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Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Objectives
  5. Literature review
  6. Methods
  7. Results
  8. Discussion
  9. Conclusion
  10. Acknowledgements
  11. Key Messages
  12. References

Objectives:  Assessment of the usage of medical library services before and after the implementation of several new services, as well as assessment of the clinical impact of the information provided by the medical library.

Methods:  A sample of employees, residents and physicians were surveyed using a stratified, random selection process in two surveys 4 years apart. The response rate for the first survey was 52% and the response rate for the second survey was 35.2%.

Results:  Differences in usage included increased overall use of the librarians and library services, decreased use of the Internet as a source of information, and direct and indirect impacts upon patient care. Information needs of respondents also increased to where 65% of employees and 94% of physicians require information at least once a week. Patient management was the main reason for needing information. The top two specific uses were to find out about a condition and determine a treatment plan.

Conclusions:  These findings parallel some of the findings of other researchers, and contradict the findings of others. Possible explanations for these findings and implications for future research are discussed.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Objectives
  5. Literature review
  6. Methods
  7. Results
  8. Discussion
  9. Conclusion
  10. Acknowledgements
  11. Key Messages
  12. References

Saskatoon Health Region (SHR), the largest health-care provider in Saskatchewan, serves 289 000 residents in more than 100 cities, towns, villages, rural municipalities and First Nation communities. SHR is an integrated health delivery agency that provides a comprehensive range of services and programmes, including hospital and long-term care, public health, home care, mental health and addiction services, and palliative care. The SHR Medical Library provides support for evidence-informed decision making and optimal service delivery.

Since April 2004, the SHR Medical Library has received operational support from the Saskatchewan Health Information Resource Partnership (SHIRP). SHIRP provides access to a comprehensive suite of online health information resources for all health practitioners in Saskatchewan, covering practice areas such as medicine, nursing, pharmacy, nutrition, psychology and therapies. In addition, because of the University of Saskatchewan distributed medical education curriculum in the SHR hospitals, SHIR also provides funding for two librarians, a half-time library technician and computers. There were no librarians working within SHR prior to SHIRP funding. The SHR Medical Library staff fulfil three key roles: provide reference services; provide training to employees, students and physicians; and facilitate access to the electronic resources provided by SHIRP.

Objectives

  1. Top of page
  2. Abstract
  3. Introduction
  4. Objectives
  5. Literature review
  6. Methods
  7. Results
  8. Discussion
  9. Conclusion
  10. Acknowledgements
  11. Key Messages
  12. References

There were two objectives of our study:

  • • 
    to assess library usage after the implementation of new services;
  • • 
    to assess the impact of information provided by the library to health-care professionals.

Literature review

  1. Top of page
  2. Abstract
  3. Introduction
  4. Objectives
  5. Literature review
  6. Methods
  7. Results
  8. Discussion
  9. Conclusion
  10. Acknowledgements
  11. Key Messages
  12. References

In the past, studies evaluating health and medical library services have focused on the efficiency of the library in providing services. In particular, research has focused on determining the information needs of clinicians,1–4 describing their information-seeking behaviours5 and monitoring their use of specific databases.6,7 Even the findings of Veenstra & Gluck,8 who examined the impact of a clinical medical librarian in an intensive care unit, focus more on the efficiency of the location of the services, rather than on the effectiveness towards the patient care that was provided by the information.

A review of the literature by O’Connor9 concluded that, even between clinicians and across a range of clinical settings, a large percentage of health-care providers are not health library users and they obtain information from sources outside of the health library. It is difficult to measure the direct impact of information services on patient care, but administrators are demanding tangible evidence of the benefits of information services in order to justify continuing to fund library services.10 Several researchers have devised models of providing information to clinicians in a timely manner, such as by providing an ‘evidence cart’, because it was shown that, by improving access to information, it was more often incorporated into patient care decisions.11,12

A study by King13 was one of the first to evaluate impact of the information provided by libraries. Using a retrospective survey, physicians, nurses and other allied health providers were asked to request information from the library related to a specific case, evaluate the information they received, and indicate whether or not the information made any difference in how they handled the case. Almost 75% of respondents indicated that they had (or would have) handled the case differently, based on the information that they received from the library.

