Comparison of accessing online databases between physicians and nurses in Taiwan

  • Published on
    27-Feb-2017

  • View
    213

  • Download
    1

Embed Size (px)

Transcript

  • Comparison of accessing online databases betweenphysicians and nurses in Taiwan

    Ya-Wen Chiu, 1,2 Yi-Hao Weng, 3 Heng-Lien Lo, 4 Ya-Hui Shih, 1 Chih-ChengHsu1 & Ken N. Kuo1,4

    1Division of Preventive Medicine and Health Services Research, Institute of Population HealthSciences, National Health Research Institutes, Miaoli, Taiwan, 2School of Public Health, Collegeof Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan, 3Chang GungMemorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, and 4Centerfor Evidence-Based Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    AbstractOnline databases have been increasingly used as a key resource in the search for health information.The current study aims to compare the use patterns of online databases between physicians andnurses. A structured questionnaire was mailed to physicians and nurses of randomly selectedregional hospitals in Taiwan. Valid questionnaires with complete answers were collected from 544physicians and 1,573 nurses from November 2008 to February 2009. In general, physicians mademore use of online databases than nurses ( p < 0.001). They more often accessed English-language online databases ( p < 0.001), including MEDLINE, MD Consult, UpToDate, CochraneLibrary and ProQuest. On the other hand, nurses accessed Chinese-language online databasesmore frequently than physicians ( p < 0.001). Using a multivariate logistic regression model toadjust the personal characteristics, we found that nurses more often accessed Chinese-languageonline databases than physicians. Physicians used online databases to locate health informationthe most for clinical practice (76.6%), followed by instruction preparation (63.3%), and research(57.0%). Nevertheless, nurses used such databases more often for class assignments (66.4%) andclinical practice (55.8%). In conclusion, the behavior and motivation of access to online databasesvaried between physicians and nurses. Our findings provide evidence in the strategies to enhancethe accessing of online databases.

    Keywords: Databases; evidence-based; nurses; online; physicians

    1. Introduction

    Numerous publications demonstrate that the Internet has changed information-searchingbehavior [16]. In the past, health professionals sought information from colleagues,pocket notes, printed textbooks and journals. Now, however, Internet has become thekey resource in the search for health knowledge [7]. Nevertheless, concerns have beenraised regarding the quality of information retrieved from the Internet [8]. In addition tothe dubiousness of its reliability, the amount of information is always greater thanneeded. In recent years, there has been a shift in attention from a focus on health

    Correspondence: Ken N. Kuo, Division of Preventive Medicine and Health Services Research, Institute ofPopulation Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County35053, Taiwan. Tel: +886 37 246 166 ext. 36383. Fax: +886 37 586 261. E-mail: kennank@aol.com

    Informatics for Health and Social Care, December 2012; 37(4): 230241Copyright Informa UK LtdISSN 1753-8157 print/ISSN 1753-8165 onlineDOI: 10.3109/17538157.2012.654842

    Info

    rm H

    ealth

    Soc

    Car

    e D

    ownl

    oade

    d fr

    om in

    form

    ahea

    lthca

    re.c

    om b

    y T

    he U

    nive

    rsity

    of

    Man

    ches

    ter

    on 1

    0/27

    /14

    For

    pers

    onal

    use

    onl

    y.

  • knowledge to evidence-based information [9]. Clinical practice based on scientific evi-dence has been identified as a core competence to improve healthcare quality [1012].Therefore, how to obtain current evidence-based knowledge from the Internet is an impor-tant issue.

    One of the common Internet-based resources is the online database, defined as a data-base accessible from the Internet. Online databases offer easy access to obtain relevanthealth information with a summary of individual research evidence. Healthcare pro-fessionals can save time and facilitate clinical decision-makings by accessing the online da-tabases [13,14]. A growing number of empirical studies have demonstrated that theutilization of online databases can improve care quality [1315]. Many institutions arebuilding substantial collections of access to various online databases. Thus, knowinghow to use online databases is a critical skill for locating evidence-based information.

    Physicians and nurses are the two important health professionals in clinical service.Mastery of acquisition of evidence-based information is as important to physicians as itis to nurses. Differences in the backgrounds between physicians and nurses lead to differ-ent perceptions regarding evidence-based practice [1618]. Because the resources of evi-dence-based databases come at a great cost, it becomes essential to gain a betterunderstanding of such discrepancies in the use patterns between physicians and nurses.The purpose of this study was to compare the behavior of accessing online databasesbetween physicians and nurses using a nationwide survey of representative samples.

