Essential PDA Resources for Geriatrics Healthcare Professionals

Author Affiliations: Dr. Kobylarz is Associate Professor, Center for Healthy Aging at Parker Stonegate Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ; Ms. Clark is Director of Medical Informatics, Department of Family Medicine and Rural Health, Florida State University College of Medicine, Tallahassee; and Dr. Brummel-Smith is Charlotte Edwards Maguire, MD, Chair, and Professor, Department of Geriatrics, Florida State University College of Medicine.
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Introduction

The use of clinical informatics is an essential 21st-century skill of physicians and other providers, and yet no articles describe the use of Personal Digital Assistants (PDAs). In geriatrics, PDAs have become a commonly used clinical tool and are increasingly used in medical student, resident, pharmacy, nursing education, and faculty development.^1-6 All of these are available for both the Palm operating system (OS) and Windows Mobile platform. Pocket PCs, Blackberry, and Mac iPhone versions are under development for many of the listed resources.

The purpose of this article is to provide a brief review of several PDA medical references that would enable healthcare providers to provide high-quality care to older adults. The geriatric issues of chronic illness, declining functional and mental status, as well as complications of polypharmacy, are of major concern, and the vast amount of new research being done is constantly changing guidelines, medications, and assessment strategies for managing geriatric conditions. The PDA can be a vital tool to be used at the point of care for quality, accuracy, and life-long learning, whether it is in a hospital, nursing home, office, or in the patient’s home. The advent of high-quality PDAs/cell phones also eliminates the need for carrying any extra equipment, while providing a wealth of interactive tools, as well as volumes of information at your fingertips.

PDA Resources

Geriatrics At Your Fingertips (GAYF)
The American Geriatrics Society (AGS) created Geriatrics At Your Fingertips (GAYF) in 1998 as a small booklet. The website was created in 2002, and the first PDA version of GAYF was released in 2004.⁷ A quick reference resource, GAYF contains basic disease information and care guidelines for a number of geriatric conditions, such as dementia. It contains drug dosages, including the starting dose for geriatric patients, and normal laboratory values for geriatric patients, which differ from those for younger patients. Assessment algorithms for certain illnesses such as depression and dementia are provided. There are many useful tables comparing medications and treatment options, images, calculators, and algorithms. It contains an index, content, and tools page, making it simple to find answers to your geriatric questions.

GAYF provides easy access to clinical tools. Some examples include the Geriatric Depression Scale for depression screening, the Mini-Cog for screening dementia, and the activities of daily living and instrumental activities of daily living scales for function.

The resource had been free until this year. It remains free to all trainees (medical students and residents) who join the AGS.

The 2007-2008 PDA version is available at: https://www.americangeriatrics.org.

Epocrates
Epocrates is one of the most popular PDA products among practicing healthcare professionals today. Epocrates Rx has been a free download for years, which partially explains its popularity. The beauty of Epocrates has always been the quality of the design of the product interface. The interface is so intuitive that little instruction is needed to become comfortable with the product.

Epocrates Rx covers the basic prescription drug information, including indications, dosing, contraindications, adverse reactions, and costs. Of particular interest to geriatrics is the dosing for renal and hepatic insufficiencies. The most useful geriatrics tool in Epocrates is the MultiCheck Multiple-Drug Interaction Checker tool, which allows the user to enter multiple drugs, and then generate a list of all the possible interactions grouped by severity. The database updates every time you synchronize your PDA with your computer. For those people running this on their PDA/cell phone, the product is designed to automatically update using wireless cellular connection. Epocrates requires a great deal of memory, and currently there are difficulties with wireless downloads to PDA/cell phone combinations.

For an annual subscription fee, the Epocrates Rx Pro version is available, which adds the alternative medicines to the drug database, and provides an infectious disease antibiotics guide, as well as an intravenous (IV) compatibility checker. The Essentials version adds to the Pro version three large databases that are interlinked with each other and the drug information: (1) a disease quick reference; (2) a differential diagnosis generator that allows you to enter multiple symptoms, as well as the age and gender of the patient and the duration of symptoms; and (3) a lab manual. The Essentials Deluxe version adds a medical dictionary and an ICD-9 and CPT coding tool.

All of these are available at https://www.epocrates.com/.

Essential Evidence Plus (EE+) (formerly InfoPOEMs/InfoRetriever)
Essential Evidence Plus (EE+) is a huge resource containing the latest evidence-based information and recommendations on those diseases and conditions managed by the healthcare professional. Using EE+ regularly is a highly effective method of lifelong learning. It also updates on synchronization.