Marshall's Rochester study14 targeted the impact of library information for physicians. Using a similar information request methodology as King,13 physicians evaluated specific areas of impact that the information had on the care of their patients. The impacts measured were either how the information was used to implement specific clinical activities, and/or how it was used to avoid other clinical activities. Results indicated that 80% of the physicians possibly handled the case differently. The most frequent impacts that changed as a result of the information were: advice given to patient (71%); choice of tests (51%); choice of drugs (45%); and change in diagnosis (29%). Physicians also indicated that the information enabled them to avoid costly medical procedures, such as additional tests (49%) or surgery (21%).

Cuddy15 also conducted a follow-up study regarding the uses of information received from the library. After library users had received the information they had requested, the patrons were surveyed for feedback about how the information was used. Patient care (32%) was the most frequent use of information.

However, none of the studies to date has evaluated the impact of information across an entire health-care organization, nor have any studies evaluated the impact of information from health-care providers who were not confirmed current library patrons.

Methods

  1. Top of page
  2. Abstract
  3. Introduction
  4. Objectives
  5. Literature review
  6. Methods
  7. Results
  8. Discussion
  9. Conclusion
  10. Acknowledgements
  11. Key Messages
  12. References

SHR conducted two surveys of library information needs and usage. In 2002, a needs assessment was undertaken to determine the information needs, usage and awareness of library services of current and potential library patrons across the organization, as well as the level of interest in new services, such as access to electronic journals and texts.

In 2006, after the implementation of new services, a follow-up survey was conducted to reassess the information needs of current and potential library patrons, as well as their level of usage and awareness of library services. The 2006 survey also served to initiate an assessment of the impact of the information that was being provided by the library.

Needs assessment—2002

The library needs assessment was designed to determine the library use and information needs of all potential patrons across the organization. Included in the needs assessment were staff from nursing, nutrition, pharmacy, psychology, and therapies (employees), medical residents studying at the University of Saskatchewan and completing their residency through SHR, and physicians working in the academic and specialty services of SHR. The sending of the survey to a sample of all potential patrons also served to promote the services and functions available through the library in an organization where they were still considered fairly new. At the time, there were no librarians at SHR and library services were limited to very basic literature searches, a modest print collection, and providing interlibrary loans.

A review of the literature revealed that there was not an existing questionnaire that was suitable for examining the information needs of employees and physicians in an organization such as ours. As a result, the survey questionnaire for the needs assessment was created, based on discussion with various library colleagues about their opinions regarding library needs of SHR.

The questionnaire had quantitative sections on information needs, information-seeking behaviour, usage of the physical library services, and the usefulness and appropriateness of resources and services offered by the libraries. The majority of the quantitative questions were formatted with mutually exclusive nominal response categories (i.e. less than 1 year, 1–5 years and 6–10 years). Some quantitative opinion questions had ordinal response choices which examined the strength of agreement with key statements regarding library services (i.e. strongly agree, somewhat agree). The last question was qualitative and invited respondents to provide any comments or concerns.

The sampling method for each group was slightly different. For employees, a random sample was taken from a human resources list of current full- and part-time front-line health-care providers and their managers. Medical residents, with access to both university and hospital libraries, were randomly sampled from a list of medical residents from all specialty programmes.

Physicians were surveyed using a convenience method of sampling. Copies of the questionnaire were left in the library and the physicians who visited during the study period (May–June 2002) were invited to complete the survey and return it by post.

The total population of employees and medical residents was 863. A stratified random sample of 400 individuals was chosen, of which 209 surveys were returned, giving a response rate of 52%. Twenty-one physicians completed and returned surveys.

Usage and impact assessment—2006

One of the purposes of the 2006 survey had been to compare the results of the needs assessment for library services to their rates of use after implementation. To make this comparison, both the questionnaires and the sampling strategy used in each survey needed to be as similar as possible but, because of the extent of the service changes in the library and the extent of organizational changes that had occurred within SHR, revisions to the questionnaire and sampling strategy were needed.

Changes in the available library services meant that at least one response choice on almost all questions was different from the response choices on the 2002 survey. There was only one question on information needs in the 2002 survey but, as a result of recent literature outlining the impact of information on clinical practice, there were three questions on information needs and the impact of information in the 2006 survey. Several sections of the 2002 survey were removed entirely as the services in question were no longer offered. With the introduction of the electronic resources, potential library patrons were able to make use of library services without physically visiting the library, so the one question in the 2002 survey about visiting the library was expanded to four questions about accessing the electronic and physical library services. As a result, the surveys could not be directly compared; only inferences can be made between the levels of responses to similar response choices.

