Expanding rural primary care training by employing information technologies: the need for participation by medical reference librarians

The use of rural sites to train badly needed primary care providers requires access to sophisticated medical information not traditionally available outside of academic health centers. Medical reference librarians can play a key role in the development of primary care training sites in rural settings. Electronic information technologies, with proactive support from medical reference librarians, can provide current and detailed information without concern for distance from the health science center library. This paper discusses recent developments in technology, describes current challenges to the application of this technology in rural settings, and provides policy recommendations for medical reference librarians to enhance rural primary care training.     

Effectiveness of information skills training and mediated searching: qualitative results from the EMPIRIC project

OBJECTIVES: To explore library staff and health professionals' views on the effectiveness of information skills training and librarian mediated searching as methods of providing information for patient care. This is the second article describing the Effective Methods of Providing InfoRmation for patIent Care (EMPIRIC) project. The first paper, in a previous issue of this journal (Brettle et al. The costs and effectiveness of information skills training and mediated searching: quantitative results for the EMPIRIC project. Health Information and Libraries Journal 2006, 23, 239-247) describes the quantitative results. METHODS: A questionnaire survey to library staff and health professionals in the North West. Data was collected on perceptions of services, satisfaction and service usage. Statistical data were analysed using the Statistical Package for the Social Sciences (SPSS) and qualitative data using thematic analysis. RESULTS: Both information skills training and mediated searches are perceived by library staff and health professionals to be effective. There is strong support for mediated searches carried out on behalf of the health professional and information skills training to enable them to carry out their own searches. The results provide insights into the effectiveness of the services and the factors that make them effective. CONCLUSIONS: Evidence and stakeholders views support the provision of both information skills training and mediated search services. Both services are valued by users who see them as complementary methods of obtaining information depending on their needs at different times.     

Known Knowns and Known Unknowns

Abstract

Health care professionals often request information delivered stat. Patient treatment is urgent. Any hospital library, large or small, that uses Internet document delivery (IDD) systems can place information in the hands of the health professional faster. Libraries that use Internet document delivery technologies can provide health care professionals with information more quickly. Ultimately, it could reduce the length of a hospital stay and reduce health care costs. However, hospital libraries are faced with significant barriers that prevent them from utilizing electronic document delivery systems. docMD successfully overcame barriers and allowed small and/or rural hospital libraries to take advantage of the benefits of electronic document delivery that larger libraries have enjoyed for over a decade. It provides health professionals affiliated with smaller hospitals an equal opportunity to access professional literature quickly in order to make quicker, well-informed patient care decisions. The docMD pilot project investigated, eliminated the barriers and provided IDD services to eleven small and rural hospital libraries using a centralized document mediation center. This paper provides background information, describes the creation of the docMD service delivery model and discusses possible future project outcomes.     

Achieving change through mutual development: supported online learning and the evolving roles of health and information professionals

Introduction: Major changes in health care, within an information‐ and technology‐rich age, are impacting significantly on health professionals and upon their education and training. Health information professionals—in both the National Health Service (NHS) and higher education (HE) contexts—are consequently developing their roles, skills and partnerships to meet the needs of flexible education and training. This article explores one facet of this—supported online learning and its impact on role development. Methodology: A case study approach was taken, aiming to explore how academics, health information professionals and learning technologists are developing supported online learning to explicitly address the e‐literacy and information needs of health students within the context of NHS frameworks for education. This was contextualized by a literature review. Results: The case study explores and discusses three dynamics—(i) The use of supported online learning tools by future health‐care professionals throughout their professional training to ensure they have the appropriate e‐literacy skills; (ii) the use of supported online learning by current health professionals to enable them to adapt to the changing environment; (iii) the development of the health information professional, and particularly their role within multi‐disciplinary teams working with learning technologists and health professionals, to enable them to design and deliver supported online learning. Conclusions: The authors argue that, in this specific case study, health information professionals are key to the development of supported online learning. They are working successfully in collaboration and their roles are evolving to encompass learning and teaching activities in a wider context. There are consequently several lessons to be drawn in relation to professional education and role development.     

Outreach to health professionals in a rural area

An outreach project which juxtaposed technology (Grateful Med) and a human intermediary (a circuit librarian) to serve health professionals in a rural area of Illinois is described. The five goals of the project were: promote Grateful Med as a clinical tool; introduce circuit librarianship to Illinois; heighten the awareness of health professionals to the value of timely information services; increase the visibility of the resource library; and evaluate the impact of the two components, Grateful Med and circuit librarianship. While the project was well-received and enjoyed short-term success, sustaining the same level of information activity post-project has not been achieved. Insuring utilization of health information by remote health professionals may be characterized as a Sisyphean task.     

