4
Understanding the Information Needs of Health Professionals

As knowledge about the health effects of exposure to occupational and environmental chemicals increases, health professionals and other interested individuals need to be able to access and use resources that provide timely and accurate toxicology and environmental health information in an efficient and accessible manner. To better understand the toxicology and environmental health information needs of health professionals and the methods by which they locate this information, the committee reviewed the published literature (which deals primarily with physicians and their general methods of seeking information) and focused on those issues specific to toxicology and environmental health information by receiving input from health professionals through focus group discussions (see Appendix C), data collected from the questionnaire (see Appendix B), and committee discussions with colleagues and other health professionals.

INFORMATION NEEDS

In 1967, R.E. Maizell estimated that the half-life of the current information known by scientists, engineers, and health professionals was close to 10 years; that is, in 10 years half of what is learned by those in technical fields will become obsolete, and half of what such professionals will need to know is not yet available (Maizell, 1967). Advances in technology continue to increase the expansion of biomedical information at such a rapid rate that health professionals cannot possibly absorb and retain all of the information available. However, the development of online information resources, such as the TEHIP databases, have the potential to alleviate this problem by providing a framework for stor



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 69
4 Understanding the Information Needs of Health Professionals As knowledge about the health effects of exposure to occupational and environmental chemicals increases, health professionals and other interested individuals need to be able to access and use resources that provide timely and accurate toxicology and environmental health information in an efficient and accessible manner. To better understand the toxicology and environmental health information needs of health professionals and the methods by which they locate this information, the committee reviewed the published literature (which deals primarily with physicians and their general methods of seeking information) and focused on those issues specific to toxicology and environmental health information by receiving input from health professionals through focus group discussions (see Appendix C), data collected from the questionnaire (see Appendix B), and committee discussions with colleagues and other health professionals. INFORMATION NEEDS In 1967, R.E. Maizell estimated that the half-life of the current information known by scientists, engineers, and health professionals was close to 10 years; that is, in 10 years half of what is learned by those in technical fields will become obsolete, and half of what such professionals will need to know is not yet available (Maizell, 1967). Advances in technology continue to increase the expansion of biomedical information at such a rapid rate that health professionals cannot possibly absorb and retain all of the information available. However, the development of online information resources, such as the TEHIP databases, have the potential to alleviate this problem by providing a framework for stor

OCR for page 69
ing, processing, and retrieving needed information. It then becomes important to fully understand the information needs of health professionals so that the correct information is collected and stored in an accessible manner. Thus, the ability to define the information needs of health professionals (although not well-studied) is essential to the development of systems that will support their needs. Why Health Professionals Need Information The information needs of health professionals stem from a variety of factors including patient care, patient education, professional curiosity, and research. Additionally, the rapid advancements in technology and science have expanded the knowledge base in all fields of medicine and health care. In 1991, Osheroff and colleagues developed a typology that assesses the information needs of health professionals, specifically physicians, by analyzing the questions posed during clinical teaching. They concluded that information needs are driven by the extent of a patient's problem, a patient's inquiry, the professional's knowledge base, and his or her level of awareness of available resources and curiosity to find out more information. The study defined the information needs of health professionals in terms of three components: (1) information that is needed for decision making and that is already known by the health professional (currently satisfied needs); (2) information that is not known by the health professional but that he or she recognizes as being applicable to the decision-making process (consciously recognized needs); and (3) information that is important to the circumstances at hand but that the health professional does not realize is applicable (unrecognized needs) (Osheroff et al., 1991). Williams and colleagues (1992) categorized the information needs of health professionals by the reason that health professionals begin their search for information, to: confirm or disconfirm existing knowledge; assist in solving a new or unfamiliar health care problem; update basic knowledge on a topic through review; obtain information from another specialty when dealing with a patient or person with multiple problems; highlight particular patient care concerns to other members of the health care team; find out about a rare or unusual patient care problem; determine whether a knowledge gap exists in the literature and whether a new research project or publication should be planned; or assist in implementing new administrative or organizational initiatives.