The 2006 survey was able to use a similar sampling strategy as the 2002 survey, with two exceptions. The first change was as a result of organizational restructuring between 2002 and 2006; new departments needed to be included in the sample. The second change was in the sampling methods for the physicians. A random sample was conducted instead of a convenience sample. Physician department groups were selected based on their level of affiliation with SHR, and physicians were randomly selected from within those department groups. The definition of employees did not change (staff from nursing, nutrition, pharmacy, psychology and therapies), other than there were more departments that could be included. Medical residents were again sampled from all specialty programmes.

Mutually exclusive lists of eligible employees, residents and physicians were obtained and the sample was randomly selected using a stratified selection process. The population of employees, residents and physicians totalled 1608 individuals. A sample of 825 individuals was chosen, of which 291 surveys were returned, giving a response rate of 35.2%.

Survey distribution

In the 2002 survey, the questionnaires for the employees were distributed with a covering letter through the internal mail system of the organization, while the questionnaires for the physicians were left in the library for the convenience sample. In the 2006 survey, all questionnaires were distributed with a covering letter through the internal mail system. In both surveys, respondents were given 3 weeks to complete the survey, and completed surveys were returned directly to the Research Services Unit.

Data analysis

Quantitative responses from the questionnaires were entered first into an Excel spreadsheet and then imported into the statistical package SPSS (SPSS Inc., Chicago, IL, USA) for Windows. Results were then analysed and comparisons made using descriptive frequencies, comparisons of means and cross tabulations. Comments provided by respondents were analysed using qualitative content analysis to determine key points and to provide context for the quantitative responses. For ease of reporting and comparing results, managers were grouped together with employees (employees), and medical residents were grouped together with physicians (physicians), as the number of managers and medical residents in the population was small.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Objectives
  5. Literature review
  6. Methods
  7. Results
  8. Discussion
  9. Conclusion
  10. Acknowledgements
  11. Key Messages
  12. References

Response rate

The overall response rate was lower in the 2006 survey. It was 52.2% (n = 209 + 21 physicians) in the 2002 survey and 35.2% (n = 291) in the 2006 survey (Table 1).

Table 1.  Population, sample, and response rate for each respondent group in the 2002 and 2006 medical library surveys
 20022006
PopulationSentReturnRatePopulationSentReturnRate
  • *

    The population, sample and response rate of physicians in the 2002 survey is not known because the sample was a convenience sample.

  • N/A, not available.

EmployeesN/A31819561.3%118459423639.7%
Physicians*N/AN/AN/AN/A 218140 4129.2%
Medical residentsN/A 82 1417.0% 206 91 1415.3%
Overall/total86340020952%160882529135.2%

Use of the stratified random sampling process helped to ensure that the sample was representative of the organization. In 2002, employee (staff from nursing, nutrition, pharmacy, psychology and therapies) respondents represented 22 departments, physician respondents represented 10 departments, and resident respondents did not indicate their area of specialty. In 2006, employee respondents represented 29 departments, physicians represented eight departments, and residents represented nine departments.

Finding information

In both surveys, respondents were asked to indicate where they searched for information when they needed a specific journal article or literature review (Table 2).

Table 2.  Comparison of the percentage of respondents who obtain information from the Internet and from the library in 2002 and 2006
Information sourceEmployeesPhysicians
2002 (n = 195)2006 (n = 236)2002 (n = 35)2006 (n = 55)
Obtaining journal articles from Internet38.5%29%20%26%
Obtaining journal articles from library 9.7%27%23%23%
Obtaining literature review from Internet  41%36%61%51%
Obtaining literature review from library 9.7%30%18%15%

For journal articles, looking on the Internet was the most frequent course of action for respondents in 2002. In 2002, only 9.7% (n = 19) of employees and 23% (n = 8) of physicians would contact the medical library to obtain a journal article. Looking on the Internet was also the most frequent method used by respondents to conduct a literature review in 2002. Only 18% (n = 6) of physicians and 9.7% (n = 19) of employees used the library to conduct a literature review.