Outreach to Health Professionals in a Rural Area

An outreach project which juxtaposed technology (Grateful Med) and a human intermediary (a circuit librarian) to serve health professionals in a rural area of Illinois is described. The five goals of the project were: promote Grateful Med as a clinical tool; introduce circuit librarianship to Illinois; heighten the awareness of health professionals to the value of timely information services; increase the visibility of the resource library; and evaluate the impact of the two components, Grateful Med and circuit librarianship. While the project was well-received and enjoyed short-term success, sustaining the same level of information activity post-project has not been achieved. Insuring utilization of health information by remote health professionals may be characterized as a Sisyphean task.     

Outreach to public health professionals: lessons learned from a collaborative Iowa public health project

In 1995, the National Library of Medicine (NLM) and the Public Health Service (PHS) recommended that special attention be given to the information needs of unaffiliated public health professionals. In response, the National Network of Libraries of Medicine (NN/LM) Greater Midwest Region initiated a collaborative outreach program for public health professionals working in rural east and central Iowa. Five public health agencies were provided equipment, training, and support for accessing the Internet. Key factors in the success of this project were: (1) the role of collaborating agencies in the implementation and ongoing success of information access outreach projects; (2) knowledge of the socio-cultural factors that influence the information-seeking habits of project participants (public health professionals); and (3) management of changing or varying technological infrastructures. Working with their funding, personnel from federal, state, and local governments enhanced the information-seeking skills of public health professionals in rural eastern and central Iowa communities.     

Making information skills meaningful: a case study from occupational therapy

The effective delivery of information literacy training can be a challenging process, and health library and information professionals are constantly innovating in this area. This article presents a case study of the BHSc (Hons) Occupational therapy degree programme at York St John University to demonstrate ways in which deep integration of information skills into the curriculum can be achieved. The article advises that in the delivery of health and social care related information skills, we should look more broadly at where relevant learning can happen. In particular, contexts of the health care environment are suggested as a consideration rather than the narrow scope of the academic, classroom‐based environment. Examples are provided of specific teaching and learning activities used on the programme alongside CPD activity and curriculum design.     

Web-based PDA downloads for clinical practice guidelines and decision support tools

The extraordinary volume of health-related information made available on the Internet comes at a high cost for effectively storing and accessing clinical information resources. Additionally, the ability to use critical patient care information is limited to the availability of computer access. Physicians and other health care professionals have readily adopted personal digital assistants (PDAs), also known as handheld computers, because the devices provide succinct critical patient care information at the point of need. Clinical practice guidelines available through the Internet for use with PDAs present health professionals, who have little time, with powerful information already formatted for point-of-care devices. This paper will review several strategies for finding and accessing point-of-care clinical information.     

Information-seeking behavior changes in community-based teaching practices.

A National Library of Medicine information access grant allowed for a collaborative project to provide computer resources in fourteen clinical practice sites that enabled health care professionals to access medical information via PubMed and the Internet. Health care professionals were taught how to access quality, cost-effective information that was user friendly and would result in improved patient care. Selected sites were located in medically underserved areas and received a computer, a printer, and, during year one, a fax machine. Participants were provided dial-up Internet service or were connected to the affiliated hospital's network. Clinicians were trained in how to search PubMed as a tool for practicing evidence-based medicine and to support clinical decision making. Health care providers were also taught how to find patient-education materials and continuing education programs and how to network with other professionals. Prior to the training, participants completed a questionnaire to assess their computer skills and familiarity with searching the Internet, MEDLINE, and other health-related databases. Responses indicated favorable changes in information-seeking behavior, including an increased frequency in conducting MEDLINE searches and Internet searches for work-related information.     

The role of the information specialist in the systematic review process: a health information case study

There is an increasing body of literature on the information specialist's role in supporting evidence-based health care. In particular, the information component in systematic reviews has received considerable attention in recent years. Information professionals have evolved from simply acting as 'evidence locators' and 'resource providers' to being quality literature filterers, critical appraisers, educators, disseminators, and even change managers. This paper describes ten possible roles for information professionals in the systematic review process, using a case study of a review of the health information needs of visually impaired people carried out by the Centre for Health Information Management Research (CHIMR) at the University of Sheffield. This health information review was undertaken entirely by a team of information professionals. The ten roles identified are: project leader, project manager, literature searcher, reference manager, document supplier, critical appraiser, data extractor, data synthesiser, report writer and disseminator. This review has also identified an eleventh possible role for information professionals; that of primary researcher. Finally, the implications for evidence-based health care and evidence-based health informatics are discussed.     

The evolution of undergraduate medical informatics programmes

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Information Needs Assessment for K-12 School Nurses in Rural Eastern Washington State

School nurses are an often-overlooked population of health care professionals who have great importance in rural communities where access to health care is limited. In order to better serve school nurses in rural eastern Washington, an assessment was conducted to determine their information needs, behaviors, and perceptions. Results indicated this population of school nurses searches for multiple types of health information on a daily basis and navigates obstacles to information access using a variety of resources. While largely confident in their searching ability, they are open to learning more about how to find reliable health information to support their daily responsibilities. These results will guide the development of a workshop for school nurses about using reliable health information resources to improve health care in their rural communities.     