OCR for page 69
Information Needed by Health Professionals The type of information needed by health professionals is dependent on many factors, including the topic or issue in question, the knowledge base of the health professional, his or her awareness of information sources, the associated costs of acquiring information, and the purpose for which the information will be used. The "trigger" or starting point for conducting a search for information varies widely among health professionals. Focus group participants indicated that most of their inquiries related to environmental health information begin with the name of a chemical substance or with symptoms potentially associated with a known exposure (Appendix C). For example, emergency room and primary care professionals stated that they often need to "translate" the brand name of a household product into the scientific chemical name before beginning a common starting points included the place of work, type of job, or geographic location (see also Chapter 6). A 1988 IOM committee examined the growing occupational and environmental information needs of health professionals, particularly of primary care physicians, and formulated a list of information search. Other needs that included: causative agents of occupational and environmental illnesses; signs, symptoms, and diagnosis of and treatment for occupational and environmental illnesses; nonclinical and supportive interventions; and disease and exposure patterns within the community (IOM, 1988). Once an information need has been identified, determining who actually conducts the information search depends on a number of factors, including having the ability to conduct a database search (access to the database and the knowledge required to conduct the search); having time available to conduct the search; and determining whether a high value is placed on seeing the data and information available and following leads and data "trails." Focus groups indicated that specialists and researchers in toxicology and environmental health, as well as information specialists, public health officials, educators, and students, are more likely to conduct searches themselves, whereas physicians in general or health professionals working in nontoxicology-related fields are most likely to have others conduct a search for them. FACTORS AFFECTING INFORMATION SEEKING When health professionals make a decision on whether to pursue an information query, they must weight and reach a compromise between a number of conflicting factors including the need for the information and the associated costs of locating the information such as the time, effort, and financial costs involved in information seeking (Connelly et al., 1990). Huth (1985) analyzed information-seeking methods in terms of a utility-cost analysis. In this approach

OCR for page 69
(as seen below), the value of the information resource depends on the utility of the retrieved information (its relevance, thoroughness, and the efficiency with which it is retrieved) as it relates to the costs necessary to obtain the information (including the purchase cost and time and other access costs). Studies on the information-seeking behaviors of health professionals have found that colleagues and reference books are frequently the information resources that health professionals first turn to with an information query (Blackwelder and Dimitroff, 1996; Covell et al., 1985; Curley et al., 1990; Williamson et al., 1989). The access costs are minimal, and the relevance and efficiency are usually high. A recent study of nurses, physicians, pharmacists, occupational and physical therapists, and other health professionals found that 45 percent would first consult a colleague to answer an information query, 28 percent would first use personal files and reference collections, and 17 percent would first consult a librarian (Blackwelder and Dimitroff, 1996). Similarly, a 1990 survey revealed that nurses sought information from colleagues 45 percent of the time, consulted written sources 45 percent of the time, and used other resources including databases 10 percent of the time (Corcoran-Perry and Graves, 1990). Participants in the focus group discussions (see Appendix C) identified similar factors influencing the way in which they locate information. A number of studies have shown that owing to a host of factors, including lack of awareness, access, training, and time, many health professionals have not developed effective and efficient information-seeking habits that expand beyond colleagues and textbooks (Covell et al., 1985; Haynes et al., 1990; Williamson et al., 1989; Woolf and Benson, 1989). Studies of younger health professionals who have consistently used computers during their education and training show that they are more likely to search the medical literature online, whereas many older professionals are more likely to be unfamiliar with searching online databases and tend to turn to colleagues and textbooks for information (Gruppen, 1990; King, 1987; Lockyer et al., 1985; Osiobe, 1985). The following sections discuss a number of the factors that influence information-seeking behaviors in health professionals. An understanding of these factors is critical for the development of future information resources that best serve the diverse information needs of health professionals.

