Sidelines 14 (1)

This selection of abstracts explores some new information resources, assesses selected publication trends, reviews recent research on the use of information in health care and gazes into a crystal ball to predict the future of publishing and information seeking habits.

Barbour, V. UK Biobank: a project in search of a protocol? Lancet 2003;361:1734-1738

The Chief Executive of the controversial UK Biobank project has recently been named as John Newton, previously Director of Research at the John Radcliffe Hospital, Oxford.

The project is a prospective cohort study that aims to collect baseline data and blood samples from 500 000 individuals aged 45-69 years. The UK Biobank project is one of a number of national databases of prospective population based studies. The prospectively collected samples are linked to baseline data and can be used to look back for evidence of exposure when diseases arise. Previous examples have included investigations of the association of cholesterol with vascular diseases and sleeping position with cot death.

There is debate surrounding the project about the study design, the cost, and the ethics and security of the project. Supporters say the protocol is just the beginning, some believing it should be simpler and bigger; some thinking it should be smaller and more detailed.  The author suggests that the next stage will need to include frank open debate about the scientific worth of the project and its financial implications.

Rubin R M, Chang C F.  A bibliometric analysis of health economics articles in the economics literature: 1991-2000.  Health Economics 2003;12:403-414.

This paper analyses and describes trends in the publication of health economic articles during the 1990s.  The study found that there was rapid growth in the health economics literature. It also noted that co-authorship of health economic articles increased, particularly when there were more than 4 authors, and that author concentration ratios declined whilst journal concentration ratios remained much the same.

However, the authors recognise that there are limitations to their study.  The analysis was based on data derived purely from the EconLit electronic bibliographic database of the American Economic Association.  EconLit is biased in favour of US publications and does not index numerous important health care and social welfare journals where economic evaluations in particular are published. Other studies have indicated that prolific health economics authors publish far more in journals likely to be indexed in MEDLINE/PubMed.

The study is ultimately a descriptive analysis of trends within the EconLit database, which saw a three-fold increase in health economic articles published and the number of journals publishing health economic articles almost double during the decade.  It does not address the underlying questions of why there has been such an increase in health economic publications over recent years.

Rousseau N, McColl E, Newton J, Grimshaw J, Eccles M. Practice based, longitudinal, qualitative interview study of computerised evidence based guidelines in primary care. BMJ 2003;326(7384):314-317.

General practitioners and practice nurses were surveyed on the use of a clinical decision support system highlighting evidence-based guidelines relating to asthma and angina. Overall, the feedback from the GPs was negative. Major areas of concern were the timing of the guidelines alert, the ease of use of the system generally and the helpfulness of its content. Some GPs considered that the software did not integrate well into the consultation process as it triggered the electronic guideline to open at the beginning of the consultation when the reason for the patient’s visit was yet unknown. Other GPs commented that the guideline was triggered by the entry of a morbidity code at the end of the consultation when it was too late to be useful. In general, the practices involved in the survey found the software slow to load and difficult to navigate with survey participants having to exit out of the system so they could access the patient record. The GPs who continued in their use of the system, despite the problems outlined above, did not generally find the content of the clinical guidelines helpful. Reasons for this were that the management options presented could not be individualised and new treatments were not presented as options. It is not clear whether the practitioners would have been more enthusiastic if the software had been better designed or if different guideline topics had been selected. Further investigation would be interesting.

Baker L, Wagner T H, Singer S, Bundorf M K. Use of the Internet and e-mail for health care information: results from a national survey. JAMA 2003;289(18):2400-2406.

The Internet has become recognised as an increasingly important way in which members of the public access health care information. This study aimed to measure the extent of Internet and email use for health care in a sample of the US population, and to assess the effects of these resources on users' knowledge about health, and their use of the health care system.

A sample of 12,878 individuals, drawn from a research panel of 60,000 US households, was surveyed between December 2001 and January 2002. Responses from 4,764 Internet users were analysed.

The survey found that approximately 40% of respondents used the Internet to look for health care information. Around one third of these reported that use of the Internet had affected a decision about their health care, but few reported that this had an impact on their use of health care services, such as visits to a general practitioner. Six percent of respondents reported using email to contact a GP or other health care professional. Five percent reported use of the Internet to obtain prescriptions or to purchase pharmaceutical products.

