Abstract

Clinicians and patients are increasingly accessing information through Internet searches. This study aimed to examine clinicians' current search behavior when using the Turning Research Into Practice (TRIP) database to examine search engine use and the ways it might be improved. A Web log analysis was undertaken of the TRIP database-a meta-search engine covering 150 health resources including MEDLINE, The Cochrane Library, and a variety of guidelines. The connectors for terms used in searches were studied, and observations were made of 9 users' search behavior when working with the TRIP database. Of 620,735 searches, most used a single term, and 12% (n = 75,947) used a Boolean operator: 11% (n = 69,006) used "AND" and 0.8% (n = 4,941) used "OR." Of the elements of a well-structured clinical question (population, intervention, comparator, and outcome), the population was most commonly used, while fewer searches included the intervention. Comparator and outcome were rarely used. Participants in the observational study were interested in learning how to formulate better searches. Web log analysis showed most searches used a single term and no Boolean operators. Observational study revealed users were interested in conducting efficient searches but did not always know how. Therefore, either better training or better search interfaces are required to assist users and enable more effective searching.

Highlights

  • Clinicians continually encounter clinical questions for which they need to find answers

  • The study was conducted in two phases: (1) a Web log analysis of the Turning Research Into Practice (TRIP) database and (2) an observational study of health care professionals’ use of the TRIP database

  • All search terms that appeared more than once in a year of Web log data from the TRIP database were analyzed, and an observational study focused on usability of the resources as employed by clinicians

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Summary

Introduction

Clinicians continually encounter clinical questions for which they need to find answers. 350 million general practice National Health Service (United Kingdom) consultations per year take place [1], and, with a conservative estimate of one question per four primary care consultations [2], there could be at least 80 million consultation-related questions per year. Of the questions primary care physicians recognize, they have been shown to pursue only one-third [3]. Real-time information needs in clinical care are often poorly addressed or ignored [4]. A consequence is that high-quality evidence is underused by clinicians to the detriment of patient care. Reflecting this issue, one study indicates that approximately half of recommended processes for health care are delivered to patients [5]. The causes of the gap between clinicians’ information needs and meeting the needs include information overload (more than 1,800 research papers, including at least 55 randomized trials, are published per day), insufficient knowledge synthesis, and ineffective methods of continuing medical education [6, 7]

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