Clinical Librarianship: A Systematic Review

Alison Winning & Catherine BeverleyInformation Resources Section, ScHARR

Evidence Based Librarianship Conference3rd September 2001

Overview• Background

• Aims of our review

• Methods

• Results to date

• Conclusions

What is clinical librarianship?

• The provision of quality-filtered case-specific information directly to health professionals in acute settings to support clinical decision making (based on Veenstra & Gluck, 1992)

Fact or fiction?• Is there evidence for clinical

librarian (CL) programmes?• Can CLs have an impact on

clinicians’ information skills?• Can an effect on clinical outcomes

and interventions be measured?• Do clinicians value this service?• Are they cost-effective?

Cimpl’s (1985) review• Historical review 1971–1983• Reasons to evaluate:

– determine the quality of the service– measure cost– measure educational benefit to clinicians

• Benefits of clinical librarianship– enhancement of patient care– greater awareness of library resources

Aims of our review• To build upon Cimpl’s review

• To determine whether a CL service:

– Improves patient care

– Has an impact on clinicians’ use of the literature in practice

Methods• Application of NICE/CRD framework

to health information topic

• Inclusion and exclusion criteria • Search strategy• Quality assessment• Data extraction

Inclusion & exclusion criteria

• Types of study• Types of participants• Types of intervention• Types of outcomes

– General, relating to service use– Patient care– Clinicians’ use of the literature in practice– Cost

Inclusion & exclusion criteria (2)

• Excluded studies:– Health science librarians providing a

general hospital library service– Outreach librarians involved in

education of remote HCPs– Initiatives outside the acute setting– Initiatives aimed at patients– Non-English language papers– Pre-1983 studies

Search strategy• Multiple methods:

– Major information science, health & social science electronic bibliographic databases

– Internet searches– Citation searches– Reference lists checked– Key journals handsearched

Quality assessment• CRISTAL checklist for user studies

employed for evaluative studies

– Checklist comprises three components (based on CASP):

• Validity• Reliability• Applicability

Data extraction• Pre-determined data extraction form:

– General information (e.g. bibliographic details)

– Participant characteristics– Details about the intervention– Methods– Results for each outcome– Additional notes

Results … to date• Quantity of research:

– 215 references retrieved– 166 references ordered– 12 studies met our inclusion criteria

for evaluative studies– A further 29 studies met our inclusion

criteria for descriptive studies

Results … to date (2)• Quality of research:

– Poor reporting

– Bias– Reliability & validity of approach– Representative sample group?– Failure to acknowledge limitations

General outcomes

• Description of programmes

• Service usage

Patient care• Improved patient care?• Impact on factors:

– Advice given to patients– Choice of treatment– Choice of tests

• Prevention of events– Additional tests/procedures

HCPs’ use of the literature

• Ability of clinicians to find literature themselves

• Utilisation of the literature by clinicians

Costs

• No cost benefit analysis

• Limited applicability

Conclusions• Implications for practice and

research:– Evaluate CL programmes in practice

• Longer follow-up periods to assess impact on patient care

• Identification of use of the literature

• Future research:– High quality studies with large,

representative samples• Examination of clinical outcomes• Assessment of cost-effectiveness

Summary• Limited evidence for effectiveness

of CL• Outcomes can be measured• Clinicians appear to value service,

but this is not adequately explored in the literature

• No information regarding cost-effectiveness