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Scand J Prim Health Care 1989; 7: 105-9

Information Needs and Information Seeking behaviour in


Primary Health Care
TOOMAS TIMPKA M.D..2.3,MARIE EKSTROM M.Sc. and PER BJURULF M.D. P.h.D.

Department of Medical Informatics, Department of Community Medicine, Department of Computer and Information
Science, Linkoping University
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Timpka T, Ekstriim M, Bjurulf P. Information Needs and Information Seeking behaviour in


Primary Health Care. Scand J Prim Health Care 1989; 7: 1059.
A questionnaire survey of 186 general practitioners in Sweden showed that 67% saw the
overall supply of medical information as less satisfactory or unsatisfactory, and that 80%
experienced major hindrances in seeking relevant information. The most frequent need for
information concerned general medicine, with respect to both diagnosis and choice of therapy.
Of situations which required additional information, only every second was completely resol-
ved. These results imply a need for a reorganization of the supply of information to general
practitioners. As they cannot depend on conventional medical libraries for day-to-day infor-
mation, personal libraries should be improved and updated regularly, and be readily to hand.
Computer technology should be considered for communication between health care providers,
and as support for differential diagnosis in general medicine.
For personal use only.

Key words: general practitioners, information needs, information sources, critical incidents,
system design.
Toomas Timpka M.D., Department of Community Medicine, Faculty of the Health Sciences,
Linkoping University, S-58183 Linkiiping, Sweden.

present use fo sources of information, and a descrip-


INTRODUCTION tion of his information dilemma, his perceived
General practitioners (GPs) often work far from need for information. The word information is used
essential sources of medical information such as li- in its broad sense of enlightenment and advice.
braries and databases. It is important to know their The study was part of the LIMEDS project to
information needs and information-seeking habits in analyse the information needs of primary care doc-
order to design improved information supply sys- tors and to design services to meet these needs (2).
tems. Few studies on this subject have been carried
out in primary care. An American study (1) showed Study population
that specialist physicians in outpatient practice felt Two groups of GPs were included in the study:
the need to seek additional information on two ques- Group A, GPs at health care centers (HCs) in Os-
tions for every three individual consultations (pa- tergotland county in Sweden, and Group B , GPs at
tients seen), and that they only got answers to 30% all Swedish HCs with research and development ac-
of these questions during the consultation, mainly tivities involving computer systems and registered by
from colleagues and other health care professionals. the Informatics section of the Swedish Society of
However, the strategy of a GPs decision-making General Medicine. The head GPs of all the HCs
differs from that of a specialist practice, since the G P were contacted by telephone. All agreed to partici-
has to solve all types of medical problems. pate, except for two in Group B. In all, question-
The aim of the present study was therefore to naires were sent to 119 GPs at 28 Group A HCs, and
investigate the GPs decision-making habits with re- to 94 GPs at 16 Group B research HCs.
spect to his need and search for information, his

S c a d J Prim Health Cure 1989: 7


106 T o o m Timpka et al.

Table I. Number and percentage of GP information dilem- The data were analysedd with the SPSSX statisti-
mas recorded wing the critical incident questionnaire by cal package, using multiple regression and chi-
medical speciality and urgency.
square analyses.
Numbers (per cent)
Recorded Urgent RESULTS
dilemmas information need Eighty-seven per cent of the questionnaires were
returned, 92% from Group A, and 82% from Group
General medicine 71 (43) B. The respondents were 81 GPs from h e r g o t l a n d
Dermatology 21 (13)
Pharmacology 12 (7)
HCs, 56 GPs from research HCs, and 49 assistant
Orthopaedics 11 (7) GPs from both groups. Ninety-seven to 100% of
Surgery 9 (5) multiple choice queries were filled in, while only 86
Infectious diseases 8 (5) to 91% of the CI queries were completed and leg-
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Gy naecology 7 (4) ible.