OCR for page 69
Demographics Although current health professionals appear to be in a transition phase regarding computer use, the new generation of young health professionals is more computer literate and more reliant on computers for many different kinds of information. Many current medical and nursing students spent their high school and college careers using computers for school and recreation. School libraries at all levels have online library catalogs, and the use of computers in schools has been increasing rapidly.1 In the next 10 years, there will be a dramatic shift in student computer expertise, in computer familiarity, and in the assumption on the part of students that information is more easily located online than in reference books. This changing dynamic will have a significant impact on computer utilization skills and on the extent of online database searching. Work or Practice Setting The work environment or practice setting also affects the information-seeking behaviors of health professionals. There are wide variations between work settings in the opportunities that health professionals have to access online databases and computer networking capabilities. Health professionals in smaller work environments or practice settings (e.g., clinics and private practices) tend to rely more heavily on informal sources, such as colleagues, and limited formal sources, including textbooks and handbooks (Dalrymple, 1990). Although health professionals working in academic settings or in larger clinics and hospitals associated with medical schools or research institutions still refer to textbooks and colleagues frequently, they are more likely to have access to health science libraries and extensive computer networks (Dalrymple, 1990; Gruppen, 1990; Osiobe, 1985). As computers continue to become more commonplace in all health care settings, access to online resources will no longer be an issue of concern. Time Sensitivity and Level of Detail The time sensitivity factor, or how quickly an answer is required, is closely correlated to the level of detail needed and the type of information resource consulted. Owing to time constraints, health professionals working in patient care require information resources that are readily accessible so information can be 1   It is estimated that there were 4.1 million computers in U.S. classrooms in the 1994–1995 school year, compared with 2.3 million computers in the 1991–1992 school year (GAO, 1996).

OCR for page 69
efficiently retrieved (e.g., colleagues, textbooks, and handbooks). These health professionals often need a summary of known information (e.g., summary information on a specific chemical and its effects) that accurately answers their questions (Cohen et al., 1982; Northup et al., 1983; Osiobe, 1985). This is particularly true in emergency care situations. When an emergency room physician encounters a patient who has swallowed a household cleaning product, that physician needs immediate factual data (i.e., What product was swallowed? What are the harmful ingredients in that product?) and detailed treatment management information. On the other hand, health professionals involved in research, policy development, and other activities that allow for a greater length of time to be devoted to locating information will frequently require comprehensive retrieval, an exhaustive search of the literature, and the use of in-depth sources of information (Cohen et al., 1982; Northup et al., 1983; Osiobe, 1985; Wallingford et al., 1990). Additionally, they are most likely not to want summarized information but rather are searching for original data from which they can draw their own conclusions or hypotheses. For example, a study of physicians' use of medical information resources found that 73 percent of the respondents indicated a willingness to spend between 10 and 30 minutes on computer searches (Woolf and Benson, 1989). However, most of these physicians indicated that they would devote this amount of time to conducting research, but not to making clinical decisions. Online databases can serve both the acute and long-term information needs of health professionals if systems are designed with those factors in mind. Cost In addition to the expenditure of the health professional's time involved in locating information, the financial costs of online searching may be a factor in determining what sources of information are consulted (Curley et al., 1990; Dalrymple, 1990). Since online charges generally are determined both by the amount of time spent online (the per-minute connect time) and by the amount of information retrieved online, knowledge of the database and expertise in developing relevant search strategies relate directly to the final costs. Because online costs are difficult to determine ahead of time, health professionals may prefer to use CD-ROM resources, which allow for unlimited searching for fixed costs. The extent to which search costs affect searching of online databases as well as potential strategies to simplify pricing structures (thereby providing the user with cost estimates at the outset of the search) need to be considered in future studies.

OCR for page 69
Accessibility and Relevance Ease of access and the relevance of the data retrieved are important considerations when seeking information and solutions to diagnostic and treatment problems. The use of textbooks and journals is easy and convenient for most practitioners. Furthermore, discussing a case with a trusted colleague, particularly one who has examined a similar case, may provide more relevance to the situation at hand. These are traditional methods of obtaining information, particularly among many current physicians who were not trained in the use of online resources and who are not aware of the benefits of online searching. Searching a computer database usually results in more extensive amounts of information, if not always completely relevant information,2 and substantial benefits to the patients. Several studies have demonstrated the benefits of online literature searching to the patients when health professionals have consulted online databases for additional or the most up-to-date information on diagnosis, treatment, and prevention (Haynes et al., 1990; King, 1987; Marshall, 1992). The retrieved information affected patient care in a positive way by changing the way in which a case was handled, contributing to a better-informed clinical decision, or resulting in higher-quality patient care. In 1994, Klein and colleagues examined the association between the use of MEDLINE searches by health care professionals and economic indicators of hospital costs, charges, and length of stay for inpatients. For the patients whose health professionals used MEDLINE and conducted literature searches early in the patients' stay, costs and lengths of stay were significantly lower than those for patients whose health professionals conducted searches later or not at all (Klein et al., 1994; Lindberg et al., 1993). Health professionals may not be aware of these benefits. Health care trends such as the use of evidence-based medicine approaches that emphasize incorporating the biomedical literature into clinical decision making may provide an impetus for increased searching of bibliographic databases. CURRENT AND POTENTIAL USERS OF THE TEHIP DATABASES The following section examines statistics on current TEHIP users and then focuses on potential users, discussing their information needs, the information sources that are currently being consulted for toxicology and environmental health information, barriers to using the TEHIP databases, and opportunities that 2   A study of literature searching by physicians found that physicians deemed 58 percent of the articles retrieved relevant to their initial queries (Gorman et al., 1994).

