Allied health professionals’ use of online evidence: a survey of 790 staff working in the Australian public hospital system

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Abstract

Objective: To measure the impact of a state health department policy to provide allied health professional staff with access to a point-of-care, 24 h, online evidence system in terms of awareness, use and clinical impact of the system on clinical practice; to identify perceived barriers to use, and differences in measures between seven professional groups (physiotherapists, occupational therapists, speech pathologists, dieticians, clinical psychologists, pharmacists and social workers). Method: A convenience sample of 790 allied health professionals from 65 randomly selected hospitals in New South Wales, Australia. A self-administered questionnaire was distributed. Rates of use, frequency and types of resources accessed were calculated. Comparisons between professional groups were undertaken using Chi-square analyses and t-tests. Results: The results showed that 82% of allied health professionals had heard of the online evidence system, and of those 76% had used it. Pharmacists had the highest rates of use and social workers the lowest. Of users, 90% agreed that use of the system had the potential to improve patient care and 45% reported direct experience of this. Computer skills and easy access were significantly associated with use and frequency of use. Among non-users, lack of specific training in the use of the online evidence system and lack of time were the most frequently reported reasons for not using the system. However, among users there was no relationship between this training and the frequency or effectiveness of use, i.e. the ability to find the information required. Conclusions: Allied health professionals will use an online evidence system when it is provided, however there are marked differences in use by professional groups. General training aimed at improving computer skills appears more important in encouraging use of an online evidence system, than specific system-based training. Perceptions of organisational and professional support for allied health professionals to use online evidence as a legitimate part of their work play an important role in influencing system use.

Introduction

Provision of online evidence systems to support clinical work at the point-of-care has been adopted as a strategy to support evidence-based practice (EBP) in the UK, USA and Australia [1], [2], [3]. Study of the effectiveness of this strategy has been largely limited to the study of doctors’ experiences of the systems, most frequently examination of rates of use [4], [5], [6] and a few studies of doctors’ reports of the impact of use on patient care [7], [8], [9], [10], [11].

Allied health professionals (AHPs)1 make up approximately a quarter of the clinical health workforce, yet very little is known of their experiences with online evidence systems. In general, patterns of allied health professionals’ use of information resources in practice are poorly understood. The few studies conducted used small samples and occurred before electronic resources were widely available; consequently reported use of electronic resources is low [12]. In a qualitative study, 27 US physiotherapists reported using multiple sources of information, with personal libraries and colleagues being their main sources. They reported reading a small range of journals and books and rarely used library computer databases [13]. Forty-four US physiotherapists in private practice were surveyed about their information needs, and although colleagues and personal library collections were reported to be the most frequently used sources of information, they rated document delivery services and mediated searches as having the greatest anticipated usefulness for clinical decision-making [14]. This finding was consistent with results from a study of GRATEFUL MED in a sample of rural hospitals in the US, which found that the majority of requests for documents came from allied health professionals [15]. Pharmacists’ attitudes were surveyed after exposure to an online information service and were found to be generally positive. They also perceived that its use had a positive impact on quality of health care [16]. A search of MEDLINE, CINAHL and EMBASE revealed no studies of other allied health staffs’ online evidence use.

Investigation of the adoption of evidence-based practice by allied health professionals has revealed a number of barriers which include a perceived lack of time [17], [18], lack of EBP skills [18], [19], organisational constraints [18], [19], lack of relevant published evidence [20], and ambivalent attitudes towards EBP [21]. The extent to which the availability of an online evidence system may overcome these, has not been studied.

In 1997, the New South Wales Health Department (NSW Health), Australia launched an initiative to improve access to information to support evidence-based practice by clinicians. This was part of a wider electronic health record and information management strategy [22]. The Clinical Information Access Program (CIAP) is an online, web-based evidence retrieval system allowing clinicians across the public hospital sector to gain access to clinical databases to support evidence-based practice, 24 h a day, at the point-of-care [3]. The CIAP provides access to a range of resources including MEDLINE, CINAHL, online journals, pharmaceutical databases and online textbooks (see Table 1). A defining feature of the CIAP initiative was the recognition that clinical evidence should be available to all clinicians, including allied health staff, close to where they treat patients.

The introduction of the CIAP was intended to lift some of the barriers to the use of evidence such as lack of time to visit libraries and placing all the available literature in one place [18]. Promotion of the CIAP to clinicians and managers, and training in its use were also instituted as part of the implementation strategy [3].

In 2001, 4 years after its implementation, a 2-year evaluation of the use and impact of the CIAP on clinicians’ (i.e. doctors, nurses and allied health professionals) work was commenced. The first stages of the evaluation found wide variation in the rates of use of the CIAP across hospitals [23], [24]. Qualitative data from case-studies indicated that allied health staff perceived a range of factors influencing their use of the system, including support from facility managers and direct supervisors, access to computer terminals, training and skills (both appraisal of evidence and database searching skills), and the place of EBP in their professional work. The resources available via the CIAP were sometimes perceived of as being of limited applicability to allied health professionals and some participants reported using other sources of information such as paper journals and hospital librarians to assist them with their information needs. A large-scale survey was conducted to further examine health professionals’ awareness and use of CIAP and to identify factors which influenced the use and the application of evidence to improve patient care. The survey allowed an assessment of the extent to which the case-study data were representative of the views of the wider clinician populations. In this paper we report the results from the 790 allied health professionals who completed the survey.

Our aims were to assess allied health professionals’ (1) awareness of an online evidence system, (2) use of the system, (3) perceptions of the impact the use of the system has on their clinical practice, and (4) perceptions of barriers to use of the system. We then compared seven allied health professional groups (physiotherapists, occupational therapists, speech pathologists, dieticians, clinical psychologists, pharmacists and social workers) to find whether there were professional differences on these four variables.

Section snippets

Sample

Each transaction on the CIAP is captured in an automatic computer web log. An analysis of these computer web logs for all hospitals in NSW had been conducted previously in the first stage of the evaluation program allowed calculation of CIAP utilisation rates for 81 hospitals in the state [25]. To obtain a representative sample of health professionals from high and low use CIAP hospitals, CIAP rates were used as a basis for selecting a random sample of hospitals from the high/medium and low use

Awareness and use of online evidence

Seven hundred and ninety allied health professionals (85% females) completed the survey. The high proportion of females reflects the gender composition of the allied health professions. The mean age of respondents was 35 years. Table 3 shows respondents by professional groups.

Eight-two percent (n=642) of respondents had heard about the CIAP. There were significant differences in level of awareness among AHP groups (χ2=73.2, d.f.=6, P<0.001). Social workers (SW) reported the lowest level of

Discussion

To our knowledge, this is the first large-scale survey which provides baseline data of AHPs’ use of electronic evidence resources. As a group, over 75% of those AHPs who had heard about the CIAP had used it. Factors associated with use of online evidence resources included accessibility to CIAP at work and home, perceived support for use from the organisation, individuals’ supervisors and team, and attainment of reasonable computer skills. Among those AHPs who had not used CIAP, 63% reported

Conclusion

Interventions to increase allied health professionals’ adoption of evidence-based practice are often based upon a model of ‘one size fits all’. Our study has demonstrated considerable differences exist between allied health professions exposed to the same online evidence system and these should be taken into account when designing and implementing such interventions. For example, whereas pharmacists adopted and incorporated online evidence into their work, other professions face a number of

Acknowledgements

This research was funded by the New South Wales Department of Health. We thank the health professionals who completed the survey and the staff in hospitals who assisted in data collection. Michelle Wensley was an invaluable support throughout the course of the study.

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