Student: Gemma Griffin
Supervisors: Dr Phil Hider, Dr Edward Coughlan, Ms Marg Walker [Dept Public Health & General Practice and CSMHS Library]
Sponsor: Canterbury Medical Research Foundation
Health professionals cannot be expected to know the answer to every clinical question they face in practice. Clinical information-seeking is where a health professional has a question regarding the diagnosis or management of a patient, and seeks further information. In order to provide the most effective care health professionals need to be able to readily find and use the results from the best available evidence. However, findings from both New Zealand and international literature suggest that they may sometimes fail to find the best information available.[1] It is thought that many clinical staff are overwhelmed by the volume of scientific literature and some may lack confidence in their ability to find what they need or believe it will take them too long to do so. This is concerning because failing to find the best information available can result in clinical errors, increased patient costs, and longer hospital admissions.
Finding the best information requires special skills, and it is important that health professionals, and their employers, develop these. Our project sought to assess the clinical information-seeking behaviour of staff at the Canterbury District Health Board (CDHB), to measure their skill level in using Internet-based resources, and to assess staff demand for further training in this area of their work.
We randomly selected 900 CDHB staff who were on permanent contracts as nursing, medical, dental or allied health professionals, and sent them a postal survey. The nursing group included midwives, and the allied health group included a wide range of positions such as physiotherapists and pharmacists. The survey asked staff how often they consult a range of resources to find information. A number of questions then focused on their use and perceived value of 11 Internet-based resources. We also asked staff who reported that they use Ovid Medline (a large database of summaries of medical research) whether they use the more advanced database functions which Medline offers. Finally, all staff were asked how they decide if the information they find is reliable, and if they would like to receive further training in this area of their work. The survey was anonymous, with only limited demographic data (age and professional group) collected. Two reminder mail-outs were conducted to increase the response rate.
We received replies from 61% of our sample group. The answers from the survey forms were entered in to a database, and the data entry was checked for accuracy against the original survey forms before we began our analysis. We then used a statistical test to compare the demographic information given by the staff who responded to our survey to demographic information held for all CDHB staff in our selected professional groups. The test showed that there were no significant differences between our survey responders and the total staff population suggesting that our findings may be representative of all CDHB clinical staff.
We found that staff were most likely to use experts and co-workers as a source of information, after that their preferred information sources were to consult textbooks, internet search engines and library resources. The Google Internet search engine was the most frequently accessed electronic resource, accounting for over 50% of the instances where a resource was used daily. Google was followed by Ovid Medline, BMJ ClinicalEvidence and Google Scholar. Some resources – such as TRIP and Embase – were rarely accessed. However when we asked staff to state how valuable they found the various resources, some resources which were accessed less often were still given comparatively high value ratings. Staff most commonly judged information to be authoritative if it was published in a reliable journal, suggesting that while staff frequently use Google they are cautious about the reliability of information found this way. There were no differences in resource use when the results were analysed by age-group. There were some significant differences when the results were analysed by professional group - for example, medical and dental staff ranked Ovid Medline as the most valuable resource, compared to nursing and allied health staff who selected Google. Over 82% of staff wanted to receive further training, particularly in searching electronic databases and journals, and there was an overwhelming preference for any training given to be delivered as a 1-2 hour course.
Our project filled a gap in the New Zealand-based literature on clinical information-seeking. It was the first New Zealand study to focus on staff in a hospital setting, and to include allied health professionals. Our findings suggest that a large number of staff use and also highly value Internet-based resources for clinical information-seeking. This has practical implications because employers will need to ensure that skills in this area continue to be developed with appropriate training resources and to make sure that reliable Internet-based resources are readily available for staff to use. Our findings indicate that there is a need for future research to explore issues such as for what type of clinical questions health professionals use different resources and to assess how they carry out their search for information.
- Cullen, R. J. (2002). In search of evidence: family practitioners' use of the Internet for clinical information. J Med Libr Assoc, 90(4), 370-379.