OCR for page 69
may increase the use of TEHIP databases. Potential users include all health professionals and other related user communities that might benefit from using the TEHIP databases as a source for toxicology and environmental health information. Current Users Toxicology and environmental health information is used by professionals working in a number of fields, including chemical manufacturing, pharmaceutical development, transportation of hazardous materials, environmental law, public advocacy, nursing, and clinical medicine. The general public, as discussed in Chapter 1, is also concerned about the adverse health effects from chemicals and environmental exposures, such as lead, radon, pesticides, smog, dioxin, and carbon monoxide, and may request additional information from their health care professionals or seek out the information themselves. Only partial statistics on the current use of the NLM databases are available. NLM does have statistics on searches conducted on the NLM servers, however, because NLM licenses its databases for tape, online, and CD-ROM access through commercial vendors, universities, and other institutions (see Chapter 6) complete statistics on all searches of the NLM databases are not available. A recent survey of 2,500 online users of the NLM databases (on the NLM servers) found that 46 percent of the users are health professionals, 20 percent are librarians, and 19 percent are scientists (NLM, 1996). This is in contrast to statistics on use of the TEHIP databases3 (on the NLM servers), which indicate that the primary users are in industry, with health professionals accounting for only a minor percentage of users. In 1995, 37 percent of the users of HSDB were identified as being from industry, whereas only 6 percent were from the health care community (data supplied by Specialized Information Services Division, NLM). Other TEHIP databases reported similar distributions of users. MEDLINE is widely used in the health care community as the source for bibliographic citations of the biomedical literature, and training on searching MEDLINE is included in the curricula of many health professional schools. Statistics on searches of the NLM servers show that, as may be expected, the use of MEDLINE far exceeds the use of specialized MEDLARS databases. NLM statistics indicate that in 1995 there were 5,262,329 online searches of MEDLINE, 71,631 of TOXLINE, 30,296 of HSDB, 17,593 of IRIS, 12,793 of 3   These statistics are based on the occupational information provided by users registering for NLM passwords and user IDs.

OCR for page 69
TRI, 33,427 of DIRLINE, and 13,808 of RTECS (NLM, 1997).4 MEDLINE contains only limited toxicology and environmental health-related information (including case reports, human toxicity levels, epidemiological studies, and literature reviews). Potential Users The committee discussed the health professional communities that potentially have information needs in toxicology and environmental health and use for the information in the TEHIP databases (Box 4.1). The committee took a broad perspective that encompasses a number of groups with interests in environmental health (Chapter 1). The committee realizes that the health professional community does not have homogeneous information needs and that there is wide variation in access to online databases and other information resources. Even with these variations, however, the committee believed that it was worthwhile to discuss potential user communities to provide generalized insights into how NLM might better meet the toxicology and environmental health information needs of these groups. The following list of potential user communities is not meant to be definitive or exhaustive but rather was used by the committee for purposes of discussion: primary care professionals (e.g., physicians, nurses, nurse practitioners, and physician assistants) and pharmacists; specialists in occupational and environmental health (physicians, nurses, nurse practitioners, physician assistants, industrial hygienists, and safety officers); emergency medicine and poison control center personnel (e.g., emergency room health professionals, emergency medical technicians, clinical and medical toxicologists, and specialists in poison information); health science librarians and faculty at health professional schools (including medical, nursing, public health, pharmacy, and dental schools); environmental health researchers and scientists (including health physicists, epidemiologists, toxicologists, and forensic practitioners); patients, the general public, and community organizations (including local emergency planning committees, public librarians, educators, and advocacy and activist organizations); and health professionals in local public health departments or in state and federal agencies (e.g., policy advisors, health educators, and public clinic personnel). 4   Note that these statistics only reflect searches on the NLM servers and do not account for searches from commercial or institutional access points.