In 2006, more employees used the medical library to obtain journal articles (n = 64; 27%) and conduct literature reviews (n = 71; 30%) than they did in 2002, but the Internet was still the most frequent source for obtaining journal articles (n = 69; 29%) and conducting literature reviews (n = 85; 36%). The percentage of physicians using the library to obtain journal articles remained steady at 23% from 2002 (n = 8) to 2006 (n = 13), but their first choice for obtaining journal articles was the University of Saskatchewan Health Sciences Library (n = 21; 38%), while the most frequent method of conducting a literature review was using the Internet (n = 28; 51%). Generally, in 2006, respondents overall were not using the SHR Medical Library as their first choice to obtain information. The most frequent information source for employees was the Internet (n = 92; 39%), and the most frequent choice for physicians was using the University of Saskatchewan Health Sciences Library (n = 16; 29%).

Accessing services

In both surveys, respondents were asked if they had ever accessed any of the services offered by SHR Medical Library. In 2002, respondents were asked ‘Approximately how many times since January 1, 2002 have you visited a medical library?’. It was found that about 28% of employees (n = 209) and 86% of physicians (n = 21) had visited the library at least once in the past 6 months (January–June 2002). In 2006, the question was expanded so that respondents were first asked ‘Have you ever used the services offered by the medical libraries to obtain information?’ to which 48% (n = 113) of employees and 60% (n = 33) of physicians indicated that they used the services.

In 2006, respondents who had indicated that they had used the services of the medical library (n = 149) were then asked further questions about the ways in which they accessed the services. Library users are able to access the library and information services three ways: use the library website and electronic resources independently from their office or home computers; contact the library staff for assistance through electronic mail or by phone; or get assistance from the library staff by visiting the library. Table 3 depicts how often each respondent group accesses library services.

Table 3.  Percentage of respondents using assisted and unassisted library services
 Employees (n = 115)Physicians (n = 34)
WebsiteContact or visitWebsiteContact or visit
Daily 1% 0 0 0
Two to three weeks 9% 1% 3% 0
Weekly12% 3% 9%12%
Biweekly11% 4% 0 6%
Monthly13% 8%22%15%
Bimonthly20%25%22%15%
Six months12%22% 6%15%
Once a year16%28%22%31%
Never 6% 9%16% 6%

Respondents do not frequently access electronic resources. Fifty-four per cent of employees (n = 62) and 66% of physicians (n = 22) who use the library access electronic resources less than once a month. Physicians are more likely to access resources by contacting or visiting the library; 33% of physicians (n = 11) contacted the library staff through electronic mail or phone more than once a month, whereas only 16% of employees did so (n = 18). Library users are also more likely to get assistance by physically visiting the library now than they were in 2002. In 2006, 91% of employees (n = 104) and 100% of physicians (n = 34) reported visiting the library at least once in the past year, compared with the 28% of employees (n = 54) and 86% of physicians (n = 18) who reported visiting the library at least once in 2002.

In both surveys, respondents were asked to indicate their level of awareness of and use of three selected services; requesting materials available at the library, requesting materials not available at the library (interlibrary loans) and literature search performed by the library staff (Table 4).

Table 4.  Percentage of respondents in 2002 and 2006 using selected library services
  2002 n = 712006 n = 115
AwareUseAwareUse
EmployeesRequesting resources56%15%92%67%
 Using interlibrary loans46% 7%83%44%
 Literature searches36% 5%86%49%
Physicians n = 18n = 34
 Requesting resources68%34%88%61%
 Using interlibrary loans62%15%79%50%
 Literature searches65%18%82%44%

There have been increases in both levels of awareness and levels of use of library services between 2002 and 2006. The biggest increases in service use have been employees requesting resources and physicians requesting interlibrary loans.

Information needs

The 2002 survey did not evaluate the impact of the information that was received from the library. The 2002 survey only assessed the frequency of information needs of the respondents (Table 5). Further analysis of information needs indicated that 55% of employees (n = 107) and 77% of physicians (n = 27) needed information at least once a month in 2002. When asked this question in 2006, it was found that 66% of employees (n = 156) and 96% of physicians (n = 53) required information at least once a month. Furthermore, 36% of employees (n = 85) and 76% of physicians (n = 42) required information at least once a week. These figures indicate that the information needs of respondents have increased over time.

