Project Summary

Goals and Objectives
Family physicians and members of the primary health care team have very busy practices.  Each day they are confronted with many questions that arise from patient visits.  Due to the large volume of patients that they see each day, there is very little time to find the answers to their questions.
 
This project will demonstrate a librarian consultation service to Family Health Networks (FHNs) to answer short reference questions.  Family physicians, nurse practitioners and other members of the primary care team will be taught how to use this service, including which types of questions they should request from the librarian. The questions will be answered within twenty minutes to provide “just-in-time” information.
 
This demonstration project will be measured at several different time periods to assess the impacts of the service.  By providing access to librarians, who are experts in information retrieval, it is anticipated that this service will provide valuable and timely information to the FHN.  It may be very cost-effective to use librarians in this role.  It is anticipated that the results of this project can be applied widely to other FHNs, including urban and rural FHNs, either locally, provincially or nationally.
 
For more information contact:

justintime@bruyere.org
 
Research Questions
This project will address the following questions:

• Does inter-disciplinary collaboration between the discipline of library and information science and the various disciplines of family medicine, nursing and allied health professions improve access to information for quality patient care decision-making?
• Will the use of an information, communication technology (ICT) enabled librarian consultation service reduce the workload and/or save time for family physicians, nurses and allied health professionals and office staff in FHNs, whether in urban or rural areas?
• Is it cost-effective to use a librarian service to locate and disseminate information to primary care staff in a primary care setting?

Methodology

• Randomized controlled trial of 70 to 80 physicians and allied health professionals working in Family Health Groups and Family Health Teams. 
• Clinicians are trained by information specialists (medical librarians) to use a BlackBerry handheld to send clinical questions that arise during patient visits. Clinicians are also taught how send questions using an evidence-based (PICO) approach.
• Outcome assessments:
  • Ongoing clinician questionnaires and informal interviews will be used to assess satisfaction level with the service;
  • Participants complete questionnaires examining their information-seeking behaviour at both the start and end of the study to evaluate the impact of the clinical answers provided by the librarians.

Phases / Timeline
Phase I (April 2004 - September 2004) – Establish research team, develop intervention, recruit Information Specialists.  Train information specialists and develop web portal specifications with contractor. Finalize data collection instruments.  Recruit and educate FHN clinicians and staff about project, intervention and collaboration.
 
Phase II (October 2004 - September 2005) – Trial commences with entry of information specialist into first FHN
 
Phase III (October 2005 - December 2005) – Randomization commences.
 
Phase IV (January 2006) – Completion of study. 
 
Phase V (March 2006 - July 2006) – Dissemination and completion of project.
 
Results

• Librarians answered 1,889 clinical questions in <15 minutes (mean =13.58 minutes/question) during the project
• 83.7% of answers to intervention questions were rated by clinicians as having a high-to-moderate impact on clinical decision-making
• 23.0% of answers to control questions were rated by clinicians as having a high-to-moderate impact on clinical decision-making
• 40.5% of control questions were answered by clinicians, 7.2% asked a practice colleague, 4.6% discussed by phone with another physician, 1.7% had their patient return, and 3.4% arranged for a referral and 9.5% took other actions.
• Questions by Type:
  • Therapy 39%
  • Etiology 19%
  • Diagnosis 18%
  • Prevention 14%
  • Other 8%
  • Prognosis 2%
• Popular Topics:
  • Pregnancy, Cancer, Immunization, Diabetes, Vitamins
• Commonly Consulted Information Resources:
  • Cochrane Collaboration Library (www.cochrane.uottawa.ca)
  • TRIP Database (www.tripdatabase.com)
  • Clinical Evidence (www.clinicalevidence.com)
  • National Guideline Clearinghouse (www.guideline.gov)
  • Emedicine (www.emedicine.com)

Funding body and amount
This project is funded by the Ontario Ministry of Health and Long-Term Care, Primary Health Care Transition Fund in the amount of $561,900.

Principal Investigators

Dr. William Hogg, Director, C.T. Lamont Centre 
 
Jessie McGowan, Senior Information Scientist, Trials Search Coordinator Centre for Global Health/EPOC 
 
Co-Investigator

Dr. Craig Campbell, Director, Professional Development, Royal College of Physicians and Surgeons of Canada