and Nutrition Examination Survey (NHANES 1999(NHANES -2000, and data from the Third National Health and Nutrition Examination Survey (NHANES III) (1988)(1989)(1990)(1991)(1992)(1993)(1994). METHODS Data SourcesWe analyzed data from the NHANES 1999-2000 and the NHANES III....

PURPOSE We compared use of a new diabetes dashboard screen with use of a conventional approach of viewing multiple electronic health record (EHR) screens to fi nd data needed for ambulatory diabetes care. METHODSWe performed a usability study, including a quantitative time study and qualitative analysis of information-seeking behaviors. While being recorded with Morae Recorder software and "think-aloud" interview methods, 10 primary care physicians fi rst searched their EHR for 10 diabetes data elements using a conventional approach for a simulated patient, and then using a new diabetes dashboard for another. We measured time, number of mouse clicks, and accuracy. Two coders analyzed think-aloud and interview data using grounded theory methodology. RESULTSThe mean time needed to fi nd all data elements was 5.5 minutes using the conventional approach vs 1.3 minutes using the diabetes dashboard (P <.001). Physicians correctly identifi ed 94% of the data requested using the conventional method, vs 100% with the dashboard (P <.01). The mean number of mouse clicks was 60 for conventional searching vs 3 clicks with the diabetes dashboard (P <.001). A common theme was that in everyday practice, if physicians had to spend too much time searching for data, they would either continue without it or order a test again.CONCLUSIONS Using a patient-specifi c diabetes dashboard improves both the effi ciency and accuracy of acquiring data needed for high-quality diabetes care. Usability analysis tools can provide important insights into the value of optimizing physician use of health information technologies.