Table 5.  Comparison of the information needs of respondents between 2002 and 2006
Information needs20022006
Employees n = 195Physicians n = 35Employees n = 236Physicians n = 55
Daily 5%11%11%29%
Weekly17%38%25%47%
Biweekly10%11%12% 9%
Monthly23%17%18%11%
Occasionally35%14%28% 4%
Rarely 7% 3% 5% 0
Never 3% 6% 1% 0

Impact of information obtained from the medical library

In 2006, two further questions were asked about the impact of health information. The first question about the impact of health information asked respondents to indicate the general reason why they need health information. Respondents were given a list of general reasons why they might need health information including; patient/client management, continuing education, teaching, research, and keeping updated in their field. Respondents were able to check all the responses that applied. Patient management was the top reason for needing information for both respondent groups, while research was the least frequent response for both groups. Keeping updated was the second most frequent reason for employees needing information, while teaching was the second most frequent reason for physicians needing information (Table 6).

Table 6.  Percentage of respondents who need information for general reasons
ReasonEmployees (n = 236)Physicians (n = 52)
Patient management81%83%
Continuing education55%69%
Teaching32%71%
Research30%50%
Keep updated66%67%

The second question about the impact of health information asked the respondents to think about the last time that they needed information, and to identify how they had used the information from the choices given. Results are presented in Table 7.

Table 7.  Percentage of respondents who need information for specific reasons
 Employees (n = 235)Physicians (n = 54)
Confirm diagnosis 1%15%
Change test request 0 0
Change prescription 2% 2%
Determine treatment plan33%45%
Reduce length of stay 0 0
Avoid transfer 0 0
Find out about condition37%33%
Change diagnosis 0 0
Change X-ray request 0 0
Avoid tests 1% 0
Provide patient advice25% 2%
Avoid admission 0 0
Change patient advice 1% 2%

Employees most frequently needed information to find out about the condition (n = 87; 37%), to determine a treatment plan (n = 78; 33%) and to provide patient advice (n = 59; 25%). Physicians most frequently needed information to determine a treatment plan (n = 24; 45%), to find out about the condition (n = 18; 33%), and to confirm a diagnosis (n = 8; 15%). Respondents indicated that they did not use information to change a test request, reduce length of stay, avoid transfer, change a diagnosis, change an X-ray request or avoid hospital admissions.

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Objectives
  5. Literature review
  6. Methods
  7. Results
  8. Discussion
  9. Conclusion
  10. Acknowledgements
  11. Key Messages
  12. References

Impact of increasing library usage

Several differences were identified in the usage of library services before and after the implementation of new services.

First, more respondents overall are using the library services in 2006 than in 2002. This is an important finding for administrators. These results support the continued funding of librarians and associated library services, as their use is increasing. However, like others,9 our study found that a large percentage of respondents still do not access the services available from the library. This finding suggests that more information is needed about the reasons why respondents are not accessing the library for their information needs.

Second, the awareness of and use of three selected library and information services have increased for respondents between 2002 and 2006. In order to get health-care providers to access and use information in clinical decision making, they need to know of the existence of such information and services. This finding confirms that our current marketing strategies are working, but there is still room for improvement, if we can determine what other factors affect a respondent's decision to use the library to meet their information needs. For example, in the comments, respondents indicated that the demands of their clinical schedule limited their ability to search for information, but we do not know how many of them are aware that the librarians can do the searching for them.

Third, like others,9 our study found that most respondents obtain information from sources other than the library. However, the use of the library to obtain information is increasing and the use of the Internet to obtain information is decreasing for both respondent groups. It was found that physicians chose to access the services at the University of Saskatchewan Health Sciences Library rather than the SHR Medical Library, but it is positive to learn that physicians are accessing an established library system instead of continuing to obtain information unassisted from the Internet. Although the number of reputable open and free publication sites on the Internet is increasing, the inherent value in having a librarian help to find the best overall sources of information cannot be overlooked.

These findings and impacts indicate that the trend for all respondent groups to use SHR Medical Library to meet their information needs is increasing. Given further time and expanded marketing of available SHR Medical Library services, it is likely that the SHR Medical Library will overtake the Internet as the preferred information source for health-care providers in our organization.

Impact of increasing information needs

Respondents in both 2002 and 2006 were asked to identify how often they required information to carry out their job duties. To assess for changes, detailed analysis was completed comparing the results from 2002 and 2006 using different levels of information needs. Overall, the information needs of respondents are increasing.

