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STRAIT to the future8th Asia-Pacific Specials, Health and Law Librarians Conference Evidence-based health care and library intervention
Jan Weaver Keywords: Evidence-based health care; intervention study; health services research AbstractDiscussion of health care practitioners adoption of evidence-based health care (hereinafter referred to as EBHC), usually generates discussion of the sources of information and the role of libraries and librarians in the provision of that information. This focus session describes a local intervention study undertaken in the Cairns District Health Service, which assessed changes in the information seeking behaviour of different professional groups subsequent to a tutorial on EBHC. Outcomes sought were an analysis of information seeking behaviour changes and the development of a literature search request form which follows EBHC principles. The study was voluntary, unfunded and managed by one individual. Some foundations have been laid for a wider study if ALIAHealth concurs on a need for such research. IntroductionMany studies have measured the impact of information on clinical decision making and outcomes, but few have focused on the potential for libraries to positively influence the information seeking behaviour of health care practitioners, and perhaps through this, their adoption of EBHC into daily practice. Hamill (1997, p.2), noted at this forum two years ago: The value of library services to their clients is in being able to provide useful information with maximum relevance and validity while reducing the work needed to obtain it. Over the last few years, especially since the wide adoption of the world wide web and internet/intranets as a medium for delivering information, there has also been continuing discussion of the need to provide health care workers with online access to clinical databases which enable evidence based research, linked to full text resources. Corporate managers may perceive the provision of such tools to be sufficient unto themselves, without realising the need for users to develop expert skills in their use! The paradox arises that a health care worker may have some of the resources they need at their fingertips to search for evidence to support their clinical decision making, but they do not have the information seeking or management skills with which to find and evaluate that information for the good of their patient. Recently in the Australian literature a study on Australian GPs' use of the Cochrane Library generated some discussion on the value of studies of the effectiveness of information provision (Young and Ward, 1999). The researchers noted in their discussion that GP's access to not only the databases but also to reliable information technology provision, would be an immediate challenge in ensuring their use (Young and Ward, 1999, p.58). They also noted that there may be a use for "mediated search services", a sentiment echoed in the editorial of the same journal (van der Weyden, 1999, p.53). Silagy et al (1999, p.393), noted a selective clinical information service for GPs being trialed by the University of Queensland. Cate Dawson then fortunately stated the obvious in a follow up letter: that health library services throughout the country incorporate not only the resources but also the expertise to provide such a mediated service, and that for health professionals to: "...take on this information role is neither necessary nor cost-effective." (Dawson, 1999, p.394). Gruppen (1990), notes that health libraries should perform "market research" to determine the needs, preferences, and use patterns of their clients. Leckie, Pettigrew and Hylvain (1996, cited by Hamill, 1997), note that these needs and patterns are affected by variables such as:
BodyThe intervention study undertaken at the Cairns District Hospital consisted of the development and delivery of a "show and tell" PowerPoint slide show on searching for evidence in the literature, which was tailored for different disciplines, namely, student midwives, allied health practitioners, and student doctors. An evaluation form was completed immediately after the presentation by each participant, and a follow up interview was then conducted with the participants after two weeks and again after four weeks, to ascertain whether the intervention had affected their information seeking behaviour. The evaluations also provided feedback on barriers to searching for published evidence. At the time of writing, evaluations have not been completed; full evaluation analysis will be presented at the focus session. The interim results show that approximately 66% of clinical decisions made following the presentation involved use of published evidence. All respondents noted that searching the literature was time consuming. 