OCR for page 69
BOX 4.1 Examples of the Applicability of the TEHIP Databases for the Work of Health Professionals CLINICALLY RELEVANT INFORMATION Information that has direct clinical relevance includes the emergency medical treatment information and the human toxicity summaries found in HSDB and TRIFACTS. Additionally, the bibliographic references found in DART provide information on reproductive toxicology, and the TOXLINE/TOXLIT databases provide extensive references on all areas of toxicology and environmental health. Health professionals may find DIRLINE useful in identifying additional information resources and relevant health-related organizations and associations for patients. RESEARCH INFORMATION The most likely users of the extensive animal and laboratory data found in several of the TEHIP databases are researchers. CCRIS, RTECS, and GENE-TOX all contain detailed experimental data on carcinogenicity and mutagenicity studies including the dose, target tissue, route of exposure, and test results. RTECS also contains information on skin and eye irritation studies, reproductive studies, and general toxicity studies. EMIC and EMICBACK contain bibliographic references to the literature on mutagenicity studies. REGULATORY INFORMATION Health professionals, particularly those working in occupational health settings, can use the information on exposure standards and regulations found in the HSDB, IRIS, RTECS, and TRIFACTS databases. There is extensive information on occupationally permissible exposure levels (OSHA standards and NIOSH recommendations) and the requirements for specific chemicals under a number of environmental laws including CERCLA, TSCA, FIFRA, and the Clean Air and Clean Water Acts. RISK ASSESSMENT INFORMATION In working on risk assessments and developing health policies based on risk, health professionals should be aware of the EPA carcinogenic and noncarcinogenic assessments in the IRIS database. This database provides reference doses for oral and inhalation exposures and carcinogenicity assessments based on inhalation or oral exposure. COMMUNITY ISSUES The TRI series of databases is a useful information resource for community members and health professionals interested in finding information on industrial emissions in and around their locality. Health professionals should be aware of this information resource as a tool for locating community-based information.

OCR for page 69
Although the type, depth, and frequency of toxicology and environmental health information needed by each of these groups will differ among individuals within and across the groups, depending on job responsibilities, demographics, training, work or practice setting, time, access, and availability, these groupings provide a framework from which to explore information needs, current strategies for finding information, and potential use of the TEHIP databases. The generalizations presented below draw on input provided to the committee from focus group discussions, responses to the committee questionnaire, and discussions with colleagues and other health professionals. They are presented here as examples from which some general conclusions may be made. Primary Care Professionals Information needs. Health care professionals in family health, pediatric health, and women's health are often the first point of contact for patients with environmental health questions and concerns. Primary care professionals often expressed a need for summarized information that they could then provide to patients. For example, pediatricians and pediatric nurse practitioners are frequently asked questions on environmental health exposures by breast-feeding mothers and by mothers concerned about the effects of exposure to hazardous substances during pregnancy. More infrequently but demanding more acute action are cases of poisonings. In these cases primary care professionals need specific and detailed treatment management information immediately. Information sources. Primary care professionals frequently consult textbooks or colleagues to answer their information needs (Gorman and Helfand, 1995). For acute care situations, primary care professionals call poison control centers for specific treatment management protocols. These resources are rapidly accessible and can provide summarized information. Primary care professionals do not have the time during the patient's visit to search online databases, although searching may be an option prior to providing patient follow-up. Barriers to using the TEHIP databases. Primary care professionals indicate that the major barriers that they face in searching the TEHIP databases are time, access, training, and the user interface. As indicated above, patient visits are short in duration and require rapidly available information. Primary care professionals may not have immediate access to online databases in the clinic or private-practice office. Additionally, training of primary care professionals has traditionally been based on searching MEDLINE. Therefore, these health professionals are often unfamiliar with the content of the TEHIP databases or the navigation methods necessary to conduct a search.