Laboratory specialities 6 (4)
Paediatrics 4 (2)
Psychiatry 4 (2) Overall information supply
Other 13 (8) The overall possibilities for handling medical infor-
Complete responses 166 (100) mation were characterized as follows: very good,
Incomplete responses 20 1%; satisfactory, 32; less satisfactory, 52% ;unsatis-
Total 186 factory, 15%. A multiple regression analysis of satis-
faction with respect to availability of new informa-
tion against the GPs background variables pointed
towards the following information distress profile
METHODS (pcO.1):
Based on previous studies (3,4), questionnaires - practice at small H C
For personal use only.

were developed concerning 5 points: - no habitaul use of medical journals


1. background variables related to the GPs profes- - no habitual use of textbooks
sional experience, part- and fulltime employ- - time constraints
ment, work-load, size of HC, available library - difficulties in using sources of medical information
facilities, information search habits, research ac- - difficulties in defining problems in information di-
tivities at HC, etc. lemmas
2. perceived overall practice update and informa-
tion search facilities. Twenty per cent of the GPs saw no difficulties in
3. nature of information dilemmas (i.e. medical searching for information, while the remaining 8%
topic). identified the following major hindrances: lack of
4. other characteristics of information dilemmas time, 65%; doubt choice of source, 25%; inaccessi-
(context, how quickly information was needed). bility of source, 10%. Multiple regression analysis
5. sources used to solve information dilemmas (type did not show significant differences with regard to
and location, criteria, and reasons for choice). the GPs background variables.

Two types of questionnaires were combined for Information needs


points 3-5 to describe information dilemmas - a The urgency for obtaining information was recorded
multiple choice questionnaire and the critical in- as follows on the CI questionnaire: immediate, 21% ;
cident (CI) questionnaire (5), in which the GPs within 15 minutes, 19%; same day, 23%; a week or
were asked: Please tell us the most recent instance in more, 37%. Thus 40% of the information was re-
which you had a question in your practice for which quired urgently (within 15 minutes). The type of
you needed additional information (i.e. information information was as follows: diagnostic, 62% ; ther-
beyond your personal knowledge of medicine for apeutic, 21%; epidemiological, 4%; miscellaneous,
which you had to consult another source of informa- 13%. There were no significant differences regard-
tion). The questionnaires were revised after a pilot ing urgency between types of information.
study that involved 10 GPs. On the multiple choice questionnaires the need

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Healt Care 107
Table 11. Number and percentage of unresolved GP information dilemmas categorized into speciality and type.

Numbers (per cent)

Diagnosis Therapy Other Total

General medicine 28 7 1 36 (48)


Dermatology 6 2 8 (11)
Orthopaedics . 6 1 7 (9)
Pharmacology 1 3 4 (5)
Gynaecology 4 4 (5)
Other 10 1 5 16 (21)
Complete responses 55 (73) 14 (19) 6 (8) 75 (loo)
!ncomplete responses 9
Total 84
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for information was classified as follows: choice of 51% in dermatology, 45% in 'infectious diseases,
therapy, 44%; diagnosis, 36% therapy control, 17%; 30% in pharmacology, but less than 25% in the
epidemiology, 5%. Assistant GPs expressed a signif- remaining specialities combined. Table I1 shows the
icantly higher need for information (p < 0.001, chi- number and percentage of unresolved G P informa-
square) on both therapy and diagnosis than their tion dilemmas, categorized into speciality and type.
more experienced colleagues. The highest number concerned the diagnostic prob-
The highest number of CI dilemmas (43%) were lems in general medicine.
related to general medicine, including neurology and
oncology (Table I), and the next highest to dermatol- Sources of information
ogy (13%), followed by surgery and pharmacology. To solve the CI dilemmas, 38% of the GPs chose a
For personal use only.

Information was needed urgently (within 15 min) for colleague, either at the HC (19%) or at the local
86% of gynaecological dilemmas, 76% of dermat- hospital ( lWO),37% their personal medical text-
ological, and 50% of pharmacological dilemmas. On books, 15% the library at the HC, 4% personal
the multiple choice questionnaires, 75% of the GPs notes, 2% medical journals, while other sources
stated that they routinely (on a weekly basis) en- were consulted by 6%. Fifty-two per cent of text-
countered dilemmas in general medicine, 54% in book consultations and 35% of colleague consulta-
orthopaedics, 54% in other surgical specialities, tions were made within 5 min. When consulting a

Table 111. Number and percentage of a) information source used, b ) time spent searching for information, and c) solved
dilemmas.