The authors conclude that although many people use the Internet for health care information, its use is not as common as is sometimes reported, and its effect on actual health service usage is low.

Schwartz A, Hupert J. Medical students' application of published evidence: randomised trial. BMJ 2003;326(7388):536-8.

Critical analysis and application of evidence-based practice are key skills that medical students need to master but few studies assess the ability of students to apply research evidence to clinical decisions. The trial reported here aims to determine how medical students apply research evidence that varies in methodological validity and the importance of results.

164 graduating medical students who had examined a standardised patient were presented with literature with one of four randomly assigned variants of a structured abstract from a study. The abstracts had varying method validity and varying levels of importance of results. After reading the abstract, changes were measured in students' beliefs about their decisions in managing the patient.

The results of the trial indicated that the students were influenced in their decision by exposure to clinically important evidence but the validity of the evidence did not appear to influence their decision. However, as the authors noted, this trial only compared prospective cohort studies and chart reviews. It would be interesting to repeat this trial with a more varied array of evidence types.

Editorial. Scientific publishing picks ups speed. Canadian Medical Association Journal 2003;168(13):1637.

This editorial examines the possibility of a faster paradigm for medical publishing. It points out that “The first Canadian case of SARS was diagnosed on March 13. Two weeks later, case reports had been published online …”. Generally, however, medical publishing is still a slow business. In order to reconcile the need for speed with the need for quality control, a two-track publication method is suggested. A fast lane would allow for online pre-print publication and a slower lane would operate for traditional peer-reviewed print publication.

Larkin, M. New internet brings medicine up to speed. Lancet 2003;361:844-845.

The author explores the emergence of a new “high speed” version of the internet, known as internet2. Internet2 will allow for multimedia patient records that contain images and sounds. The ability to instantly transmit images is at the heart of current research as pictures are so information intensive. Among other benefits, Internet2 is also expected to improve disease management by allowing for instant consultation. Larkin points out that there are various barriers to be overcome before internet2 becomes an everyday reality; not least the fact that many clinicians currently perceive such technology as a threat rather than an opportunity. However, the article predicts that once clinicians realise what the technology can do for them then they will become the driving force behind its future development.

Kedar I, Ternullo J L, Weinrib SE, Kelleher K M, Brandling-Bennett H, Kvedar J C.  Internet based consultations to transfer knowledge for patients requiring specialised care: retrospective case review. BMJ 2003;326:696-698.

This paper describes a study of internet-based patient-initiated consultations between referring doctors and consulting specialists, to assess whether online consultations improve the management of patients.

Patients registered online with Partners Online Speciality Consultations, a non-profit making organisation based in the United States.  A charge is made for the consultation that is comparable to similar services provided in a hospital or clinic in the U.S.  A letter is generated for the patient to give to their doctor requesting medical information.  Partners Online then collates this and the case triaged to a specialist centre of excellence:  one of a number of U.S teaching hospitals affiliated with the organisation.  When the consultation is completed the referring doctor is notified and details are made available on the web.

Between June 2001 and July 2002 79 consultations were conducted. 90% were for services related to oncology. 90% of consultations involved new recommendations for treatment and 5% new diagnosis. The average time taken from the collection of a patient’s medical information to completion of the consultation was 6.8 working days, which compares with an average of 19 days to see a comparable specialist.  Although patients applying for consultations were from several continents, over half were from North America and the number of consultations made was small compared to the numbers visiting the web site.

No evaluation was made of the recommendations made by the consulting specialists or whether these recommendations affected clinical outcomes.  The authors also state that comparison of waiting time for an office visit with the turnaround time of an online consultation is inexact as the services delivered and patient experience would be different.

The authors conclude that the study showed that online consultations could decrease the geographical variability of care by transferring current clinical knowledge from centres of excellence to doctors around the world and provide timely access to the latest knowledge. However, issues regarding ability to pay, increasing the awareness of these services amongst consumers, and receptivity of physicians to online consultations still need to be overcome.

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This page was last updated on: 17 March 2004