Information U se B ehavior of Cli nicians in

- Evidence Based Medicine (EBM ) P rocess in Thailand

by

Somrux Sahapong lissh@mahidol.ac.th

Sawasdee Kha

Background

“Evidence-based medicine (EBM) ...... the conscious, explicit and judicious use of current best evidence

in making decisions about the care of individual patients”

(Sackett et al., 1996)

Background

• EBM is involved in : – The use of the best current

available evidence– Life-long learning– M edical education– Modern c linical practice

Methodology• Survey research• Closed-end questionnaires in EBM

process and information usage • 198 questionnaires were sent to Thai

clinicians using EBM process (University and Non-university hospitals)

• The data were analyzed :– Mean– Standard deviation– Percentage – Factor analysis

Results• 157 questionnaires (79.3 %) were returned• Demographic characteristics• The use of EBM process in clinical practice• The use of information in EBM process :

– Frequency– Purposes– How information obtained– Type – Resources– Tools– Strategy

• The factors affecting the use of EBM process

Demographic Characteristics

•General profile• Computer and I nternet literac

y• Online d atabase literacy

General Profile• Sex

– Male 66.2 %– Female 33.8 %

• Duration of EBM experience– MEAN 8.1 SD 5.2 (1-30) years

• Hospital– University 57.3 %– Non-university 42.7 %

Technology

University hospitals (Percentage)

- Non university hospitals (Percentage)

(n1=57)

expert

good

fair novice

notuse

expert

good

fair novice

notuse

Computer 15.6 50.0

30.0

2.2 2.2 13.4 50.7

32.8

3.1 0.0 100.0

Internet 15.6 48.9

31.1

2.2 2.2 19.4 44.8

31.3

4.5 0.0 100.0

Computer includeI nternet

17.8 50.0

27.8

2.2 2.2 14.9 46.3

32.8

6.0 0.0 100.0

Computer and I nternet Literacy

Databases

University public hospitals(Percentage)

- Non university public hospitals (Percentage)

(n1=57)

expert good

fair novice

not use

expert

good

fair novice

not use

PubMed(Clinical Queries)

20.0 47.8 25.6 3.3 3.3 12.5 46.7 28.1 3.1 9.4 100.0

UpToDate 5.7 18.2 30.7 5.7 39.8 7.8 31.3 26.0 3.1 32.8 100.0

CochraneLibrary

13.5 33.7 38.2 5.6 9.0 1.5 30.8 40.0 4.6 23.1 100.0

ACP Journ al

Club

8.0 12.5 30.7 8.0 40.9 0.0 12.5 29.7 4.7 53.1 100.0

EBM Journ al Websi

te

10.3 12.5 33.8 6.2 40.0 4.6 15.4 33.3 8.0 35.6 100.0

Online D atabase Literacy

The clinicians use EBM process in clinical practice

Levels of EBM usage (score)

Percentage(n=157)

Low level of EBM usage (24-38) 5.7

Moderate level of EBM usage (39-53)

41.4

High level of EBM usage (54-68) 52.9 Total 100.0 Mean=52.7 S.D.=8.4 Min = 24.0 Max = 68.0

Level of EBM usage of Thai clinicians

The use of information in EBM process

• Frequency• Purposes• How information obtained• The types of information used in

clinical practice• Resources for information searchi

ng• Tools for information searching• Strategy in searching

Frequency of use Percentage(n=157)

Everyday 26.5 2-3 days a week 60.52-3 days a month 11.6Not use 1.4

Frequency

Purposes Percentage of use(n=157)

most moderate

seldom

least

Medical care 14.2 52.3 30.3 3.2

Continuing medical education and news medical information

39.5 50.3 10.2 0.0

Supporting their teaching and learning process

48.4 43.3 7.7 0.6

Purposes

I nformation was obtained

Percentage of use (n=157)

most moderate

seldom least

Clinicians searching by themselves

64.3 29.4 3.8 2.5

Clinicians asking for advice from (MIPs)

1.9 10.9 37.8 49.4

MIPs searching for clinicians

2.6 9.0 30.1 58.9

Colleague searching for clinicians

3.8 28.0 43.9 24.2

Nurse searching for clinicians

3.9 5.2 13.5 77.4

How information obtained

MIPs = medical informational professionals

Types of information in clinical practice

Percentage of use (n=157)

most moderate

seldom

least

Best research 33.3 57.1 9.0 0.6

Medical record 19.1 38.2 34.4 8.3

Information from clinical ex pert

14.2 47.7 34.2 3.9

Medical textbook and reference book

21.2 59.6 17.9 1.3

Medical Journal 33.3 56.4 9.0 1.3

Systematic review 32.1 51.3 14.1 2.6

Proceeding 11.5 46.2 39.1 3.2

EBM Database 18.8 52.6 24.0 4.5

The types of information used in clinical practice

Resources for informati on searching

Percentage of use (n=157)

most moderate

seldom

least

Medical record unit 7.7 34.2 46.5 11.6

Laboratory 3.9 29.9 48.7 17.5

Museum 1.4 9.15 33.8 55.6

Library inside the hospital 19.2

54.5 19.2 6.4

Library outside the hospital 5.8 23.7 41.7 28.8

Foreign library 7.9 19.5 23.7 48.9

Patient’s profile 9.9 33.1 37.1 19.9

Patient’s cousin 3.3 25.8 44.4 26.5

Expert in clinical practice 7.2 52.6 31.6 7.9Internet 33.

850.3 13.2 2.6

Resources for information searching

Tools for information searching

Percentage of use (n=157)

most moderate

seldom

least

PubMed 58.1 31.6 7.1 3.2

UpToDate 12.3 21.9 32.3 33.5

Ovid 16.8 28.4 36.0 23.9

Embase 5.2 9.7 43.9 41.3

Cochrane library 14.7 41.7 30.8 12.8

ACP Journal Club 5.2 18.7 38.7 37.4

OPAC of the library inside the hos pital or medical school

5.3 14.5 34.8 45.4

-CD Rom 3.2 25.2 38.7 32.9

Search engine 30.5 35.1 22.1 12.3

Index database 5.9 14.2 39.2 30.7

Bibliographic database 3.9 19.6 42.5 34.0

Tools for information searching

Strategy in searching

Percentage of use (n=157)

most

moderate

seldom

least

Use keyword 45.2 50.3 1.9 2.5

Consult the expert 6.5 21.9 45.8 25.8

Use similar medical term

24.8 51.0 19.7 4.5

Use medical subject heading (MeSH)

29.9 42.7 18.5 8.9

Use boolean operator (AND, OR, NOT)

35.0 41.4 15.3 8.3

Use clinical queries in PubMed

24.8 35.9 28.1 11.1

Strategy in searching

Factors affecting the use of EBM process

Factors affecting the use of EBM process

• Six variables were correlated with information use in EBM process– Information usage– EBM usage – Experience – Organization – Competency – Educational background

Conclusion

• Most Thai clinicians in this study use the EBM process in their daily practice.

• Thai clinicians have good c omputer / Int ernet l iteracy and online database litera

cy.• Thai clinicians can search information by

themselves.• Six variables were correlated with

information use in EBM process.

Suggestions• More studies on the knowledge, attitude and

practice of clinicians on information behaviors are needed.

• EBM training is necessary for MIPs in Thailand.

• MIPs should be trained to assist or facilitate clinicians in information searching and use.

• Collaboration between clinicians and MIPs should be much more closer.

• MIPs should make clinicians accept their compe tency in EBM information service.

MIPs = medical informational professionals

Thank You Very MuchMerci Beaucoup

Sawasdee Kha