Study Objective: We introduced self-service access to the medical literature database, MEDLINE, into clinical settings to assess the frequency, patterns, purposes, and success of use.

Design: Longitudinal descriptive study.

Setting: Inpatient and outpatient services of a university medical center.

Participants: All trainees and attending staff working at the service sites were invited to participate; 158 (84%) did so.

Interventions: Free online access was provided to MEDLINE through GRATEFUL MED software. Participants were offered a 2-hour introduction to online searching and 2 hours of free search time.

Measurements and Main Results: For each search, a computer program requested identification of the user and the question to be addressed. Search transactions were recorded automatically. Interviews were conducted after a random sample of searches, and search questions were given to more expert searchers to run for comparison with the original. Eighty-one percent of participants did searches oh study computers, at a mean rate of 2.7 searches per month. On comparison searches, participants retrieved 55% of the number of relevant articles retrieved by reference librarians (P = 0.024) and 50% more irrelevant articles (P < 0.001). Forty-seven percent of searches on patient problems affected clinical decisions, but often on scanty information.

Conclusions: MEDLINE searching from clinical settings is feasible with brief training and affects clinical decisions. However, inexperienced searchers miss many relevant citations and search inefficiently. Further studies are needed to assess the impact of searching on physician performance and patient care.

References

  • 1. StrossHarlan JW. The dissemination of new medical information. JAMA. 1979;241:2662-4. CrossrefGoogle Scholar
  • 2. EvansHaynesGilbertTaylorSackettJohnston CRJDDM. Educational package on hypertension for primary care physicians. Can Med Assoc J. 1984;130:719-22. MedlineGoogle Scholar
  • 3. WilliamsonGermanWeissSkinnerBowes JPREF. Health science information management and continuing education of physicians. Ann Intern Med. 1989;110:151-60. LinkGoogle Scholar
  • 4. CovellUmanManning DGP. Information needs in practice: are they being met? Ann Intern Med. 1985;103:596-9. LinkGoogle Scholar
  • 5. HaynesMcKibbonFitzgeraldGuyattWalkerSackett RKDGCD. How to keep up with the medical literature. IV. Using the literature to solve clinical problems. Ann Intern Med. 1986;105:636-40. LinkGoogle Scholar
  • 6. HaynesMcKibbonFitzgeraldGuyattWalkerSackett RKDGCD. How to keep up with the medical literature. V. Access by personal computer to the medical literature. Ann Intern Med. 1986;105:810-6. LinkGoogle Scholar
  • 7. HorowitzBleich GH. PaperChase, a computer program to search the medical literature. N Engl J Med. 1981;305;924-30. CrossrefMedlineGoogle Scholar
  • 8. CollenFlagle MC. Full-text medical literature retrieval by computer. A pilot test. JAMA. 1985;254:2768-74. CrossrefMedlineGoogle Scholar
  • 9. HaynesMcKibbon RK. Grateful Med. MD Computing. 1987;4:47-9, 57. MedlineGoogle Scholar
  • 10. McKibbonWalkerRyanFitzgeraldHaynes KCNDR. A study of MEDLINE in clinical settings: design and preliminary results. In: Greenes RA, ed. Proceedings of the Twelfth Annual Symposium on Computer Applications in Medical Care. New York: Institute of Electrical and Electronics Engineers; 1988:526-9. Google Scholar
  • 11. CollenFlagle MC. Full-text medical literature retrieval by computer: a pilot test. JAMA. 1985;254:2768-74. CrossrefMedlineGoogle Scholar
  • 12. HorowitzJacksonBleich GJH. PaperChase: self-service bibliographic retrieval. JAMA. 1983;250:2494-9. CrossrefMedlineGoogle Scholar
  • 13. SewellTeitelbaum WS. Observations of end-user online searching behavior over eleven years. J Am Soc Information Sci. 1986;37:234-45. CrossrefMedlineGoogle Scholar
  • 14. KirbyMiller MN. MEDLINE searching on Colleague: reasons for failure or success of untrained end users. Medical Reference Services Q. 1986;5:17-34. CrossrefMedlineGoogle Scholar
  • 15. White H. Putting users to work. Library J. 1988;113:40-1. Google Scholar
  • 16. DickersinHewittMutchChalmersChalmers KPLIT. Perusing the literature: comparison of MEDLINE searching with a perinatal trials database. Controlled Clin Trials. 1985;6:306-17. CrossrefMedlineGoogle Scholar
  • 17. KirpalaniSchmidtMcKibbonHaynesSinclair HBKRJ. Searching MEDLINE for randomized clinical trials involving care of the newborn. Pediatrics. 1989;83:543-6. MedlineGoogle Scholar
  • 18. Ad hoc working group for critical appraisal of the medical literature. A proposal for more informative abstracts of clinical articles. Ann Intern Med. 1987;106:598-604. LinkGoogle Scholar
  • 19. DaviesDeVierno NA. Reimbursement for computer-assisted literature searches for patient care [Letter]. N Engl J Med. 1988;319:1021. CrossrefMedlineGoogle Scholar

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