ABSTRACT

This review of literature compares 11 scholarly studies published in peer‑reviewed journals from 1990-2000. Portions of the studies demonstrate how physicians seek “cutting‑edge” information, i.e., new, innovative, and futuristic information, despite preferences for following the “Principle of Least Effort”. For timeliness and for ease in finding information, physicians prefer the known to the unknown in their information-seeking habits, by human, print, or electronic methods. How do physicians discover the unknown despite their preferences or habits? The 11 scholarly studies suggest solutions to this puzzle such as education and training, use of intermediaries, use of professional medical networks and colleagues, and pursuit of future developments in information science. Furthermore, in this review, other types of literature are cited to complement the conclusions of the scholarly studies about physicians’ information-seeking behavior. Books, essays, and reports from 1993–2002 are included from leaders across industry, government, and academia in order to expand upon the “Principle of Least Effort” observed by the scholarly studies.

Literature Review of How Physicians Seek “Cutting-Edge” Information and “The Principle of Least Effort”

INTRODUCTION

A growing body of research indicates that physicians follow the “Principle of Least Effort” when seeking “cutting-edge” information, i.e., new, innovative or futuristic information (e.g., Gaither et al, 1994; Haug, 1997; Peay & Peay, 1990; Pyne et al, 1999). According to Mann, “This principle states that most researchers (even ‘serious’ scholars) will tend to choose easily available information sources, even when they are objectively of low quality, and, further will tend to be satisfied with whatever can be found easily in preference to pursuing higher-quality sources whose use would require a greater expenditure of effort” (1993, p. 91). The “Principle of Least Effort” is also related to Mann’s “Actual-Practice Model” where physicians might “place extraordinary emphasis . . . on simple footnote chasing from known sources, especially those in their personal libraries, or on talking to colleagues” (1993, p. 75). In other words, physicians prefer the known to the unknown in their information-seeking habits.

SCOPE

In light of the “Principle of Least Effort,” this review of literature examines 11 scholarly studies published in peer-reviewed journals from 1990 to 2000 focusing on the topic: “information-seeking behavior” of physicians and their efforts to find new, innovative, or futuristic information—“cutting-edge” information. In this review, the term “physician” indicates licensed medical practitioners and does not single out a particular group of physicians such as general practitioners vs. specialists even though some of the studies make this distinction. The articles have been selected based upon relevance to the topic and to the “Principle of Least Effort”. Reading of the articles determined the final selection of relevant articles. All journal articles are written in English, and scholarly studies are conducted in Australia, Canada, Sweden, UK, or US. Qualitative and quantitative results are considered.

Other types of literature have been selected to complement the conclusions of the scholarly studies about physicians’ information-seeking behavior. In order to expand upon the common themes from the scholarly studies, relevant books, essays, and reports are included from across industry, government, and academia (e.g., Bryant, 1999; Harris Interactive, 2001; Health Strategies Group, 1999; Monaghan & Misso, 1999; Sewak, 2002; T. A. Miller Company, 2001; Quintiles Scott-Levin Market Research, 2001). For example, in his insightful book, What will be: how the new world of information will change our lives, M. Dertouzos, Director, MIT Laboratory for Computer Science, states, “no matter how far technology advances, we should—and undoubtedly will-always feel free to exercise our human prerogative by saying ‘No’ ” (1997, p. 174). That is, humans tend to follow their preferences for what is convenient and timely. Dertouzos describes easy access to medical information in the future via an imaginary program called “Guardian Angel” similar to what many of the scholarly articles predict for physicians and patients in the future.

Other authors build upon Dertouzos’ ideas. In chapters about “The Limits of Information” and “Agents and Angels”, John Seely Brown and Paul Duguid describe similar human preferences for seamless, easy, or “known” avenues of access to information (2000, pp. 31‑62).

Writing from a physician’s perspective, Jerome Kassier, M.D. Professor at Tufts University and editor-in-chief emeritus of the New England Journal of Medicine, proposes a new role for physicians. “Physicians will be called on to develop a new partnership with a public that is more responsible for its own care” (2000, p. 116). This partnership is forcing physicians to go beyond the “Principle of Least Effort” and “Actual-Practice Model”. Both the scholarly and non‑scholarly sources note how physicians are changing their information-seeking behavior despite preferences for least effort and known methods.

SOURCES

For this literature review, scholarly articles, books, essays, and reports are gathered from human, paper, and electronic sources. Human sources include consultations with colleagues at work, with librarians, and with faculty members at Drexel University. Paper methods include a combination of “look ups” via card catalogs and indexes, of browsing, and of serendipity: locating printed material; reading bibliographies within relevant articles; browsing publications in the library stacks and in book stores; and reading journals and newspapers. Electronic systems for searching include: DIALOG^®, LEXIS^®‑NEXIS^®, and W. W. Hagerty Library’s Online Public Access Catalog (OPAC). The Drug Information Association web site (www.diahome.org) is used for electronic retrieval of some article(s) in Portable Document Format (PDF), equivalent to paper. See Appendix A: How Sources Were Located for details about how each source was located.

METHOD

In focusing on “The Principle of Least Effort”, Mann warns, “There are so many of these studies that the library profession truly does not need any more of them. What it does need, however, is a crystallized understanding of the information that we already have” (1993, p. 92). In this literature review, 11 scholarly articles are compared. The physicians’ preferences for “The Principle of Least Effort” emerge when comparing sections in the articles covering discussions, conclusions, and recommendations about new, innovative, or futuristic information-seeking behavior of physicians.

COMPARISON AND COMMON THEMES

Reviews of Literature and Meta-Analyses

In the course of their studies, scholars often review the literature and provide meta‑analyses concerning information-seeking behavior of physicians. Per Mann’s statement above, these scholars attempt to understand the information we already have. For example, Peay & Peay reviewed the literature from 1940 – 1990 and proposed further study for the future on “Patterns of Preference for Information Sources in the Adoption of new Drugs by Specialists” (1990, p. 467). James D. Haug, Reference Librarian, reviewed twelve studies published between 1978 and 1992 and categorized and ranked physicians’ preferred information sources (1997, p. 223). Williams and Henzel reviewed the findings of 17 studies from 1952–1986 via 20 datasets and described the sources and importance and/or use of information about pharmaceuticals by physicians (1991, p. 46). Literature reviews and meta-analyses found that physicians select different sources and make decisions due to many different variables. Studies over time are inconclusive and tend to call for more research. However, physicians’ preferences for the “Principle of Least Effort” are observed consistently across literature reviews, meta‑analyses, and individual studies.

