For the last few years, the number of unnecessary clinic visits of patients in both primary and urgent care clinics has increased. The needs of pediatric patients’ needs can be met by maximum utilization of online access portals which enables direct communication to service providers. Currently, the field of information technology is drastically changing and offers a variety of challenges to the healthcare field. The invention of internet and EHR (electronic health record) have given opportunities to the patients to actively participate in their healthcare. According to the United States Department of Health and Human Services (HHS), an online portal is a secure online website where patients can conveniently access their health information from any geographical location by the help of internet. Besides, the online portal can be accessed via any device.
There are various advantages presented by the online portals in the healthcare field. The patients can use the portals to ask questions regarding their health and this reduces the costs of making appointments in medical clinics. The use of online portals saves time and reduces overcrowding in hospitals. The portals enhances the degree to which the patients get actively involved in matters relating to their health hence improving patient engagement. Furthermore, the online portals are more convenient because they can be accessed from any geographical location. The paper reviews the benefits of online access portals by analyzing the perceptions of mothers of pediatric patients of age 0-11 years attending private and public clinics in the same geographical area, specifically Bay area.
A search strategy refers to any organized method of searching information in the literature which plays a crucial role in identifying information suitable for the topic under study. The search strategy plays an essential task in supporting medical professionals who want to remain updated with the growth of evidence-based practices in the healthcare field. Evidence-based practice is a collection of evidence which enhances the quality of medical data and information related to the interests of the patients. A correct search technique is important because it aids in efficient retrieval of data and information.
Formulation of a question is crucial for conducting an effective literature search. The question assists in sourcing of answers from the selected databases. The database is a term which refers to a system of reviews containing electronic data collections which is well organized and can be easily accessed (De Braon & Smith, 2011). There are numerous search engines which facilitate literature search. Each of the search engines has a unique approach of identifying data and data information.
Best Databases for Search
Various search engines were used for this study. These search engines include PubMed, Google scholar, Cochrane and CINAHL. However, among the databases mentioned, PubMed was commonly used in most parts of the research, the ones accounting for a minimal percentage. The main reason for depending on this particular database is because it offers a variety of information. PubMed is one of the primary sources of clinical information and is usually connected to a central medical database known as MEDLINE. The database can easily be accessed via the National Library of Medicine, and hence it’s a trustable site which can be relied in most of the times. Furthermore, it does not charge people to access its information hence unlimited quantities of information can be retrieved. Moreover, PubMed contains evidence-based articles and this justifies why this research used it as the primary source of information.
There are various strategies for searching data and information from the databases. A search strategy technique is made up of a list of databases and appropriate terms which form vital elements of the study (De Braon & Smith, 2011). As previously mentioned, formulating a suitable research question composes an essential component of the search strategy. The problem in this case is “In mothers of pediatric patients, age 0-11 years old, what are the benefits of online access portals as compared to physically attending a clinic to obtain crucial information related to health of their children? The problem only affects nursing only. According to De Braon & Smith (2011), PICOT is the most suitable technique of managing the question. PICOT is an acronym for Problem/population/patient, Intervention, Comparison, Outcome and Time respectively. In our case, the population is the mothers of pediatric patients, the intervention is the use of online portals, the comparison is physical attendance to a medical clinic, the outcome is the results which arises from the use of online portals, for instance obtaining convenient information and the time frame is 0-11 years.
Inclusion, Exclusion and Operating Delimiters
Inclusion, exclusion and operating delimiters were used to set the boundary for the research. After formulating the research question, the next step was to determine the inclusion, exclusion and operating delimiters criteria. Some of the things considered in the inclusion/exclusion criteria include date, geographical location, participants, type of journals that is whether it is peer reviewed or not, setting, study design, exposure of interest, language, reported outcomes, and type of publication.
The study used the articles that are less than 5 years old hence date was a crucial component of the inclusion criteria. The study was limited to Bay area hence geographical location formed vital component in the inclusion criteria. In terms of exposure of interest, the mothers of pediatric patients had experiences with the use of online portals and physical attendance of the clinics and thus they were considered in the inclusion criteria. The participants of the study used in the inclusion criteria were mothers of the pediatric patients. The CINAHL and MEDLINE databases proved useful in this case because their articles contained subject headings specifying the age group under study. Therefore, it was easy to retrieve articles for the mothers of pediatric patients. Although books were used, most of the literature included peer-reviewed journals because they contain reliable information. In terms of reported outcomes, the inclusion criteria considered outcomes of using online portals. The study included the study designs were the participants were reviewed at one point in time. The language of the participants was not important in the research hence it was excluded. The type of publication was vital and the study excluded letters, reviews and editorials. The study also excluded articles that are non-peer reviewed.