OCR for page 69
Opportunities. Trends in the increased availability and use of computers bode well for the use of all online databases as health professionals come to rely more heavily on computer resources for their information. Since primary care professionals are most familiar with searching MEDLINE, any efforts toward standardizing the interfaces (i.e., making MEDLINE and TEHIP database searching comparable from the user interface) will increase the utility of the TEHIP databases to these health professionals. Any modifications or refinements made in the TEHIP databases must be firmly grounded in the realities of daily practice, including issues of need, access, and cost. Training should be focused on those databases of greatest clinical value (e.g., TOXLINE and HSDB). There are many opportunities for training primary care professionals including increased emphasis on occupational and environmental health issues during professional training and continuing education courses. Occupational and Environmental Health Specialists Information needs. Occupational and environmental health professionals (e.g., physicians, nurses, nurse practitioners, physician assistants, industrial hygienists, and safety officers) need in-depth information, often on specific exposures. Focus group participants expressed a preference for using bibliographic databases to locate the primary literature rather than relying on summarized information presented in textbooks, factual databases, or other tertiary sources. Information sources. Specialists noted that they use a number of databases to meet their information needs, including NIOSHTIC, ReproTox, and some of the TEHIP databases, particularly TOXLINE, RTECS, and IRIS. Barriers to using the TEHIP databases. Specialists often work in academic health care centers, where access to the databases is available; however, they have indicated that they are still often baffled by the user interface to the TEHIP databases (particularly the direct searching interface) and are often not familiar with the range of information available through the TEHIP complement of databases. Opportunities. Marketing the TEHIP databases to this group of health professionals at occupational and environmental health conferences may be particularly useful. These health professionals are potentially extensive users of the TEHIP databases and indicated that hands-on training by using case studies and real-life scenarios would be useful in helping them to become more comfortable with searching the TEHIP databases. Efforts to improve the user-friendliness of the search interface would also improve the utility of the databases for these health professionals.

OCR for page 69
Emergency Medicine and Poison Control Center Personnel Information needs. Health professionals working in poison control centers, in emergency rooms, and on emergency response teams need rapid information on toxic exposures. They are frequently working with exposures to household products and need to be able to specifically translate the brand name of a toxic substance into information that will provide the proper treatment protocol. Information sources. Specialized information sources have been developed for use by poison control centers. Databases, particularly POISINDEX® are used because they are searchable by brand name and provide links to detailed treatment protocols. Other databases, including the TEHIP databases and reference books, are used by poison control centers to provide additional information. Although some emergency medical departments have in-house access to the POISINDEX® database, many emergency medical personnel call poison control centers to obtain toxicity information and management recommendations. A 1991 study of emergency physicians in Utah found that 94 percent used poison control centers as their information resource, 78 percent used toxicology textbooks, 34 percent consulted with a colleague, and 24 percent accessed an in-house POISINDEX® database (Caravati and McElwee, 1991). Barriers to using the TEHIP databases. One of the major barriers to using the TEHIP databases for emergency care is that the TEHIP databases do not have the rapid links between brand names and detailed emergency treatment protocols. Treatment protocols in HSDB are provided from the POISINDEX® database and are made available to HSDB through a reciprocal agreement between NLM and Micromedex, Inc. (see Chapter 2). Opportunities. There are opportunities for NLM and the American Association of Poison Control Centers to work together on refinements to the TEHIP databases that would make these resources more useful for poison control centers and for the larger health care community. Health Science Librarians and Faculty at Health Professional Schools Information needs. Faculty in health professional schools (including nursing, pharmacy, dental, public health, and medical schools) require a working knowledge of the information resources available in toxicology and environmental health to incorporate information resources into case studies and other teaching tools. Librarians working in health science libraries and other