Fast-Paced Environment of Medical Practitioners

Each study attempts to capture the context of physicians’ information-seeking behavior. Across studies, information overload is observed in physicians’ work environments and daily lives. For example, Figueiras’ research recognizes patient load as a factor influencing information-seeking habits and quality of care, and study results indicate the need “to promote better relationships among physicians and between physicians and patients” (2000, p. 747). Pyne and co-authors use qualitative research methods in studying how physicians seek new information in a fast-paced environment and describe “the quest” for clinical research evidence. “To keep abreast of relevant developments and inform their practice with current research evidence, clinicians are estimated to need to read 19 articles per day, every day of the year, an impossible task for even the most dedicated and tireless clinician” (1999, p. 3). Pyne and co-authors discover that for physicians “Making decisions on the basis of abstracted information can be a dangerous practice” (1999, p. 8). Furthermore, “Any action that takes longer than 30 seconds is unlikely to be generally adopted in clinical practice, because the cumulative effect on the time of the professionals is too great” (1999, p. 9).

Commercial vs. Non-commercial sources for “cutting-edge” information

Many of the studies observe and discuss physicians’ preferences for commercial or non‑commercial sources (i.e., professional sources) when seeking new, innovative, or futuristic information in order to make key decisions (e.g., Gerrett & Clark, 1997; Lundborg et al, 1998; Peay & Peay, 1997; Rooney & Hornby, 2000). Rooney and Hornby note general practitioners’ “ambivalence and skepticism” towards a government information initiative in the UK (2000, p. 148). When studying physicians’ information‑seeking strategies in regard to newly approved drugs, Lundborg concludes that “Noncommercial drug information sources have high credibility . . . . Individualized information strategies tailor-made for different drug categories appear to be important” (1998, p. 777). Gerrett & Clark discover two distinct trends in the information-seeking behavior of general practitioners. The first trend is the “Principle of Least Effort” in action. It is “source-dependent” where general practitioners “relied predominantly on one or two specific sources or had a method they applied to all situations” (1997, p. 221). Gerrett & Clark name the second trend “problem-dependent” where general practitioners “used multiple information sources in a manner dedicated to resolving each problem” (1997, p. 221). The efficient use of multiple sources, i.e., human, print, and electronic, is related to discussions, conclusions, and recommendations across the 11 studies on how physicians might go beyond the “Principle of Least Effort” when seeking information.

Solutions to the Puzzle

The scholarly studies suggest ways for physicians to go beyond the “Principle of Least Effort”. Haug emphasizes why it is important for physicians to pursue knowledge beyond their routine sources and information-seeking habits. “While often asked and researched, these questions remain a matter of paramount importance. It is a matter that concerns the health of patients and the public, the professional credibility and status of physicians, and the organization of institutions and services for training and providing information to physicians.” (1997, p. 223). Many of the 11 studies recommend education and training, use of intermediaries, use of professional networks and colleagues, and pursuit of future developments in information science. For example, to facilitate improvements in the future for physicians seeking information, Pyne and co-authors provide a framework for training and continued education including a matrix of competencies—personal attributes, interpersonal skills, self-management skills, information management skills and technical knowledge and skills. Three levels of competence “could easily be identified and managed (basic, intermediate and advanced)” (1999, p. 12).

Several studies question the role of education and the potential for assistance from intermediaries and colleagues, when physicians seek new, innovative, or futuristic information. In general, according to Walker and Janes (1999, p. 279), the searcher/requestor has difficulty articulating his or her need. Education and/or assistance from an intermediary are keys to success. Along these lines, in his chapter “Reference Books, Databases, and the Repertoire,” White refers to a component of the information-seeking behavior of doctors and patients in relation to medical librarians.

But customers do have an insight that sustains them in going without help, and that is that answers to the really important questions in their lives, the fateful questions, are not to be found in reference works. The kinds of questions information specialists could help them with are typically non‑fateful—unlike those brought to, say, doctors, lawyers, and clergy—and this, too contributes to their remaining ignorant; there is no driving force of fear or trouble to make them seek assistance. . . . It is all right, for example, to be a doctor or a patient, but what is the status of the medical librarian? (White et al, 1994, pp. 70‑71)

White’s insight is consistent with Peay & Peay’s findings as the “perceived situational risk of a drug increased, so did the use of professional as opposed to commercial sources of drug information” (1990, p. 468). Medical librarians, intermediaries, are not medical practitioners or experts within the professional specialty or discipline. The 11 studies do recognize that physicians’ information-seeking behavior does not take place in a vacuum even if the “Principle of Least Effort” might isolate the physicians and limit discovery of new, innovative, and futuristic information.

CONCLUSION

In this literature review, 11 scholarly studies are inconclusive and call for more research when examining the information-seeking behavior of physicians. However, when compared, the studies have common themes. Physicians and humans in general are resistant to change and avoid extra effort to find new, innovative or futuristic information. Education and assistance to physicians are emphasized in the studies including the role of intermediaries such as medical librarians. The studies show that physicians are ambivalent and skeptical about changing their habits. However, changes in human culture and technology are forcing physicians to change their relationships with patients, with colleagues, and with intermediaries such as information professionals.

REFERENCES

Primary Sources
(Scholarly studies published in peer-reviewed journals)

Gaither, C. A., Bagozzi, R. P., Ascione, F. J., & Kirking, D. M. (1996).  Reasoned action approach to physicians’ utilization of drug information sources.  Pharmaceutical Research, 13 (Sep), 1291-1298.

Gerrett, D., & Clark, J. C. (1997). General medical practitioners’ approaches to accessing animate sources of drug information. Drug Information Journal, 31 (1), 221‑227.

Haug, J. D. (1997). Physicians’ preferences for information sources: a meta‑analytic study. Bulletin of the Medical Library Association, 85 (3), 223-232.

Lundborg, C. S, Hensjo, L. O., & Gustafsoon, L. L. (1998). Drug information sources: reported preferences by general practitioners. Drug Information Journal, 32 (3), 777-785.

