Abstract

i-DREAM Project: Interactive Diabetes Research Evidence Application in Management

Author(s): Vinod Patel, J Morrissey, S Shaikh, L Pichaipillai, K Garadi, A Gopinath, L Varadhan

A major barrier to providing effective healthcare is implementation of research evidence. i-DREAM (Interactive Diabetes Research Evidence Application in Management) is an interactive educational computer tool that helps clinicians make evidence-based decisions based on individual patient’s clinical parameters such as blood pressure (BP), HbA1c% and lipid profile. The aim of the study was to investigate the impact of teaching evidence-based medicine to health care professionals using this program as an educational tool.

Methods: The usefulness of i-DREAM was assessed based on its ability to help clinicians understand the management of 10 important clinical problems, based on implementation of 12 relevant clinical trial/guidelines in diabetes. A complex hypothetical case note was devised with 10 clinical problems to match trial profiles and given to 100 clinicians (2 diabetes nurses, 7 pharmacists and 91 doctors) to identify the clinical problem, recommend a management plan and cite research evidence. 2 points were given for a correct answer, and 1 for a wrong answer or no response. The points for each problem were then multiplied, giving 8 points for a clinical problem solved and hence a Global score of 80 points. i-DREAM was then demonstrated to the participants over a 30 minute session, and the score recalculated based on the same case note within the next 7 days.

Results: At baseline, the clinicians scored 8.0/10 on problem identification and 6.1/10 on management recommendation score. Clinicians were aware of 0.8 trials out of the 12 used. The Pre-i-DREAM Global score was 31.8/80. After i-DREAM, the problem identification score improved to 9.5/10(p<0.001) and the management recommendation score to 8.2/10(p<0.001). Trial awareness improved to 5.4/12(p<0.05) and global score post-i-DREAM to 52.4(p<0.01).

Conclusion: i-DREAM can serve as an effective interactive tool to the multi-professional diabetes care team to advise on evidence-based management plans, thereby bridging the gap between daily and desired practice.