Sidelines 14 (3)

Sidelines articles for this issue focus on health professionals’ and patients’ use of the Internet, developments in publishing practice and recent research on the impact of health services research and public health networks.

Dash P, Gowman N, Traynor M. Increasing the impact of health services research BMJ 2003;237:1339–1341

This describes a report from the Health Foundation and Nuffield Trust reviewing health services research in the United Kingdom.  The report suggests managers and policy makers are not able to base decisions about reforming health services on the best available evidence. Only 2-3% of the health services research budget is spent on health research. It is unclear how much of the information generated is used in practical health care decisions. The article highlights three questions:

• is research pursuing the right agenda?

• is research examining the right questions in the right way?

• are the results of research being communicated to and applied by the people who need them?

Generally the authors found that researchers and managers were frustrated about the applicability of some health services research.  The recommendations of the report include:

• establishing a more client centred approach to commissioning research;

• enabling users, funders and researchers to assess the value of different approaches to generating research needed by health service decision makers;

• increasing opportunities for cross-sectorial collaboration at every stage of the research process;

• looking outside the health and public sectors for sources of relevant research & information;

• increasing the development of skills required to analyse, access and utilise research;

• presenting research & analysis in user friendly formats;

• developing, at a local level,  new roles to support the implementation of the conclusions of research.

Fahey DK, Carson ER, Cramp DG, Muir Gray JA 2003. User requirements and understanding of public health networks in England. Journal of Epidemiology and Community Health 57:938-944.

This paper reports on a cross sectional survey of 60 public health professionals working in England. In-person interviews, using a mixture of open and closed questions, were conducted to determine the professionals’ understanding of the term “public health network” and to explore the functions that they would like these networks to perform.

The paper introduces public health networks and then describes in detail the methodology undertaken, from selecting respondents, to question design and data analysis. A good response rate of 75 percent was achieved although the sample was biased to particular regions in England and particular types of organisations. 58 of the 60 respondents had an understanding of the term “public health networks” and although only 22 of the 60 respondents were asked if they were in favour of such networks, 82 percent of those who replied were in favour.  The functions that the respondents would most like to see provided by the public health network were:

• identification of expertise and maximisation of scarce resources

•  education, training and CPD

• information/knowledge management.

The majority of the respondents (93%) were also in favour of a web site for local and national networks but not individual sites (23%).

The authors concluded that public health professionals have a similar, but broader, understanding of “public health networks” than the government and that the public health network is more likely to be successful if its priorities are maximising scarce resources, identification of expertise, CPD/education and knowledge management. They also suggested that web sites should be created to provide information on current projects of the network with a facility to search for people, expertise and reports.

Jorgensen P.C., and Gotzche P. 2004. Presentation on websites of possible benefits and harms from screening for breast cancer: cross sectional study. BMJ 328:148-51.

A recent study showed that 61% of women make their own decisions regarding mammography, so the quality of information available to them is of the utmost importance. The authors of this article assessed 27 websites to see if the information they provided matched current findings relating to screening for breast cancer.

The websites were divided into three categories; those that were provided by government organisations, those that were provided by advocacy groups (for example, cancer charities) and those that were provided by consumer groups. All sites were assessed to see if a balanced account of benefits and harms were provided and whether the source of funding appeared to have an impact on the advice given.

The government and advocacy groups all recommended screening (at least implicitly), whilst the consumer groups questioned its value.

All of the advocacy sites accepted industry sponsorship, whilst only one out of the three consumer sites accepted funding, and all three of the consumer sites pointed out the risks of accepting industry sponsorship.

Most sites omitted information on possible harms and emphasised the potential benefits of screening.

The main potential harm of breast screening is that of the false positive result. The level of over diagnosis appears to be about 30%. All of the consumer sites mentioned the dangers of over diagnosis and over treatment, but only four of the remaining twenty-four sites did so. Five of the government or advocacy websites claimed that screening led to fewer mastectomies, whilst research suggests that the opposite is true.