Peay, M. Y., & Peay, E. R. (1990). Patterns of preference for information sources in the adoption of new drugs by specialists. Social Science & Medicine, 31 (4), 467‑476.

Pyne, T., Newman, K., Leigh, S., Cowling, A., & Rounce, K. (1999). Meeting the information needs of clinicians for the practice of evidence-based healthcare. Health Libraries Review, 16 (1), 3-14.

Williams, J. R., & Hensel, P. J. (1991). Changes in physicians' sources of pharmaceutical information: a review and analysis. Journal of Health Care Marketing, 11 (3), 46-60.

Secondary Sources
(Books, Essays, Reports)

Brown, J.S., & Duguid, P. (2000). The Social Life of Information. Boston, MA: Harvard Business School Press. (See pages 31 – 62.)

Dertouzos, M. (1997). What will be: how the new world of information will change our lives. New York: HaperCollins Publishers.

Harris Interactive (2001). Computing in the physician’s practice. New York: Harris Interactive, Inc. (Available from Harris Interactive, 111 Fifth Avenue, New York, NY 10003)

Health Strategies Group. (1999). Access to high prescribers: the world of doorknob details. (Available from Health Strategies Group, Riverwalk, 201 South Main Street, Lambertville, NJ 08530. Phone 609-397-5282. Email info@HealthStrat or web at www.healthstrats.com)

Kassirer, J. P. (2000). Patients, physicians, and the internet. Health Affairs, 19 (6), 115‑23.

Mann, T. (1993). Library research models: a guide to classification, cataloging, and computers. New York: Oxford University Press.

Monaghan, V., & Misso, K. (1999). Evidence into practice: an information service for primary care professionals. Health Libraries Review, 16 (2), 82-88.

Quintiles Scott-Levin Market Research. (2001). E-promotion report 2001. Newtown, PA: Scott-Levin Corporate Center. (Available from Scott-Levin Corporate Centre, 60 Blacksmith Road, Newtown, PA 18940-1886. Phone 215-860-0440. Email email@scottlevin.com or marketing@scottlevin.com or web at www.scottlevin.com)

Sewak, S., Wilkin, N., Bentley, J., & Smith, M. (2002). Message and media strategies in cyberpromotion: an application of the elaboration likelihood model (ELM) to pharmaceuticals in the virtual world. (Available from Saurabh Sewak, Waller Lab Complex, Pharmaceutical Marketing and Management Research Program, University of Mississippi, University, MS 38677. Phone 662-915-5948. Email sssewak@olemiss.edu)

T. A. Miller Company. (2001). Physician use of the internet: 2001. Clifton, NJ: TAM Co. (Available from TAM Co., 1060 Clifton Ave., Clifton, NJ 0013-3699. Phone 973-778-6011. Email info@tamillerco.com or web at www.tamillerco.com)

Walker, G. & Janes, J. (1999). Online retrieval: a dialogue of theory and practice, 2^nd ed. Englewood, CL: Libraries Unlimited, Inc.

White, H., Bates, M., & Wilson, P. (1994). For information specialists: interpretations of reference and bibliographic work. Norwood, NJ: Ablex Publishing.

APPENDIX A: HOW SOURCES WERE LOCATED

Source Location

Figueiras, A., Caamano, F., & Gestal-Otero, J. J. (2000). Influence of physician's education, drug information and medical-care settings on the quality of drugs prescribed. European Journal of Clinical Pharmacology, 56 (9-10), 747-753. Sources include DIALOG searching in MEDLINE^® (154) and SCISEARCH^® (File 34) using Peay as source of relevant research.

Gaither, C. A., Bagozzi, R. P., Kirking, D. M., & Ascione, F. J. (1994). Factors related to physicians’ attitudes and beliefs toward drug information sources. Drug Information Journal, c28 (3), 817-827. Sources include Electronic Index to Drug Information Journal at www.diahome.org, Library & Information Science Abstracts (File 61), and SCISEARCH^® (File 34) using Peay as source of relevant research.

Gaither, C. A., Bagozzi, R. P., Ascione, F. J., & Kirking, D. M. (1996). Reasoned action approach to physicians’ utilization of drug information sources. Pharmaceutical Research, 13 (Sep), 1291-1298. Source includes SCISEARCH^® (File 34) using Peay as source of relevant research.

Gaither, C. A., Bagozzi, R. P., Ascione, F. J., & Kirking, D. M. (1997). Determinants of physician attitudes and subjective norms toward drug information sources: modification and test of the theory of reasoned action. Pharmaceutical Research, 14 (Oct), 1298-1308. Source includes International Pharmaceutical Abstracts (File 74) and SCISEARCH^® (File 34) using Peay as source of relevant research.

Gerrett, D., & Clark, J. C. (1997). General medical practitioners’ approaches to accessing animate sources of drug information. Drug Information Journal, 31 (1), 221‑227. Source includes Library & Information Science Abstracts (File 61).

Haug, J. D. (1997). Physicians’ preferences for information sources: a meta‑analytic study. Bulletin of the Medical Library Association, 85 (3), 223-232. Source includes Library & Information Science Abstracts (File 61).

Lundborg, C. S, Hensjo, L. O., & Gustafsoon, L. L. (1998). Drug information sources: reported preferences by general practitioners. Drug Information Journal, 32 (3), 777-785. Source includes International Pharmaceutical Abstracts (File 74)

Peay, M. Y., & Peay, E. R. (1990). Patterns of preference for information sources in the adoption of new drugs by specialists. Social Science & Medicine, 31 (4), 467‑476. Found via DIALOG and by finding same citation in bibliographies of relevant articles. Used this citation for SciSearch.

First located in bibliography of “Factors related to Physicians’ attitudes and beliefs toward drug information sources.” Bibliography is located in source above: Gaither, C. A., Bagozzi, R. P., Kirking, D. M., & Ascione, F. J. (1994). Factors related to physicians’ attitudes and beliefs toward drug information sources. Drug Information Journal, 28 (3), 817-827. Many works cited Peay & Peay across paper and electronic sources.

Pyne, T., Newman, K., Leigh, S., Cowling, A., & Rounce, K. (1999). Meeting the information needs of clinicians for the practice of evidence-based healthcare. Health Libraries Review, 16 (1), 3-14. Found via DIALOG search. Sources include Electronic Index to Drug Information Journal at www.diahome.org, DIALOG searching in MEDLINE^® (154) and SCISEARCH^® (File 34) using Peay as source of relevant research.

