Angina on the Palm: randomized controlled pilot trial of Palm PDA software for referrals for cardiac testing.
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Date
2006-08-23
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Abstract
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