Information needs of rural health professionals: a review of the literature

This review analyzes the existing research on the information needs of rural health professionals and relates it to the broader information-needs literature to establish whether the information needs of rural health professionals differ from those of other health professionals. The analysis of these studies indicates that rural health practitioners appear to have the same basic needs for patient-care information as their urban counterparts, and that both groups rely on colleagues and personal libraries as their main sources of information. Rural practitioners, however, tend to make less use of journals and online databases and ask fewer clinical questions; a difference that correlates with geographic and demographic factors. Rural practitioners experience pronounced barriers to information access including lack of time, isolation, inadequate library access, lack of equipment, lack of skills, costs, and inadequate Internet infrastructure. Outreach efforts to this group of underserved health professionals must be sustained to achieve equity in information access and to change information-seeking behaviors.     

HIV/AIDS Outreach: Curriculum Development and Skills Training to Health and Information Professionals

With funding from the National Library of Medicine HIV/AIDS Community Information Outreach Program (ACIOP), librarians at the University of Florida Health Sciences Libraries partnered with university and community groups to facilitate collaboration, develop new information resources, develop information-seeking skills, and raise general awareness surrounding HIV/AIDS risks, prevention, and treatment. This article describes the skills development elements of the project, including development and implementation of an HIV/AIDS information resource curriculum for health care providers, social services professionals, and public librarians within the project’s partner organizations.     

Building bridges: towards integrated library and information services for mental health and social care

This research focuses on identifying the information needs of health professionals, social workers and staff from voluntary agencies, who work together in the provision of services for people with a mental illness. The aim is to provide a fully integrated library and information service for mental health and social care. A number of recent government reports have prompted this research. These have culminated in the publication of the National Service Framework for Mental Health. It was decided to conduct a qualitative study using 17 semi‐structured interviews with individuals and multi‐professional groups. A thematic analysis highlighted a number of key themes including: information need, information seeking behaviour and information flows. Results have indicated that because of the dispersed nature of mental health services, across primary and secondary care, and from statutory and non‐statutory organisations, information technology is viewed as the only realistic vehicle to provide the required information. As specialist mental health trusts are configured, covering wider geographical areas, this can only increase the reliance on information technology, for information access and information sharing.     

Improving the provision of traditional health knowledge for rural communities in Ghana*

In Ghana many rural illiterate people practise traditional medicine and spread their knowledge through oral communication among themselves. This paper observes that traditional health information which freely circulates, and is actively disseminated by healers in rural communities greatly contributes to the knowledge for preparing home remedies and other traditional interventions. Oral communication can give rise to inaccurate and even dangerous information where charlatans can penetrate and operate within the health system. The Danfa project, which involved verbal teaching of modern health techniques to illiterate herbalists, and educating villagers about improved traditional medical practices, is described as a success story of information provision for illiterates. The experience is applied to propose the modification of some training programmes under the Ministry of Health to produce traditional health care information providers. Repackaged information and the public media are recommended as the most effective method of transferring knowledge to those unable to read.     

The costs and effectiveness of information-skills training and mediated searching: quantitative results from the EMPIRIC project

OBJECTIVES: To compare the effectiveness and costs of providing information for patient care via librarian-mediated searches and information-skills training. METHODS: A questionnaire survey to library staff and health professionals in the North West. Data was collected on perceptions of services, satisfaction and service usage, allowing a cost analysis to be undertaken. Statistical data was analysed using Statistical Package for the Social Sciences (spss). RESULTS: Using satisfaction and use of skills as outcome measures, both mediated searches and information skills training are effective. A breakdown of costs per type of training session and literature search is provided. Cost-effectiveness is dependent on whether costs are viewed from a library or trust point of view. Providing information skills training does not reduce the volume of mediated-search requests. CONCLUSIONS: No one method of providing information for health professionals is more effective or cost-effective than another. A decision about which services to provide cannot be made on the basis of effectiveness or costs alone; the views of library staff and the health professionals they serve should also be taken into account. A proactive approach and targeting training towards those who are most likely to benefit may be an appropriate way forward.     

Distance learning for MLA’s centennial!

In celebration of the Medical Library Association’s Centennial, their Continuing Education Committee developed a year of distance learning opportunities concerning evidence-based health care. The Centennial Distance Learning Program, as it became known, strove to reach as many members as possible by offering a wide variety of formats, including a teleconference, Web resources, journal clubs, and a suite of traditional CE courses at the annual meeting. This was the first time that MLA had attempted a multi-level distance learning project and it proved to be a rousing success! For more details, visit the ‘EBHC in Action’ Web page on MLANET at: http://www.mlanet.org/education/telecon/index.html .