FIRSTConsult: a useful point-of-care clinical reference

Journal of Family Practice, June, 2004 by Gary N. Fox, Nashat S. Moawad, R.E. Music

Procedure Files

Procedure Files contains 30 to 40 procedure monographs, including video clip illustrations of key portions; users have a choice of viewing these with Windows Media Player, RealPlayer, or QuickTime. Reference Centers contains 3 monographs: "Bioterrorism," "Contraception," and "Pregnancy" (as of May 2004). Although few in number, these Reference Centers are valuable point-of-care tools.

Medical Conditions

We would expect Medical Conditions to be the workhorse section for most physicians. FC-Web advertises that it contains more than 450 conditions.

Rapid access to information. The best feature of this core section is its organization of information--eminently logical, extremely easy to navigate, bulleted, and extensively hyperlinked, taking full advantage of the e-medium.

To illustrate the outstanding layout and hyperlinking, if a user floats the cursor over a tab (eg, Diagnosis or Treatment) in a disease monograph, a menu of subsections drops down (Figure 5). Floating the cursor over some subsections produces a menu of additional options within that subsection. Furthermore, once selected, the resulting information is often extensively hyperlinked to related or more detailed information.

[FIGURE 5 OMITTED]

Generic drug names only. Throughout, FIRSTConsult sticks to generic drug names; if the user is uncertain what cefdinir or tamsulosin is, FIRSTConsult will offer no help.

Generous detail. In terms of content, Medical Conditions distills information into bullet points. FC-Web has more depth than, for example, Griffith's 5-Minute Consult. Also, as a Web-based tool, FC-Web categorizes information multi-dimensionally with the horizontal main tabs plus drop-down, floating subcategories, allowing expeditious jumps to desired information. This organization facilitates rapid access to information.

Superb summary for point-of-care use. The Summary of Therapeutic Options subcategory of the Treatment section is particular noteworthy--an outstanding feature for busy clinicians--and concrete evidence that FC-Web was truly designed with point-of-care in mind. In this subsection, options are listed by bullet points and very briefly described (1 or 2 lines), which allows easy visual scanning. Each option (eg, medication) is then hyperlinked to its more detailed description (eg, dosage, route, etc) in the section, Drugs and Other Therapies: Details.

Sometimes, FC-Web fails to provide "drug of choice" recommendations, listing interventions randomly, which hinders rapid, point-of-care decision-making.

Putting FC-Web to the test

FC-Web answered all general questions for which a monograph existed:

* What is the preferred therapy for head lice? ("Permethrin: ... Treatment of choice for uncomplicated pediculosis.")

* At what aneurysm diameter should a patient with an abdominal aortic aneurysm be referred? ("In general, patients with aneurysms larger than 5 cm in diameter, symptomatic aneurysms, or rapidly enlarging aneurysms should be considered for repair. Treatment for aneurysms between 4 and 5 cm is controversial.")