There is a great wealth of information in EE+. The developers pulled together several databases into one product, including: the Cochrane Abstracts, systematic reviews of the literature on questions of the effectiveness of treatments; Daily POEMs [Patient-Oriented Evidence that Matters], which are evidence-based reviews of one or more recent research articles that appear in the most respected journals of each specialty; EBM [evidence-based medicine] Guidelines, which are summaries of the evidence on disease topics; and Practice Guidelines, which are the guideline statements issued by the various government agencies and specialty associations. Levels of evidence using the Oxford Centre for Evidence based Medicine Levels scale of 1 (highest) to 5 (lowest) are provided for each recommendation/guideline. Added to this text-based content are hundreds of interactive tools that calculate numeric formulas such as creatinine clearance; determine the likelihood for a particular diagnosis based on a diagnostic test, history, or physical exam finding; or help assign a score or likelihood to a condition, such as the National Institutes of Health (NIH) Stroke Scale or the Folstein Mini-Mental State Examination.

EE+ is designed to help you find answers to clinical questions such as, “In geriatric patients with suspected carotid stenosis, is duplex ultrasound as good as magnetic resonance angiography in detecting significant carotid stenosis?” The interface enables you to search all of the resources for a topic, and then it will organize all of the “hits” from the resources described above by either the type of clinical question you have (eg, treatment, diagnosis, prognosis), or it lets you select the type of resource you need (eg, Cochrane, POEM, calculator).

The resource also provides ICD-9 and Evaluation and Management (E&M) coding tools, the complete U.S. Preventive Services Task Force recommendations, and the current Centers for Disease Control and Prevention immunization schedules in color.

The EE+ interface is not as intuitive as Epocrates, so some instruction is recommended for new users. Your annual subscription gives you access to the Internet online and PDA versions of the resource, each of which has the same content. Playing with the website might facilitate learning how to use the PDA version. There are also videos on the website demonstrating how to use it.

It is available at https://www.essentialevidenceplus.com/. 

DynaMed
DynaMed is an evidence-based disease reference with a few of the most common drugs included. The PDA interface is designed by Skyscape and, therefore, is straightforward and easy to understand. Skyscape is well-known for its quality textbook products for the PDA. The index provides you with an alphabetical listing of diseases, presenting problems, or medications. Follow the link, and you have a monograph divided into the standard sections: background, diagnosis, treatment, etc., or dosage, indications, interactions, etc. as indicated. There, the similarity to the standard 5-Minute Clinical Consult ends.

Each section of a monograph begins with a summary overview, followed by well-organized summaries of the latest research, with the “bottom line” summary indicated in bold letters. It also includes a discussion of physical findings and references with links to journal articles, which work if you have Internet access on your PDA/cell phone. They assign a level of evidence based on an easy-to-understand scale of 1 (highest) to 3 (lowest) or strength of recommendation on a scale of A (highest) to C (lowest). All monographs are interlinked to other relevant topics within the resource. For example, in the “Hypertension” monograph treatment section, the antihypertension medications are linked to monographs on diuretics, beta blockers, etc. The comprehensive nature of the content somewhat limits DynaMed’s value as a “quick” reference. However, for an in-depth refresher on any topic of concern to a patient, or a resource for putting together a presentation on a topic, this is the one resource to have.

DynaMed updates when synced. There are also weekly newsletters to which one can subscribe. Your subscription gives you access to the Web and PDA versions of DynaMed.

It can be found at https://www.ebscohost.com/dynamed/.

PEPID (Portable Emergency and Primary care Information Database)
PEPID is an all-in-one medical reference package for clinicians. PEPID comes in six categories: PEPID MD, PEPID ED, PEPID MSC (for medical students), PEPID RN, PEPID EMS, and PEPID PDC (a stand-alone drug database). Describing this resource is difficult because of the wealth of information it contains. It covers more than 1600 conditions, including topics in Medicine (Hematology, Dermatology, Infectious Disease, Neurology, Pulmonary, Cardiovascular, Gastroenterology, Nephrology, and Rheumatology) Obstetrics/Gynecology, Pediatrics, Geriatrics, Surgery (Orthopedics, Ear-Nose-Throat, Urology), and Psychiatry.

One of the most useful geriatrics tools, PEPID Gerontological Nursing Suite (RN GERO), was developed with the National Association of Clinical Nurse Specialists. It allows for a comprehensive point-of-care reference database designed specifically for geriatric nurses. It addresses nearly every clinical gerontological situation and provides the user with daily tools, assessment instruments, and dosing calculators needed in practice.

One of the major issues with PEPID is the need for a substantial amount of memory— 4.5 Mb of space for a Palm OS device and 6.4 Mb for Windows CE handhelds.

It can be found at: https://www.pepid.com and https://www.pepid.com/products/gero/default.asp?product=GERO.

Conclusion

PDA resources that are specific or applicable to geriatric practice are becoming more common. They can facilitate lifelong learning because they are kept up to date through regular syncing with a personal computer, and because they provide information “at the bedside.” More research is needed to show whether the regular use of a PDA can improve quality of care and reduce errors in the care of older adults. While some programs are free, many do require subscriptions. Users should check with their academic or clinical facilities, as institutional licenses are sometimes available at no or reduced costs.

The authors report no relevant financial conflicts of interest.

The opinions expressed herein are those of the authors and do not necessarily reflect those of the institutions with which they are affiliated.