    2. Methods

    2.1 DesignA structured questionnaire was developed by the Division of Health Policy Research andDevelopment, Institute of Population Health Sciences, National Health Research Insti-tutes, Taiwan. The questions in this survey were designed by modifying a previous ques-tionnaire [7]. The study was conducted during a 4-month period from November 2008through February 2009.

    2.2 SubjectsThe targets in this study were physicians and nurses working in Taiwans regional hospi-tals. A regional hospital is defined as a secondary care hospital accredited by Taiwans JointCommission of Hospital Accreditation. In Taiwan, there are a total of 65 regional hospitals,among which 61 hospitals with around 5,000 physicians and 20,000 nurses were success-fully enrolled in a collaborative project with the National Health Research Institutes.Among the enrolled hospitals, we randomly selected 13 hospitals for the present study, in-cluding 4 located in northern part of Taiwan, 3 each in eastern, southern and western part.The postal questionnaire was distributed to all staff of selected hospitals. Respondents withthe title of either medical doctors or nurses were collected respectively.

    2.3 QuestionnaireThe survey included items for examining such background characteristics as gender, age,faculty position, administrative position, working experience and academic degree. Theuse patterns of four Internet-based resources were measured: (1) Web portals (e.g.Google, Yahoo), (2) electronic textbooks, (3) online databases, and (4) electronic journals.The frequency was classified by Likerts four-point scale (always, often, seldom and never).In addition, the questionnaire explored the usage (defined as access at least monthly) andmotivation of access to eight commonly used online databases: two databases in Chineseand six databases in English.

    Comparing physicians and nurses usage of online databases

    Informa UK Ltd

    Info

    rm H

    ealth

    Soc

    Car

    e D

    ownl

    oade

    d fr

    om in

    form

    ahea

    lthca

    re.c

    om b

    y T

    he U

    nive

    rsity

    of

    Man

    ches

    ter

    on 1

    0/27

    /14

    For

    pers

    onal

    use

    onl

    y.

  • (A) Chinese databases1. Index to Chinese periodical literature (ICPL) (www.ncl.edu.tw)The database contains

    over 700,000 articles from approximately 2,600 titles of Chinese and Western languageperiodicals published in Taiwan, Hong Kong andMacau from 1991. Retrieval for recentarticles can be done under article title, author, class code, keyword, journal title, pub-lication date, etc. ICPL is supported andmaintained by the Periodical Section of ReaderServices Division of the National Central Library of Taiwan, which makes it availablefreely.

    2. Chinese electronic periodical services (CEPS) (www.ceps.com.tw)CEPS providesmainly full-text Chinese-language articles published in Hong Kong, mainland Chinaand Taiwan. There are more than 2,000 periodicals for medicine, life science andnature science in Chinese and English. Most articles are collected since 1991. This da-tabase is browsed in Chinese and renewed daily.

    (B) English databases

    1. Cumulative index to nursing and allied health literature (CINAHL) (www.ebscohost.com/cinahl)This database focusses upon nursing and related professions. Journals,health care books, nursing dissertations, selected conference proceedings, standardsof practice, educational software, audiovisuals and book chapters are included. Over10,000 articles were indexed in more than 2,900 works published from 1981 to thepresent. The database provide browsers in multiple language, including a Chineseedition.

    2. Cochrane Library (www.thecochranelibrary.com)This is the preeminent online data-base of systematic reviews containing regularly updated evidence-based healthcareinformation. Since the beginning of 2007, the National Health Research Institutes hasoffered the regional hospitals of Taiwan free access to the systematic reviews of Co-chrane Library [19].

    3. MD Consult (www.mdconsult.com)This database covers full-text articles from over 50leadingmedical references across awide range of specialties, more than 80 clinical jour-nals, practice guidelines, clinically relevant drug information, and over 10,000 patienteducation handouts, and daily medical updates.

    4. MEDLINE (www.ncbi.nlm.nih.gov)This is an international literature database estab-lished by the United States National Library of Medicine at the National Institutes ofHealth. It contains more than 16 million references in the fields of medicine, nursing, pharmacy, dentistry, veterinary medicine, health care, biology and biochemistry. Itcan be accessed via PubMed without charge.

    5. ProQuest (www.proquest.com)The database consists of billions pages of global con-tents, including historical newspapers, dissertations and uniquely relevant resources.ProQuest Medical Library has over 1,000 titles in full text with abstracts and indexingfrom the MEDLINE.