A cross tabulation of the respondents’ information needs and work departments was completed in order to identify specific departments whose respondents reported frequent information needs so that targeted marketing strategies could be developed. Medical residents all have frequent information needs regardless of department; physicians from medicine and surgery have frequent information needs; and employees in pharmacy, public health, nursing development and mental health and addictions services have the most frequent information needs.

However, when the results of this analysis were presented to the leaders of the departments, the leaders felt that it is not the frequency of information needs that is important. Rather, the leaders felt that their staff need to have access to relevant and accurate information in a timely and efficient manner, no matter how frequently or infrequently they require it. Comparing frequencies of requiring information may not be the most effective way to establish context for determining the impact of providing information, as it was found that the frequency of requiring information had no further impact on how the information was subsequently used to impact clinical practice. The challenge for the library now is to determine how they are best going to meet these increasing needs for information.

Impact of providing information

To further assess the impact of the information received from the medical library, respondents were also asked to indicate both general and specific reasons for needing information from the library. The rationale for including two separate questions was to differentiate between respondents requiring information to decide upon a course of clinical actions that directly impact patient care, and respondents requiring information as part of the ongoing learning processes of providers that indirectly impact patient care through the improvement of overall knowledge.

Not surprisingly, respondents indicated that patient management is the most frequent general reason they require information. Given our rationale, we think that our findings are similar to those of others.13,15 Cuddy15 found that patient care was the most frequent use of information. Likewise, King13 found that the majority of respondents in his survey changed how they handled (or would handle) a clinical case based on the information they received from the library. It is possible that our respondents who are using the information for patient/client management could be using the information to make changes in how they handle clinical cases.

In order to further delineate the uses and impacts of information received from the medical library, we adapted the question used by Marshall,14 who asked respondents to indicate specifically how they had used the last piece of information that they had requested. Response choices in that question included very specific clinical actions, such as changing tests, X-rays, prescriptions and hospital admissions. Response choices also included more general uses and impacts of information, such as patient advice, determining a treatment plan and finding out about a certain condition.

Marshall14 found that the top reasons for needing information were patient advice, change in tests, change in prescriptions and change in diagnosis. These findings are directly clinical in nature, and using information for these purposes can directly affect patient care. In contrast, our survey found that physicians need information to determine a treatment plan, find out about a condition and confirm a diagnosis, and employees need information to find out about a condition, determine a treatment plan and provide patient advice. These findings, while having the potential to impact outcomes such as patient care and cost, are more intangible.

The only way in which our respondents’ choices matched the results found by Marshall14 was that our respondents needed information for patient advice. One other result was close to being similar. Marshall's14 respondents indicated that they used information to change a diagnosis, and our respondents indicated that they used information to confirm a diagnosis. Although an argument can be made to suggest that changing a diagnosis and confirming a diagnosis are similar actions, we do not believe that they are. We believe that there is a difference between using acquired information to completely change a diagnosis, and thereby possibly change treatment, and using acquired information to confirm a suspicion, and thereby continue with treatment.

There are several possible explanations for these differences. First, the differences could be as a result of the different populations being sampled. Marshall14 only sampled physicians, whereas our sample was a cross section of all health-care providers. As providers who possess a great deal of knowledge, physicians might be more concerned about patient advice, tests, prescriptions and diagnosis, whereas a sample of all health-care providers could be more interested in using the information to improve their general level of clinical care.

Second, the differences could be a measure of the health-care systems in which the studies were conducted. The study by Marshall was conducted in the USA, where privatized hospitals and health management organizations tend to put much more emphasis on how much the cost of care factors in to the overall quality of care for the patients. Our study was conducted in Canada, where the health-care system is more focused on improving the overall level of care for all patients across the entire system, and the cost impact of providing high-quality care, while also important, is a secondary concern. Given these differences in systems, it stands to reason that physicians in Marshall's study14 used the information to change clinical actions that would have a direct impact on patient care, while respondents in our study used the information to improve the level of patient care overall through the increase in knowledge about medical conditions and treatment plans.