OCR for page 69
academic institutions have a wide range of information needs depending on the type of information requested. Information sources. Since they work in academic institutions, these health professionals are likely to have access to online and CD-ROM databases. Faculty may rely on textbooks and other reference materials, which are easily accessible in their offices, and on colleagues with specialized expertise, who are also readily available. Health science librarians use numerous online and print information resources. Barriers to using the TEHIP databases. The complexities of the user interface to the TEHIP databases may deter some faculty members from exploring the scope of the databases. Since numerous databases contain toxicology and environmental health information, faculty members and health science librarians may be unaware of or unfamiliar with the specific databases in the TEHIP complement. Opportunities. Faculty members would benefit from case studies that have been put together for their use and that include links or references to the TEHIP databases and other information resources in this field. The case studies would be particularly valuable as teaching tools if they were focused on specific topics currently being addressed in the curriculum (e.g., birth defects, cancer, and acute poisonings). Seminars at health professional conferences could focus on demonstrating the scope of these online resources by using case studies. By using the National Network of Libraries of Medicine to increase awareness, not only of these databases but also of the panoply of environmental health and toxicology databases, NLM would efficiently reach health science librarians. CONCLUSION AND RECOMMENDATION As seen in the previous section, health professionals have diverse needs for toxicology and environmental health information and face various barriers to fulfilling those information needs. The strengths that NLM can bring to bear on this problem are significant. NLM has the traditional strength of librarians and libraries, which is matching information to the information need. Additionally, NLM has state-of-the-art technical expertise in information organization and retrieval through its extensive research and development program. The focus groups (Appendix C) and the responses to the questionnaire (Appendix B) sponsored by the committee provide initial insights into the toxicology and environmental health information needs of health professionals and

OCR for page 69
the use of the TEHIP databases by these individuals.5 Through this input and committee deliberations, the disparate nature of the 16 databases in the TEHIP program became more evident. The committee recognized that the databases are not equally useful for the work of the different segments of the health professional community. Although the committee realized that the current TEHIP complement of databases is the result of both NLM initiatives and interagency agreements and that each database fills an important information niche, the committee believes that the TEHIP program should set priorities that would allow efforts to be focused on those databases that meet the information needs of the greatest number of health professionals. This is particularly critical in light of the fact that the TEHIP program has experienced reduced funding levels from interagency agreements in recent years (Chapter 2). Comparable to a business marketing strategy that necessitates an understanding of the specific needs of current and potential customers prior to designing and distributing the product, this prioritization of the TEHIP program would first require a more in-depth analysis of the toxicology and environmental health information needs of health professionals. This would include an understanding of the routes of information seeking, the level of detail in the information needed, the types of information required, who searches for information, and the barriers to retrieving information. The goal of this user profile analysis would be to match, as closely as possible, the needs of health professionals with specific TEHIP databases. Upon completion of the user analysis, TEHIP program staff could not only prioritize their training and outreach efforts with an emphasis on those databases that are the most useful to health professionals but could also prioritize the resources that are devoted to the databases with the greatest utility for health professionals. An in-depth analysis of the user community could be gained from workshops, surveys, and focus groups. Additionally, as will be discussed in Chapter 7, an advisory committee to the TEHIP program composed of potential users and a liaison committee composed of representatives of other federal government agencies involved in environmental health issues would make valuable contributions in assisting NLM in understanding the needs of the user communities. 5   It is important to note the limitations of the focus groups and questionnaire. The committee did not attempt to obtain a random scientific sample for the distribution of the questionnaire. Rather, the questionnaire was distributed both to professional association members and via the Internet. Thus, it was not feasible to determine the rates of response or to charecterize the nonresponders. Additionally, responding via the Internet requires some degree of computer expertise. Because travel time and expenses were considerations in inviting focus group participants, most of the participants were drawn from the mid-Atlantic, particularly the Washington, D.C. metropolitan area.