Numbers (per cent)

Time spent Total use Solved dilemmas

<5 min 5-20 min >20 min

Colleagues 23 26 16 65 (38) 37 (57)


Personal textbooks 33 27 3 63 (37) 28 (44)
Library at HC 10 10 1 21 (12) 10 (48)
Personal notes 3 2 2 7 (4) 3 (43)
Journals 1 2 1 4 (2) 3 (75)
Local protocols 1 0 1 2 (1) 1(50)
Hospital library 0 1 1 2 (1) 0 (0)
Pther 3 3 0 6 (4) 4 (67)
Complete responses 74 71 25 170 (100) 86 (51)
Incomplete responses 16
Total 186

Scand J Prim Health Care 1989; 7


108 Toomas Timpka et al.
Table IV. Numbers and percentage of the GPs reasons for choice of an information source, recorded from the critical
incident questionnaire. Several alternatives were allowed.

Numbers (per cent)


Reason for choice of source Total use
Reliability Quick use Availability Completeness Low costs

Colleagues 43 36 15 4 4 64 (40)
Personal textbooks 19 47 45 5 4 63 (40)
Library at HC 7 10 15 1 1 19 (12)
Personal notes 2 6 2 0 0 7 (4)
Journals 2 1 2 0 0 4 (3)
Local protocols 1 2 1 0 0 2 (1)
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Complete responses 74(46) 102 (64) 80 (50) 10 (6) 9 (6) 159 (100)
Incomplete resonses 27
Total 186

textbook. the information dilemma was completely were divided among the other specialities, the GPs
resolved in 44% of incidents, and in 57% when were in need of information on most specialities,
contacting a colleague (Table 111). including the commonest.
The reasons (several were allowed) for choice of The amount of urgent information needed for der-
source of information (Table IV) were convenience matological and gynaecological dilemmas may be
(64%) and availability (50%). Other factors were difficult to deliver by conventional media - in der-
reliability (46%), completeness (lo%), and low cost matology because the major part of the information
For personal use only.

(6%). Own textbooks were chosen for quick use must be pictorial, in gynaecology because the prob-
(75%), the HC library for availability (79%), and lems are related to difficulties with the physical ex-
colleagues for reliability (67%). amination, i.e. a practical skill.
That 50% of dilemmas recorded as CIS could
eventually be resolved implies that these dilemmas
might be solved by increasing the amount of in-
DISCUSSION formation by conventional media, i.e. a quantitative
The present study showed a need for an improve- problem. For the remaining dilemmas there was a
ment of information supply to primary health care qualitative problem, since the existing sources of
centers, since only one of three of the responding information were deficient.
GPs found that their supply of medical information Possible ways to resolve the diagnostic and ther-
was acceptable, and four of five were dissatisfied apeutic dilemmas in the various specialities would be
with the available information services. continued medical training, including both practical
The information distress profile showed three skills, and computer-based diagnostic support. How-
components in a satisfactory information supply: ever, since 40% of the information was needed
availability of sources of information, and an interest within 15 min, any computerised support should be
in and the possibility of using them. designed with this in mind.
Like previous studies (3,4), the present study In conclusion, there is a need for GPs to organize
showed that diagnostic dilemmas were the most fre- their search for information, since they, unlike hos-
quent. However, in the multiple choice question- pital doctors, can not depend on institutionalised
naire the GPs recorded their need for therapeutic information services. Therefore, in their planning,
information higher. In explanation, it is possible that time must be set aside for such searches. Personal
some GPs might not expect to find answers to their libraries should be regularly up-dated, indexed, and
diagnostic dilemmas from any source, and therefore kept ready to hand. Second opinion contacts with
did not record them as such. colleagues should be regarded as routine. Relevant
Since half of the dilemmas were related to general information is usually available, but its source is not
medicine and pharmacology, and the remaining 50% always known to the GPs. Computer technology

Sciiiid J Prim Health Care 1989; 7


Healt Care 109

should be considered for communication between REFERENCES


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Received June 1988


Accepted February 1989
For personal use only.

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