Rooney, I., & Hornby, S. (2000). From troglodytes to information managers: information management and technology needs to achieve the primary care NHS modernization agenda--the views of three GPs. Health Libraries Review, 17 (3), 148‑156. Sources include DIALOG searching in MEDLINE^® (154) and SCISEARCH^® (File 34) using Peay as source of relevant research.

Williams, J. R., & Hensel, P. J. (1991). Changes in physicians' sources of pharmaceutical information: a review and analysis. Journal of Health Care Marketing, 11 (3), 46-60.

First located in bibliography of “Factors related to Physicians’ attitudes and beliefs toward drug information sources.” Bibliography is located in source above: Gaither, C. A., Bagozzi, R. P., Kirking, D. M., & Ascione, F. J. (1994). Factors related to physicians’ attitudes and beliefs toward drug information sources. Drug Information Journal, 28 (3), 817-827. Other sources include DIALOG searching in MEDLINE^® (154) and SCISEARCH^® (File 34) using Peay as source of relevant research.

Secondary Sources
(Books, Essays, Reports)

Bryant, S. L. (1999). Information services for primary care: the organizational culture of general practice and the information needs of partnerships and primary care groups. Health Libraries Review, 16 (3), 157-165. Sources include DIALOG searching in MEDLINE^® (154) and SCISEARCH^® (File 34) using Peay as source of relevant research.

Brown, J.S., & Duguid, P. (2000). The Social Life of Information. Boston, MA: Harvard Business School Press. (See pages 31 – 62.) Recommended by member of Faculty at Drexel University. Source recommended by Sandra Hughes-Hassell, faculty member, Drexel University.

Dertouzos, M. (1997). What will be: how the new world of information will change our lives. New York: HaperCollins Publishers. Source found via newspaper article and visit to bookstore for Reading by author.

Harris Interactive (2001). Computing in the physician’s practice. New York: Harris Interactive, Inc. (Available from Harris Interactive, 111 Fifth Avenue, New York, NY 10003). Source provided by colleague at work.

Kassirer, J. P. (2000). Patients, physicians, and the internet. Health Affairs, 19 (6), 115-23. Sources include DIALOG searching in MEDLINE^® (154) and SCISEARCH^® (File 34) using Peay as source of relevant research.

Mann, T. (1993). Library research models: a guide to classification, cataloging, and computers. New York: Oxford University Press. Source introduced by Kate McCain, faculty member, Drexel University.

Monaghan, V., & Misso, K. (1999). Evidence into practice: an information service for primary care professionals. Health Libraries Review, 16 (2), 82-88. Sources include DIALOG searching in MEDLINE^® (154) and SCISEARCH^® (File 34) using Peay as source of relevant research.

Walker, G. & Janes, J. (1999). Online retrieval: a dialogue of theory and practice, 2^nd ed. Englewood, CL: Libraries Unlimited, Inc. Source introduced by Steve Bell, faculty member, Drexel University.

White, H., Bates, M., & Wilson, P. (1994). For information specialists: interpretations of reference and bibliographic work. Norwood, NJ: Ablex Publishing.

Used in course at Drexel University. Source introduced by Sandra Hughes‑Hassell, faculty member, Drexel University.

Details about electronic searching

Some of the relevant citations were identified via the following DIALOG^® databases: DIALINDEX^® (File 411); Educational Resources Information Center (File 1); Information Science Abstracts (File 202); International Pharmaceutical Abstracts (File 74); Library & Information Science Abstracts (File 61); Library Literature (File 438); MEDLINE^® (File 154); Social SciSearch^® (File 7), and SCISEARCH^® –A Cited Reference Science Database (File 34).

Key search techniques included search preparation and concept identification; database research via DIALOG^® Bluesheets; Boolean logic; proximity operators, field searching, and truncation. DIALOG^® DIALINDEX^® and OneSearch^® were used to search across databases. Both bibliographic and full text databases were used with controlled vocabulary, free text, and pearl growing (a combination of controlled vocabulary and free text) depending on the database(s). The Expand command and descriptor fields were especially helpful in identifying the best terms to use for searching the various databases.

Citations below are in alphabetical order by author. Each citation is followed by an extract from the article and by sources used to find the article. At the end of the bibliography, a TACTICS section provides detailed search statements and conclusions.

CITATIONS DERIVED FROM ELECTRONIC SOURCES

In a primary-care led National Health Service it is imperative for librarians not only to develop user-centred services for health professionals based in the community but also to facilitate information management within Primary Care Groups. In this article recent research in the field is discussed, and challenges intrinsic to delivering information services to primary care are identified. Drawing on the experience of one Practice Librarian in the Aylesbury area, the importance of organizational culture is considered, along with its implications for making successful approaches to partnerships. Five factors that motivated these practices to contract the services of an independent librarian are identified. The information needs of Primary Care Groups are discussed and the essential characteristics of future service provision are noted.

Search sources:

MEDLINE^® (154)

ss (PHYSICIAN? OR DOCTOR?) AND USER? AND (INFORMATION OR INFORMATION(1N)NEED? OR LIBRAR?) AND PY>1990 Set     Items   Description

S1      62093   PHYSICIAN?

S2      12763   DOCTOR?

S3      16474   USER?

S4     113320   INFORMATION

S5     113320   INFORMATION

S6     161135   NEED?

S7       1586   INFORMATION(1N)NEED?

S8      25348   LIBRAR?

S9    3089847   PY>1990

S10       578   (PHYSICIAN? OR DOCTOR?) AND USER? AND (INFORMATION OR INFORMATION(1N)NEED? OR LIBRAR?) AND PY>1990

S11       512   S10/ENG

S12    824332   PATIENT?

S13       208   S10 NOT (PATIENT?)

S14    114762   SEX?

S15       199   S13 NOT (SEX?)

Note:  The terms patient? and sex? were eliminated (NOT) because many of the citations in set 11 were not relevant but had descriptors related to patient? and sex?.

Also, SCISEARCH^® (File 34)

See TACTICS section below.

