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.
Prospective randomized controlled pilot trial using a cluster design.
Primary care practices in the Toronto area.
Eighteen family physicians belonging to the North Toronto Primary Care
Research Network (Nortren) or recruited from a local hospital.
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.
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%,
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.