    6. UpToDate (www.uptodate.com)This database is a clinical reference designed toprovide access to current peer-reviewed information. Topic reviews are written byexperts who review the literature and then synthesize the information into specific rec-ommendations for diagnosis, management and therapy.These eight databases were selected based on the popularity [7,2022]. Overall, ICPL

    and MEDLINE are freely accessible. In addition, the other six databases are accessedwith charge from individuals or organizations.

    Y.-W. Chiu et al.

    Informatics for Health and Social Care

    Info

    rm H

    ealth

    Soc

    Car

    e D

    ownl

    oade

    d fr

    om in

    form

    ahea

    lthca

    re.c

    om b

    y T

    he U

    nive

    rsity

    of

    Man

    ches

    ter

    on 1

    0/27

    /14

    For

    pers

    onal

    use

    onl

    y.

  • 2.4 Validity and reliabilityContent validity was examined by nine experts with more than 15 years of clinical experi-ence each. The internal consistency of all indexes was estimated by using Cronbachs coef-ficient alpha based on 50 pilot test data. In this survey, the content validity index of 0.98 andCronbachs coefficient alpha of 0.81 indicated sufficient validity and reliability of par-ameters in the questionnaire.

    2.5 Ethical considerationsThe study had the permission of the Ethical Review Board of the National Health ResearchInstitutes. The questionnaire was accompanied by an introductory letter stating thepurpose of this study and promising confidentiality. Return and completion of the ques-tionnaire were considered as indicating consent to participate in this study.

    2.6 Statistical analysesThe statistical analyses were conducted using a commercially available program (SAS 9.1.3service pack 2). Significance was defined as p < 0.05. Pearsons chi-square test was used tocompare the differences between physicians and nurses. Logistic regression analyses wereused to adjust personal characteristics, expressed by odds ratio (OR) and 95% confidenceintervals (CI).

    3. Results

    3.1 Data collectionA total of 5,147 questionnaires were distributed and 2,975 questionnaires were returned(response rate: 57.8%). Valid questionnaires with complete answers for analysis were2,117 subjects, including 544 physicians and 1,573 nurses (valid rate: 71.2%). Eighthundred and fifty-eight questionnaires were excluded because of incomplete answers.

    3.2 Demographic characteristics between physicians and nursesThe demographic data of physicians and nurses are summarized in Table I. Physicians andnurses had divergent characteristics. Nurses were predominantly female (99.1%). In con-trast, only 97 (17.8%) physicians were female. The average age of physicians (39.3 9.2

    Table I. Demographic characteristics of respondents.

    Physician (N = 544) Nurse (N = 1,573) p

    Female (%) 17.8 99.1

  • years old) was higher than that of nurses (34.8 6.5 years old). The work experience ofnurses was significantly longer than that of physicians (p < 0.001): 64.3% of nursesworked for over 10 years and only 44.9% of physicians had work experience of morethan 10 years. In addition, having a position as a faculty member was more common inphysicians (39.3%) than nurses (20.2%) (p < 0.001). Similarly, having a position as anadministrative member was more common in physicians (24.8%) than nurses (17.7%)(p < 0.001). Furthermore, physicians tended to have higher additional academicdegrees than nurses (p < 0.001). Approximately three quarters of nurses did not have abachelors or higher degree. In order to determine whether there was a bias after excludingincomplete answers, comparison of demographic information between questionnaireswith complete and incomplete answers was performed. Analysis indicated that the demo-graphic information of the 2,117 enrolled subjects had no significant differences from thatof the 858 participants excluded.

    3.3 Use patterns of the Internet-based resources between physicians and nursesThe usage of Internet-based resources for medical information is illustrated in Table II.

    Physicians most frequently used Web portals and online databases. Approximately 84%of physicians often or always accessed Web portals and online databases. Electronic jour-nals were the third commonly used resource for physicians. Electronic books were usedthe least; approximately 60% of physicians seldom or never used it. On the other hand,nurses most frequently usedWeb portals, followed by electronic journals, online databasesand electronic books. About 40% of nurses always accessed Web portals for health infor-mation, but only less than 20% of nurses always used the other Internet-based resources.More than a half of nurses seldom or never used online databases. When comparedwith nurses, physicians more frequently used all four Internet-based resources: Webportals (p = 0.002), online databases (p < 0.001), electronic journals (p < 0.001), andelectronic books (p < 0.001).

    Table II. Use patterns of the Internet-based resources, comparing 544 physicians and 1,573 nurses.

    Resource Physician Nurse p

    Web portals (%) 0.002Always 45.4 39.4Often 38.1 36.6Seldom 14.7 21.7Never 1.8 2.3

    Online databases (%)

  • 3.4 Awareness of availability for the online databases between physicians and n...

Recommended

View more >