OBJECTIVE: To identify factors associated with low prescription quality in primary care. METHODS: We carried out a cross-sectional study on a sample of 405 primary care physicians in Galicia (Northwest Spain). The following independent variables were collected through a mail questionnaire survey: physician's education and specialty, physician's perception of the quality of available drug information sources, type of practice and number of patients. We constructed multiple regression models using as dependent variables four indicators of the quality of drugs prescribed. RESULTS: The response rate was 75.2%. The quality of drugs prescribed was found to be associated with regulated physician training (P = 0.001), perceived credibility of information sources (P = 0.013) and environmental characteristics of the practice (reform model and number of patients' cards). CONCLUSION: Study results suggest that in order to improve the quality of drugs prescribed, physician education and training must be improved and the role of pharmaceutical companies in physician training should be limited, emphasising more objective sources of information, such as therapeutic guidelines. Our results also underline the need to complete the reform of our primary care system and promote better relationships among physicians and between physicians and patients.
Search sources:

MEDLINE^® (154)
SCISEARCH^® (File 34)

See TACTICS section below.

Through the use of a mail questionnaire, factors related to physicians’ attitudes and beliefs toward seven drug information sources were investigated. A sample of 108 physicians was obtained from a large health maintenance organization (HMO). Responses were obtained to questions on past use, ease of use, emotional response to use, quality of information on harmful effects and drug efficacy, colleagues’ opinions, degree of usefulness and availability, and intention to use. The results show that physicians differ on each of the above factors, depending upon the source of drug information. Future studies should include an analysis of these factors when investigating physicians’ use of drug information sources.

Search Highlights:

Library & Information Science Abstracts (File 61)

After searching the thesaurus via the expand command:

Set     Items   Description

S1        252   PHYSICIANS

S2        468   DOCTORS

S3      22786   USERS

S4     108609   INFORMATION

S5     141651   LIBRAR?

S6        136   (PHYSICIANS OR DOCTORS) AND USERS AND (INFORMATION OR LIBRAR?)

S7      47871   PY>1995

S8         46   S6 AND PY>1995

S9         14   PHYSICIANS/DE

S10       192   DOCTORS/DE

S11     16437   USERS

S12     81996   INFORMATION

S13    100760   LIBRAR?

S14     47871   PY>1995

S15        27   (PHYSICIANS OR DOCTORS)/DE AND USERS AND (INFORMATION OR LIBRAR?) AND PY>1995

Also, used SCISEARCH^® (File 34)

See TACTICS section below.

Gaither, C. A., Bagozzi, R. P., Ascione, F. J., & Kirking, D. M.  (1996).  Reasoned action approach to physicians’ utilization of drug information sources.  Pharmaceutical Research, 13 (Sep), 1291-1298.

The researchers expand their analysis of factors noted in their previous research.  See citation noted above.

Search Highlights:

International Pharmaceutical Abstracts (File 74)

After searching the thesaurus via the expand command:

Set     Items   Description

S1       5318   PHYSICIANS/DE

S2     190816   DRUG

S3      25870   INFORMATION

S4       4996   DRUG(W)INFORMATION

S5      25870   INFORMATION

S6       3170   NEEDS

S7        133   INFORMATION(W)NEEDS

S8        616   PHYSICIANS/DE AND (DRUG()INFORMATION OR INFORMATION()NEEDS)

S9         75   S8/ENG AND PY>1995

Also, used SCISEARCH^® (File 34)

See TACTICS section below.

The researchers expand their analysis of factors noted in their previous research. See citation noted above.

Search Highlights:

International Pharmaceutical Abstracts (File 74)

After searching the thesaurus via the expand command:

Set     Items   Description

S1       5318   PHYSICIANS/DE

S2     190816   DRUG

S3      25870   INFORMATION

S4       4996   DRUG(W)INFORMATION

S5      25870   INFORMATION

S6       3170   NEEDS

S7        133   INFORMATION(W)NEEDS

S8        616   PHYSICIANS/DE AND (DRUG()INFORMATION OR INFORMATION()NEEDS)

S9         75   S8/ENG AND PY>1995

Also, used SCISEARCH^® (File 34)

See TACTICS section below.

Gerrett, D., & Clark, J. C. (1997). General medical practitioners’ approaches to accessing animate sources of drug information. Drug Information Journal, 31 (1), 221‑227.

The aim of this study was to determine the decision making approaches for problem solving used by general medical practitioners (GPs) when accessing the animate information sources, colleagues, consultants, drug information centers (DICs), medical information centers, hospital pharmacists, and community pharmacists. Of 463 GPs practicing within the county boundary of Derbyshire on January 1, 1990, 106 were randomly sampled from groups stratified for age; gender; type of practice, single or group; and, use or nonuse of DICs. One hundred interviews were conducted. Structured inspection of transcripts indicated that, if a source was used, it was for either mechanical solutions and allocated to “prescribing practice,” or for “general drug information” which encompassed use for subjective problem solving. For each animate information source, GPs’ approaches to “general drug information” use were collated, categorized, and inspected for global trends. This identified two fundamental, discrete approaches. Forty-eight per-cent of those interviewed, representing 218/463 of the sample frame, were categorized as “source-dependent” and relied predominantly on one or two specific sources or had a method they applied to all situations. These were distinct from the remaining “problem-dependent” GPs who used multiple information sources in a manner dedicated to resolving each problem as though it were unique. No significant differences were found in epidemiological characteristics when GPs were grouped into source‑dependent and problem-dependent categories. That GPs could be readily differentiated by two distinct approaches has implications for optimizing the provision of information.

Search Highlights:

Library & Information Science Abstracts (File 61)

After searching the thesaurus via the expand command:

Set     Items   Description

S1        252   PHYSICIANS

S2        468   DOCTORS

S3      22786   USERS

S4     108609   INFORMATION

S5     141651   LIBRAR?

S6        136   (PHYSICIANS OR DOCTORS) AND USERS AND (INFORMATION OR LIBRAR?)

S7      47871   PY>1995

S8         46   S6 AND PY>1995

S9         14   PHYSICIANS/DE

S10       192   DOCTORS/DE

S11     16437   USERS

S12     81996   INFORMATION

S13    100760   LIBRAR?

S14     47871   PY>1995

S15        27   (PHYSICIANS OR DOCTORS)/DE AND USERS AND (INFORMATION OR LIBRAR?) AND PY>1995

Also, used SCISEARCH^® (File 34)

See TACTICS section below.