In conclusion, the authors found that the websites of consumer groups were more balanced and comprehensive than those of advocacy groups or government sites. This article suggests that improvements are required in the level of information given to women about breast screening; the harms as well as the benefits must be presented.

Delamothe T., and Smith R. 2004. Open access publishing takes off: the dream is now achievable. BMJ;328:1-3.

This BMJ editorial discusses recent advances in the drive towards open access publishing.  The aim of this method of publishing is to make the full text of original research articles freely available via the World Wide Web.

Rather than the current 'reader pays' system of journal subscription, medical publishers such as BioMed Central and the Journal of Clinical Investigation operate an 'author pays' system where authors are charged for an accepted article to cover the costs of processing the article and for its electronic distribution.

The main motivation behind this change is the cost of journal subscriptions, which are increasing far faster than the underlying rate of inflation. As librarians are forced to cut back on journal subscriptions to stay within budget, publishers increase their prices even further to compensate for lost profits. The result is that medical research, mainly funded by governments, universities and charities, has been available only at higher and higher costs to its users.

Open access publishing and an 'author pays' system offers the research community a way out of this problem, as publishing on the world wide web is virtually cost free. Any fixed costs passed on to the research community are lower than the costs of paying for journal subscriptions under the current system.

The BMJ supports this method of publishing, and offers suggestions for a long-term sustainable model for open access publishing.

Benigeri M., and Pluye P. 2003. Shortcomings of health information on the Internet. Health Promotion International;18(4):381-6.

Recent studies have shown that the majority of Internet users use the World Wide Web to seek health information. When used correctly, with good quality resources, the Internet can be a valuable tool in the dissemination of health and medical information from healthcare professionals to the general public. However, the web has several shortcomings, such as the quality of health information available on the Internet, uneven access to the Internet across society, patient difficulties in finding, using and understanding health information on the Internet, and the potential for harm and the risk of over-consumption.

This article discusses each of these issues. The authors conclude that the Internet can offer great promise for educated people, who know how to find and critically assess useful information on the Internet about self-care and disease prevention. However, for many others, including the less educated, the elderly and those with multiple health problems, the Internet will only offer benefits if health information is designed according to users’ needs and capacities. Internet access needs to be increased and supported, and health information needs to be more accurate, relevant and easier to find. Health care professionals must be integrated into the process of diffusing medical information on the Internet, for example by suggesting web sites to patients. Finally, the authors suggest that the impact of medical information on the Internet should be measured in order to determine the extent to which the promise held by this new medium is fulfilled.

Smith J. J., Mallard-Smith R. J., Beattie V., and Beattie D.K. 2003.  Use of information technology in general practice.  Journal of the Royal Society of Medicine 96:395-397.

The use of information technology (IT) by an increasingly computer-literate population is growing, and with it are expectations for easily accessible, good quality health information and advice on the Internet.

This paper presents the results of a questionnaire survey to assess how the Internet and the NHSNet are being used in general practice, and what other IT services are being offered to patients, particularly via practice-based websites. The questionnaire was sent to 141 randomly chosen general practices in southern England (London, Buckinghamshire and Hertfordshire).  77 (55%) questionnaires were returned, with 60 practices reporting a connection to the Internet and 71 to the NHSNet.  This data immediately displays a fundamental misunderstanding of what the NHSNet provides, as connection to NHS Net automatically allows access to the Internet.  Furthermore, it was found that specific facilities provided by NHSNet, such as access to patient results and direct hospital outpatient bookings are being little used.  Further research  would be useful to identify why NHSNet is being underutilised, why there is obvious confusion about what it can provide, and how these problems can be resolved.

Two further problems were revealed by the questionnaire. The costs involved in setting up and maintaining a practice website are usually under-estimated, and there is a problem of data security on existing websites.  None of the practices using online forms for transmitting patient data had secure connections.

Although the study highlights some of the problems that might explain the slow uptake of IT in general practice, the authors do recognise that their findings have to be qualified by the low response rate to the questionnaire.

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This page was last updated on: 30 June 2004