Third, the study conducted by Marshall14 is not a recent one and, in the time since the study was conducted, there may have been a general shift regarding the impact of information received from health libraries.16–19 For example, Abels and colleagues16 have developed a taxonomy of ways in which libraries contribute to the organizational goals of hospitals and academic health centres. The taxonomy includes the specific impacts of care outlined by Marshall,14 but it also includes indirect aspects of patient care, and the more intangible concepts that large health-care organizations are concerned with, such as accreditation standards, improving productivity and increasing staff satisfaction. The finding that our respondents most often use information received from the library to determine treatment plans and find out about medical conditions is closer to the intangible impacts outlined by Abels et al.16 than they are to the more specific cost impacts found by Marshall.

This finding indicates that the assumption on which we measure the impact of providing information to health-care providers may be faulty. To date, the definition and importance of determining the impact of information provided by the library has been related to measuring the existence of differences in patient care, such as outcomes and costs, as a result of the information. Administrators today require proof that their investment in the information service is not going to waste. The assumption is that if the information is used to make a situation better for a patient, then the information was worthwhile and, therefore, funding should be made available to continue to provide the information service.

While more study is needed to determine the tangible impacts of information provided to health-care providers in our organization, we also believe that the emerging areas outlined in the taxonomy of Abels et al.16 may be a better fit with our specific organizational goals. As a result, more research is needed to determine how our library service can provide information so that both tangible and intangible aspects of care are impacted by the provision of information to health-care providers.

Conclusion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Objectives
  5. Literature review
  6. Methods
  7. Results
  8. Discussion
  9. Conclusion
  10. Acknowledgements
  11. Key Messages
  12. References

The results of these surveys showcase the impact of the development of medical library services in our organization. It is evident that the usage of information services and the impact of the information provided are two distinct concepts that should be measured separately. Although continuous monitoring of library service use and access is needed to ensure the appropriateness and relevance of services, more detailed information is needed about the impact of the information received from the health libraries by health-care providers. It is not enough to simply ask respondents to indicate what they did with the information that they received. Measuring impacts at one point in time does not create an accurate picture of the impact of the services and information that the library provides. The results of this survey also highlight the importance of surveying all potential library users. Physicians who were sampled by convenience in the 2002 survey reported a higher incidence of approaching the library when they needed a journal article than did the randomly sampled physicians in the 2006 survey.

In order to obtain the most useful information from future surveys, potential changes to the survey questions and analysis methods could allow for greater examination of the value of information for future decision making, not just retrospective decision making, as has been done to date. A separate survey, conducted in a prospective manner, could generate more detailed and in-depth information about how health-care professionals across an organization are making use of information that they obtained from the medical library.

The results of future surveys should provide progressive evidence of the impacts of health information provided by the medical library, including increased overall use of the librarians and library services, decreased use of the Internet as a source of information, and direct and indirect impacts upon patient care.

Acknowledgements

  1. Top of page
  2. Abstract
  3. Introduction
  4. Objectives
  5. Literature review
  6. Methods
  7. Results
  8. Discussion
  9. Conclusion
  10. Acknowledgements
  11. Key Messages
  12. References

The authors would like to acknowledge Melanie Rathgerber MSc for her work in the initial development of the survey questions. Further acknowledgements go out to the SHR Medical Library Staff (Erin Romanyshyn, Amy Beaith, Colleen Haichert and Shirley Blanchette) for their contributions to the further development of the survey questions and format.

Key Messages

  1. Top of page
  2. Abstract
  3. Introduction
  4. Objectives
  5. Literature review
  6. Methods
  7. Results
  8. Discussion
  9. Conclusion
  10. Acknowledgements
  11. Key Messages
  12. References

Implications for Policy

  • • 
    Despite the accessibility of information through improving technology, clinicians are not using electronic resources as frequently as library and information services professionals may think.
  • • 
    The differences in how information from the library is used to impact upon patient care, is in part dependent upon the system in which the health-care providers are practising.

Implications for Practice

  • • 
    Library and information services professionals need to increase their awareness of how the information that they provide is being used in their particular health-care system.
  • • 
    Library and information services professionals may need to rethink how to assess the impact of the information they provide to include both the tangible and intangible benefits.
  • • 
    Although the predominant system of providing information is in reaction to a specific request from a clinician, information services professionals may need to start becoming proactive in providing information to clinicians, to keep them updated on advances in their fields.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Objectives
  5. Literature review
  6. Methods
  7. Results
  8. Discussion
  9. Conclusion
  10. Acknowledgements
  11. Key Messages
  12. References