Haug, J. D. (1997). Physicians’ preferences for information sources: a meta‑analytic study. Bulletin of the Medical Library Association, 85 (3), 223-232.

Identification of the resources physicians use to acquire information for clinical practice and medical research is an important area of research for health sciences librarianship and medical practice. During the past twenty years several studies have addressed questions about physicians' preferences for information sources, but generalization from the results of these studies has been hampered by limited sampling, diverse methods, and varied reportorial formats. Meta-analysis provides a method for reducing these limits. Using a meta-analytic procedure, this study reviews twelve studies published between 1978 and 1992, categorizes and ranks the physicians' preferred information sources reported in each study, then aggregates and counts the frequencies of the top six preferences, as well as the associated first and second preferences, for all the study populations or their strata. The results indicate that physicians prefer to obtain information from journals and books, but also that they often consult colleagues to get answers to clinical and research questions. The implications of these findings for health sciences librarianship are briefly discussed.

Search Highlights:

Library & Information Science Abstracts (File 61)

After searching the thesaurus via the expand command:

Set     Items   Description

S1        252   PHYSICIANS

S2        468   DOCTORS

S3      22786   USERS

S4     108609   INFORMATION

S5     141651   LIBRAR?

S6        136   (PHYSICIANS OR DOCTORS) AND USERS AND (INFORMATION OR LIBRAR?)

S7      47871   PY>1995

S8         46   S6 AND PY>1995

S9         14   PHYSICIANS/DE

S10       192   DOCTORS/DE

S11     16437   USERS

S12     81996   INFORMATION

S13    100760   LIBRAR?

S14     47871   PY>1995

S15        27   (PHYSICIANS OR DOCTORS)/DE AND USERS AND (INFORMATION OR LIBRAR?) AND PY>1995

Also, used SCISEARCH^® (File 34)

See TACTICS section below.

Kassirer, J. P. (2000). Patients, physicians, and the internet. Health Affairs, 19 (6), 115-23.

The Internet will have a profound effect on the practice and business of medicine. Physicians, eager to provide high-quality care and forced by competition to offer online services, will introduce e-mail and patient-friendly Web sites to improve administrative services and manage common medical conditions. Patients will identify more health information online and will take more responsibility for their care. The doctor/patient relationship will be altered: Some aspects of electronic communication will enhance the bond, and others will threaten it. Patients will have access to vast information sources of variable validity. Many physician organizations are preparing for the electronic transformation, but most physicians are unprepared, and many are resistant.
Search sources:

MEDLINE^® (154)
SCISEARCH^® (File 34)

See TACTICS section below.

Lundborg, C. S, Hensjo, L. O., & Gustafsoon, L. L. (1998). Drug information sources: reported preferences by general practitioners. Drug Information Journal, 32 (3), 777-785.

Objective: To estimate general practitioners’ (GPs) self-reported exposure, use, and value assessments of different drug information sources, and explore strategies for information seeking in regard to newly approved drugs. Participants and methods: A self-administered questionnaire was sent to GPs (n = 291) in an urban area of Sweden covering approximately 10% of the Swedish population. Results: Response rate was 69% (202). More verbal noncommercial information was requested by 61% of the respondents. Two out of the three sources rated as most valuable were noncommercial. Commercial written information was received weekly by 67%. Regarding awareness of new drugs, the top sources were direct mail advertisements and written information from the regulatory authority. Differences in how quickly the GPs would consider prescribing a new drug were reported depending on the drug class. For example, 64% of GPs reported that they would try a new low-sedating antihistamine rather quickly, while only 6% said so regarding a new H2-blocker. Conclusion: Noncommercial drug information sources have high credibility. GPs would like more verbal noncommercial drug information. Individualized information strategies tailor-made for different drug categories appear to be important.

Search Highlights:

International Pharmaceutical Abstracts (File 74)

After searching the thesaurus via the expand command:

Set     Items   Description

S1       5318   PHYSICIANS/DE

S2     190816   DRUG

S3      25870   INFORMATION

S4       4996   DRUG(W)INFORMATION

S5      25870   INFORMATION

S6       3170   NEEDS

S7        133   INFORMATION(W)NEEDS

S8        616   PHYSICIANS/DE AND (DRUG()INFORMATION OR INFORMATION()NEEDS)

S9         75   S8/ENG AND PY>1995

Also SCISEARCH^® (File 34)

See TACTICS section below.

Monaghan, V., & Misso, K. (1999) Evidence into practice: an information service for primary care professionals. Health Libraries Review, 16 (2), 82-88.

This paper describes the development of the Primary Care Information Service (PCIS) in South Humber Health Authority--a practical example of an information service which aims to make it easier for primary care practitioners to have access to information services and resources, both by electronic and more traditional means. Also, issues to consider when establishing a service for primary care professionals, including barriers to be overcome, are outlined, and an examination is made of how the service has been developed around principles of evidence-based medicine. Finally, the achievements to-date are considered.

Search sources:

MEDLINE^® (154)
SCISEARCH^® (File 34)

See TACTICS section below.

Peay, M. Y., & Peay E. R. (1990). Patterns of preference for information sources in the adoption of new drugs by specialists. Social Science & Medicine, 31 (4), 467‑476.

The present study investigated the adoption of new prescription drugs by specialists who treat serious disorders using relatively high risk drugs with potentially serious side effects. One-hundred and fifty-six specialists, primarily practicing in medical specialties, evaluated a number of drug information sources and reported their use of these sources both in their general drug adoption procedures and in the adoption of one of a number of target drugs. As predicted, the pattern of drug adoption among specialists is substantially different from that generally reported in earlier studies, which are usually based on samples of general practitioners or of general practitioners and specialists combined. Professional sources of information predominate throughout the process, both in adoption procedures generally used and in the adoption of target drugs. The majority of specialists reported contact with commercial sources at some stage in the adoption process for the target drugs, but these sources were not, as is often reported in the literature, the main sources of first news of a new drug, nor did they exert much influence at the prescribing stage. It is clear from these results that in future research on drug innovation, different classes of medical practitioners, such as specialists vs general practitioners, will need to be distinguished.

Located in bibliography of “Factors related to Physicians’ attitudes and beliefs toward drug information sources.” See citation above: Gaither, C. A., Bagozzi, R. P., Kirking, D. M., & Ascione, F. J. (1994). Factors related to physicians’ attitudes and beliefs toward drug information sources. Drug Information Journal, 28 (3), 817-827.