50% found it "somewhat" time consuming, 50% found it "very" time consuming. Some typical comments were: "It was hard to find what I wanted in Cochrane - the words I searched brought up a lot of irrelevant stuff." "It was hard to find relevant articles, or they were too basic. Once I found the right subject, there was a lot of information." "Getting the abstracts is good." All respondents believed that the evidence found contributed to the quality of their decision. Respondents explained that for 33% of decisions, evidence was not sought because decisions were based on tried and accepted methods, which were believed to be unquestionable. Quote: "If there had been any doubt, the evidence would have been checked!" The evaluation forms were then amended to include a question seeking examples of such decisions. These evaluations have not yet been completed. Evaluations to date have also indicated that the hospital library was visited when searching for evidence. Being mindful of some of the variables to information seeking patterns identified by Leckie, Pettigrew and Hylvain (1996, cited by Hamill, 1997), the evaluation follow up questionnaires were again amended to include possible reasons why the library was used instead of desktop access from within the workplace, or via the internet at home. At the time of writing these evaluations also have not yet been completed. From observation, it is postulated that the reasons may include poor IT and T support within the hospital campus, and that the library provides the appropriate atmosphere, or the most comprehensive access to resources in a remote area, or the expertise of the library staff, all of which support the research process. All participants to date have expressed a need for continuous training in EBHC. A literature search request form has also been designed which follows EBHC principles (attached). This form will also be trialed before the focus session, and some tentative postulations regarding its usefulness and effectiveness will be presented for discussion. As a result of the analysis to date, it is suggested that as health care professionals are in fact visiting the library to search for evidence, they are a "captive audience" for library staff who wish to promote sound searching techniques which support EBHC principles. However remote clients are at a disadvantage, not only because of IT and T challenges, but also because they lack the more constant communication with library staff which occurs when working on the same campus where the library is physically located. At a workplace desktop, or at home, there is little chance of library staff reaching clients. Possible techniques for outreach marketing online could include the use of online "advertising" on a well-planned home page which points the client towards their local library for help with EBHC searching, the use of a literature search request form and guide (both online and in hard copy), which follows EBHC principles, and the use of EBHC Helpdesk stickers giving contact numbers and addresses for help. ConclusionThis intervention study sought to provide data on changes in the information seeking behaviour of health care workers after they had been shown some techniques and resources with which to search for evidence to support their clinical decisions. Results to date indicate that, in a rural/remote environment where IT infrastructure support may be severely constrained, the physical resources of the health centre library and its staff expertise are not only useful but in fact necessary to ensure the best evidence is provided to support clinical decision making. Changes in information seeking behaviour patterns are likely to ensue from educational interventions, but these alone may not be sufficient to ensure the best evidence is sought and found when reliance is based only on online access to information. Health centre libraries are ideally placed to develop and market procedures to ensure the best evidence is sought and found for clinical decision making. The ALIA Board of Education has identified the following as one of six research priorities for our profession: Understand information seeking and information utilisation in an information-rich environment... Dr. Ross Todd notes under this priority the need to understand how libraries can: ...provide the 'intellectual' scaffold of information and critical literacies to help people effectively engage with the Net, even outside the library context. (Todd, 1999, p.10) EBHC principles ensure that only reviews which answer relevant clinical questions are undertaken. It is suggested for discussion at the focus session, that either
...would help to satisfy the needs of our clients, and build our professional knowledge in this area. AuthorJan Weaver, BA (Library and Information Studies). Over 20 years experience in special libraries, the last 3 as Director of Library Services at Cairns Base Hospital Library. ReferencesDawson, C. (1999) General practitioners' use of databases (letter). MJA 170, 393-4. Gruppen, L.D. (1990) Physician information seeking: improving relevance through research. Bull Med Libr Assoc, 78(2), 165-72. Hamill, C. (1997) Adding value, changing practice. Proceedings of the Asian Pacific Specials', Health and Law Librarians Conference: On the Edge, http://203.14.179.30/scripts/dbtcgi.exe (accessed 30/3/99) Leckie, G.J., Pettigrew, K.E. and Hylvain, C. (1996) Modelling the information seeking of professionals: a general model derived from research on engineers, health care professionals, and lawyers. Library Quarterly, 66, 161-93. (cited in Hamill, op. cit.) Silagy C.A., Weller D.P., Middleton P.F., Doust J.A. General practitioners' use of evidence databases. Med J Aust. 1999 Apr 19;170(8):393. Todd, R. (1999) Research priorities for the profession. inCite, 20, 10. Van der Weyden, M.B. (1999) Databases and evidence-based medicine in general practice: we have built it, but will they come? MJA, 170, 52-3. Young, J.M. and Ward, J.E. (1999) General practitioners' use of evidence databases. MJA 170, 56-58. Draft Only Evidence Based Health Care Research Form and Guide
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