OCR for page 69
The committee recommends that NLM further expand its efforts to understand the toxicology and environmental health information needs of health professionals and the barriers they face in accessing that information by conducting a detailed user profile analysis. Additionally, the committee recommends that the results from that analysis be used to set priorities for subsequent efforts of the TEHIP program. REFERENCES Blackwelder MB, Dimitroff A. 1996. The image of health science librarians: How we see ourselves and how patrons see us. Bulletin of the Medical Library Association 84(3):345–350. Caravati EM, McElwee NE. 1991. Use of clinical toxicology resources by emergency physicians and its impact on poison control centers. Annals of Emergency Medicine 20(2):147–150. Cohen SJ, Weinberger M, Mazzuca SA, McDonald CJ. 1982. Perceived influence of different information sources on the decision-making of internal medicine housestaff and faculty. Social Science and Medicine 16(14):1361–1364. Connelly DP, Rich EC, Curley SP, Kelly JT. 1990. Knowledge resource preferences of family physicians. Journal of Family Practice 30(3):353–359. Corcoran-Perry S, Graves J. 1990. Supplemental-information-seeking behavior of cardiovascular nurses. Research in Nursing and Health 13:119–127. Covell DG, Uman GC, Manning PR. 1985. Information needs in office practice: Are they being met? Annals of Internal Medicine 103:596–599. Curley SP, Connelly DP, Rich EC. 1990. Physicians' use of medical knowledge resources: Preliminary theoretical framework and findings. Medical Decision Making 10:231–241. Dalrymple PW. 1990.CD-ROM MEDLINE use and users: Information transfer in the clinical setting. Bulletin of the Medical Library Association 78(3):224–232. GAO (General Accounting Office). 1996. Consumer Health Information: Emerging Issues. Publication No. GAO/AIMD-96-86. Washington, DC: U.S. General Accounting Office. Gorman PN, Ash J, Wykoff L. 1994. Can primary care physicians' questions be answered using the medical literature? Bulletin of the Medical Library Association 82:140–146. Gorman PN, Helfand M. 1995. Information seeking in primary care: How physicians choose which clinical questions to pursue and which to leave unanswered. Medical Decision Making 15:113–119. Gruppen LD. 1990. Physician information seeking: Improving relevance through research. Bulletin of the Medical Library Association 78(2):165–172. Haynes RB, McKibbon A, Walker CJ, Ryan N, Fitzgerald D, Ramsden MF. 1990. On-line access to MEDLINE in clinical settings: A study of use and usefulness. Annals of Internal Medicine 112:78–84. Huth EJ. 1985. Needed: An economics approach to systems for medical information. Annals of Internal Medicine 103(4):617–619.

OCR for page 69
IOM (Institute of Medicine). 1988. Role of the Primary Care Physician in Occupational and Environmental Medicine. Washington, DC: National Academy Press. King DN. 1987. The contribution of hospital library information services to clinical care: A study in eight hospitals. Bulletin of the Medical Library Association 75(4):291–301. Klein MS, Ross FV, Adams DL, Gilbert CM. 1994. Effect of online literature searching on length of stay and patient care costs. Academic Medicine 69:489–495. Lindberg DAB, Siegel ER, Rapp BA, Wallingford KT, Wilson SR. 1993. Use of MEDLINE by physicians for clinical problem solving. Journal of the American Medical Association 269:3124–3129. Lockyer JM, Parboosingh JT, McDougal GM, Chugh U. 1985. How physicians integrate advances into clinical practice. Mobius 5(2):5–12. Maizell RE. 1967. Continuing education in technical information services. Journal of Chemical Documentation 7:115. Marshall JG. 1992. The impact of the hospital library on clinical decision making: The Rochester study. Bulletin of the Medical Library Association 80:162–178. NLM (National Library of Medicine). 1995. National Library of Medicine: Programs and Services, Fiscal Year 1994. Bethesda, MD: NLM. NLM. 1996. Survey of Online Customers: Usage Patterns and Internet Readiness. NIH Publication No. 96-4181. Bethesda, MD: NLM. NLM. 1997. National Library of Medicine: Programs and Services, Fiscal Year 1995. Bethesda, MD: NLM. NIH Publication No. 97-256. Northup DE, Moore-West M, Skipper B, Teaf SR. 1983. Characteristics of clinical information-seeking: Investigation using critical incident technique. Journal of Medical Education 58:873–881. Osheroff JA, Forsythe DE, Buchanan BG, Bankowitz RA, Blumenfeld BH, Miller RA. 1991. Physician's information needs: Analysis of questions posed during clinical teaching. Annals of Internal Medicine 114:576–581. Osiobe SA. 1985. Use of information resources by health professionals: A review of the literature. Social Science and Medicine 21(9):965–973. Wallingford KT, Humphreys BL, Selinger NE, Siegel ER. 1990. Bibliographic retrieval: A survey of individual users of MEDLINE. MD Computing 7(3):166–171. Williams RM, Baker LM, Marshall JG. 1992. Information Searching in Health Care. Thorofare, NJ: SLACK Inc. Williamson GW, German PS, Weiss R, Skinner EA, Bowes F. 1989. Health science information management and continuing education of physicians. Annals of Internal Medicine 110:151–160. Woolf SH, Benson DA. 1989. The medical information needs of internists and pediatricians at an academic medical center. Bulletin of the Medical Library Association 77(4):372–380.

OCR for page 69
This page is blank in original.