Also SCISEARCH^® (File 34)

See TACTICS section below.

Pyne, T., Newman, K., Leigh, S., Cowling, A., & Rounce, K. (1999). Meeting the information needs of clinicians for the practice of evidence-based healthcare. Health Libraries Review, 16 (1), 3-14.

This article reports on clinicians' use of library resources and the competencies they require to access information necessary for the practice of evidence-based healthcare. It is based on the results of a study commissioned by North Thames Region to identify the training needs of clinicians for the adoption and practice of evidence-based healthcare. Participants in this qualitative research study included librarians, clinicians (doctors, nurses and PAMs) and managers from four Acute and Community Trusts in and around London. The research indicates that the majority of clinicians recognize the need to keep up-to-date with changes in their specialty and many visit their libraries on a frequent basis, however, few appear to be searching for information with which to inform their immediate clinical decisions. Our sample acknowledged their low usage of journals such as Bandolier, the Health Effectiveness Bulletin and Journal of Evidence-Based Medicine. Similarly, low use of electronic databases, such as Cochrane and Cinahl, were reported. Examination of skill and self-efficacy levels in accessing and using information databases revealed wide variations across professions, specialties and Trusts. Qualitative research methods were employed to elicit the key competencies required to access clinically relevant research evidence, and a framework for integrating these competencies is presented.

Search sources:

MEDLINE^® (154)

SCISEARCH^® (File 34)

See TACTICS section below.

In response to the information management and technology changes proposed by the Government's NHS modernization initiative this article examines the issues that GPs feel to be of major significance to their work. Although information and communications technology is widely used in general practice there is no one agreed standard system. The level of technology and the manner in which it is used is also diverse throughout the profession, as are the attitudes that exist amongst GPs regarding the value of information management and technology, and the benefits efficient information management offers to them and to their patients. The views of three local GPs from practices with varying levels of information technology were obtained through semi-structured interviews and the findings developed in the light of current discussions in the published literature. The GPs chosen reflect the disparity within general practice and, perhaps, other units of the NHS in the use and understanding of information management. The main conclusions were that there is ambivalence and scepticism about what NHSnet currently has to offer; that local electronic records benefit patient care, but when networked more widely problems of confidentiality and security result. Practitioners were also mindful of the financial costs of changes and concerned, given the impact of PCGs and clinical governance, as to who will be responsible for ensuring a common level of electronic records, IT provision, and financial and technological support.

Search sources:

MEDLINE^® (154)
SCISEARCH^® (File 34)

See TACTICS section below.

Williams, J. R., & Hensel, P. J. (1991). Changes in physicians' sources of pharmaceutical information: a review and analysis. Journal of Health Care Marketing, 11 (3), 46-60.

Since 1952, 20 datasets have been generated through 17 studies in an attempt to describe the sources and importance and/or use of information about pharmaceuticals by physicians. The authors review the findings of the studies and subject them to three sequentially relevant, but different, meta-analytic procedures. The results of these analyses indicate significant changes in the sources and importance of various commercial/noncommercial and personal/nonpersonal information as they relate to physicians' prescribing behavior. Those changes over time have specific implications for marketers of pharmaceuticals.

Also SCISEARCH^® (File 34)

See TACTICS section below.

TACTICS

Marcia J. Bates writes, “To BIBBLE is to see whether the searching one plans to do has already been done by someone else—that is whether a “bibl.” (bibliography) already exists (White et al., 1994, pp. 201-202). So, I looked for bibliographies citing scholarly studies about how physicians seek “cutting-edge” information. The search terms for bibliography or review were used during preliminary searching. In other words, the set (biblio? or review) was connected to other sets of search terms by “and”.

During preliminary searches, I noticed that most of the relevant scholarly articles cite M. Y. Peay’s pioneering studies from the 1980’s and 1990’s. So, a citation search was completed in Social SciSearch^® (File 7) and in SCISEARCH^® (File 34) to expand upon Peay’s body of work and to compare scholarly articles that cite Peay’s work with search results from other databases.
Social SciSearch^® (File 7):

e cr=peay my

Ref   Items  Index-term

E1        1  CR=PEAY M, 1984, V18, P1019, SOCIAL SCI MED

E2        1  CR=PEAY M, 1985, COMMUNICATION 0401

E3        0 *CR=PEAY MY

E4        2  CR=PEAY MY, UNPUB USE DRUG INFOR

E5        4  CR=PEAY MY, 1976, V11, P139, AUSTR PSYCHOL

E6        1  CR=PEAY MY, 1976, V11, P139, AUSTR PSYCHOLOGIST

E7        2  CR=PEAY MY, 1976, V29, P1115, HUM RELAT

E8        3  CR=PEAY MY, 1977, V52, P685, J MED EDUC

E9        1  CR=PEAY MY, 1977, V52, P685, J MEDICAL ED

E10       1  CR=PEAY MY, 1980, V10, P367, EUROPEAN J SOCIAL PS

E11       1  CR=PEAY MY, 1983, V22, P13, BRIT J SOC PSYCHOL

E12      15  CR=PEAY MY, 1984, V18, P1019, SOC SCI MED

page

Ref   Items  Index-term

E13       1  CR=PEAY MY, 1986, V26, P1183, SOC SCI MED

E14       9  CR=PEAY MY, 1988, V26, P1183, SOC SCI MED

E15       1  CR=PEAY MY, 1988, V26, P183, SOC SCI MED

E16       8 CR=PEAY MY, 1990, V31, P467, SOC SCI MED

E17       1  CR=PEAY MY, 1998, V21, P57, J BEHAV MED

s e4-e17

2  CR=PEAY MY, UNPUB USE DRUG INFOR

4  CR=PEAY MY, 1976, V11, P139, AUSTR PSYCHOL

1  CR=PEAY MY, 1976, V11, P139, AUSTR PSYCHOLOGIST

2  CR=PEAY MY, 1976, V29, P1115, HUM RELAT

3  CR=PEAY MY, 1977, V52, P685, J MED EDUC

1  CR=PEAY MY, 1977, V52, P685, J MEDICAL ED

1  CR=PEAY MY, 1980, V10, P367, EUROPEAN J SOCIAL PS

1  CR=PEAY MY, 1983, V22, P13, BRIT J SOC PSYCHOL

15  CR=PEAY MY, 1984, V18, P1019, SOC SCI MED

1  CR=PEAY MY, 1986, V26, P1183, SOC SCI MED

9  CR=PEAY MY, 1988, V26, P1183, SOC SCI MED

1  CR=PEAY MY, 1988, V26, P183, SOC SCI MED

8  CR=PEAY MY, 1990, V31, P467, SOC SCI MED

1  CR=PEAY MY, 1998, V21, P57, J BEHAV MED

S11      37  E4-E17

SCISEARCH^® (File 34):