The operating delimiters were used to refine the search. Various limiters were used for narrowing the search. For instance, the “Full Title” option was used for limiting results for articles with full text only. The “Cover Story” button was clicked to restrict the results to articles which were only available in the library. The “Abstract Available” button was used to limit the search results to materials that include abstracts which summary the contents of the article. The “Peer Reviewed” option was employed in limiting the results on the search to peer reviewed journals only. Furthermore, the “Date published” button was utilized in obtaining materials that are only less than five years old.
Best Strategies for Searching
There are various words of searching for articles in a database. Some of the search strategies employed in this research include the use of keywords, thesaurus, exact phrases, Boolean logic, truncated and wildcard searches, citation searching and subject headings. A keyword is a combination of free text words and phrases. The search strategy apply a combination of subject headings and free text words. The method of searching using keywords looks for the search terms in the title and abstract of a reference material. Some of the keywords used in the search include online portals, benefits of online portals, and pediatric patient mothers’ perceptions on online portals. Thesaurus search entails searching of words with an associated set of phrases and synonyms in locating the most suitable search articles. For instance, in this research paper, the use of word such as “web-based portals” was used instead of online portals because the two phrases are closely related. Thesaurus search technique significantly reduces the results of the search and this improves the chances of locating the required articles.
Quotation marks were used for ensuring that words appeared next to each other in an exact phrase. For instance “online portals”, “web-based portals” employed exact phrase search. The technique proved useful in decreasing the number of results hence producing more relevant materials. The search also used Boolean logic which involves combination of words. The approach aided in improving the relevance of words in the PICOT question by the use of joining words like and, not, or, with, inverted commas and brackets. The use of AND in a search helps in displaying articles composed of both words. For instance online portals and its advantages. On the other hand, the use of OR portrays the materials that constitute of either word or both of them. For example, online portals or web-based portals. The joining word NOT restricts the search to the specified terms. For instance, searching for Bay area NOT other geographical areas.
Wildcard and truncation search saves time in conducting literature search. Truncation involves the utilization of symbols such as asterisks (*) which minimizes the number of steps in the search. On the other hand, wildcard search is the use of question mark (?) and this assists in differentiating English spellings and handling plurals. Truncation search was used in various ways. For instance, keying the character child* in the search helped in displaying articles related to pediatric patients, child, children, childhood among others. Above all, the inclusion, exclusion and operating delimiters were used to refine the articles which met the required criteria. After refining the articles, only 16 materials were obtained which is a manageable number. The materials were used to facilitate the rest of the research.
Level, Validity and Quality of Evidence
Levels of evidence
Materials regarded as robust evidence in the study include CPG (clinical practice guidelines), individual RCT (randomized control trials), systematic reviews combined with meta-analyses, systematic reviews alone, and well-designed non-randomized control trials. The need to control bias and the notion of causation were the basis of hierarchy of evidence
Figure 1: Hierarchy of the study and the levels of evidence
Validity of Evidence
Validity refers to the degree to which a particular measurement, concept or conclusion is well founded and relevant to the real world. According to research, the scientific validity concept has proved useful in addressing the nature of reality and thus it is a philosophical and epistemological issue as well as a question of measurement. There were various factors considered in determining the validity of the references used. Some of these include the author, source of information and the age of the publication. The research mostly used peer-reviewed journals related to the topic which were less than five years old.
Quality of Evidence
According to GRADE (Grading of Recommendations Assessment Development and Evaluation), the quality of evidence is a reflection of the degree to which confidence in an estimate of the effect is sufficient enough to support a specific recommendation. Various factors were considered in determining the quality of evidence for this study. Some of the factors which reduce the quality of evidence include imprecision, limitations of the study, indirectness of evidence, publication bias and inconsistency of the results. Others increase the quality of evidence and include dose-recipient gradient and large magnitude of effect. Study designs are crucial in evaluating the quality of evidence. RCTs present stronger evidence than observational studies hence RCT articles were considered in writing the project. However, rigorous observational studies offer more robust evidence as compared to uncontrolled case studies. According to GRADE, RCTs without limitations provide high quality evidence as these were also important in handling the paper. Besides, observational studies without special strengths were ignored because they present low quality of evidence.