e cr=peay MY

Ref   Items  Index-term

E1        1  CR=PEAY JM, 1983, BUREAU MINES TECHNOL

E2        1  CR=PEAY JM, 1991, V6, P255, APPL OCCUP ENV HYG

E3        0 *CR=PEAY MY

E4        1  CR=PEAY MY, 1977, V52, P685, J MED EDUC

E5       12  CR=PEAY MY, 1984, V18, P1019, SOC SCI MED

E6       12  CR=PEAY MY, 1988, V26, P1183, SOC SCI MED

E7        1  CR=PEAY MY, 1988, V26, P183, SOC SCI MED

E8        9  CR=PEAY MY, 1990, V31, P467, SOC SCI MED

E9        1  CR=PEAY MY, 1994, V39, P39, SOC SCI MED

E10       1  CR=PEAY MY, 1998, V21, P57, J BEHAV MED

E11       1  CR=PEAY S, 1999, V12, P665, FRESTWATER CRAYFISH

E12       1  CR=PEAY WE, 1969, V62, P1083, J ECON ENTOMOL

s e4-e10

1  CR=PEAY MY, 1977, V52, P685, J MED EDUC

12  CR=PEAY MY, 1984, V18, P1019, SOC SCI MED

12  CR=PEAY MY, 1988, V26, P1183, SOC SCI MED

1  CR=PEAY MY, 1988, V26, P183, SOC SCI MED

9  CR=PEAY MY, 1990, V31, P467, SOC SCI MED

1  CR=PEAY MY, 1994, V39, P39, SOC SCI MED

1  CR=PEAY MY, 1998, V21, P57, J BEHAV MED

S1      26  E4-E10

The e ca=peay my yielded the same search results as e cr=peay my.

A DIALINDEX^® (File 411) search was completed in order to check coverage of appropriate databases.  I learned the DIALINDEX^®/OneSearch^®techniques about four weeks after the first DIALOG^® searches in individual databases.  It was interesting to compare the results of DIALINDEX^®/OneSearch^® (searching across databases with natural language and proximity operators) with the results of single database searches (searching individual databases with controlled vocabulary).  In the end, files 61, 74, and 154 had the most relevant hits (i.e., scholarly articles about the topic).  In the future, I plan to start with the DIALINDEX^®/ OneSearch^® for comprehensive types of searches in order to save time.

b 411

sf infosci, 74, 154, 202, 438, 34

show files

File  Name

----  -------------

   1: ERIC_1966-2001/Feb 09

   2: INSPEC_1969-2001/Mar W1

   6: NTIS_1964-2001/Mar W3

   7: Social SciSearch(R)_1972-2001/Mar W1

  35: Dissertation Abstracts Online_1861-2000/Dec

  47: Gale Group Magazine DB(TM)_1959-2001/Mar 02

  61: LISA(LIBRARY&INFOSCI)_1969-2001/Feb

 121: Brit.Education Index_1976-2001/Q1

 148: Gale Group Trade & Industry DB_1976-2001/Mar 02

 202: Information Science Abs._1966-2000/ISSUE 09

 437: Education Abstracts_1983-2001/Jan

 438: Library Literature_1984-2001/Jan

  74: Int.Pharm.Abs._1970-2001/Feb

 154: MEDLINE(R)_1993-2000/Dec W4

  34: SciSearch(R) Cited Ref Sci_1990-2001/Mar W1

s (physician? or doctor? or primary()care()practic?) and

information(1n)need

Your SELECT statement is:    S (PHYSICIAN? OR DOCTOR? OR PRIMARY()CARE()PRACTIC?) ANDINFORMATION(1N)NEED

Items   File

17     1: ERIC_1966-2001/Feb 09

19     2: INSPEC_1969-2001/Mar W1

17     6: NTIS_1964-2001/Mar W3

32     7: Social SciSearch(R)_1972-2001/Mar W1

18    35: Dissertation Abstracts Online_1861-2000/Dec

735    47: Gale Group Magazine DB(TM)_1959-2001/Mar 02

23    61: LISA(LIBRARY&INFOSCI)_1969-2001/Feb

2226   148: Gale Group Trade & Industry DB_1976-2001/Mar 02               12   202: Information Science Abs._1966-2000/ISSUE 09

39    74: Int.Pharm.Abs._1970-2001/Feb

75   154: MEDLINE(R)_1993-2000/Dec W4

58    34: SciSearch(R) Cited Ref Sci_1990-2001/Mar W1

save temp

td099

b 7, 1, 61, 74, 154, 202, 438, 34

I ignored the Gale Group databases 47, 148.  A preliminary search did not produce scholarly articles.

exs td099

145733  PHYSICIAN?

52957  DOCTOR?

590233  PRIMARY

513967  CARE

579096  PRACTIC?

1429  PRIMARY(W)CARE(W)PRACTIC?

1041803  INFORMATION

331806  NEED

3703  INFORMATION(1N)NEED

S1     256  (PHYSICIAN? OR DOCTOR? OR PRIMARY()CARE()PRACTIC?) AND INFORMATION(1N)NEED

SS S1 AND PY>1990

SS S1 AND PY>1990 Processing 256

S1 S513829712 PY>1990

S6 197 S1 AND PY>1990

Finally, I struggled with limiting the searches by date. In the beginning, due to the influence of the internet and other information sources, I thought that articles after 1994 would provide the most relevant studies. Many electronic sources have been available to physicians only for a short period of time. However, some of the best articles describe how physicians interact with people when seeking “cutting-edge” information. Even though we have new technology, the need to interact with people has not changed. Some of the best research is from the 1950’s, 1980’s, and 1990’s. So, the citations above are a combination of current scholarship with respected scholarship from the past.