Fresh NEWS!! - order ambien without prescription from us pharmacy

Health Libraries in Ireland [May 2002]

Health libraries in Ireland and their role in the delivery of a modern health service Submission to the Department of Health and Children for the National Health Information Strategy

Prepared by The Healthcare Libraries Panel and approved by The Executive Board, 29 May 2002

MS Word Version (35kb)

Evidence based medicine is the process of life-long, self directed learning in which caring for patients leads to critical appraisal, the search for and incorporation into practice of valid and clinically important information about diagnosis, prognosis, therapy and other clinical and health care issues.
David Sackett,Centre for Evidence Based Medicine, Oxford
The Library Association of Ireland welcomes the Department of Health and Children’s proposal to develop a National Health Information Strategy and wishes to present the Minister with the following observations and recommendations in relation to the development of this Strategy. These complement the recommendations of the MacDougall Report Information for Health1, published in 1995 by the Library Association of Ireland and supported by research funding made available from the Department of Health and Children.

The challenge for all involved in the development of our health services is to devise strategies that ensure current best practice in patient care, policy making and health service administration is understood by the clinical community and health service managers and is consistently applied across the state’s health system. Indeed the only possible model for Ireland’s health service is that based on the utilisation of the best possible evidence – in other words evidence based practice.

Evidence based practice will provide many of the solutions to the state’s often under performing health system. The benefits of evidence based practice, which are well documented in the literature2, can facilitate dramatic improvements in clinical and other decision making which currently are too frequently based on the faulty memories of health care practitioners who are expected to remember, synthesize and utilise complex data and information. An evidence-based approach will provide the necessary knowledge and information

  • to deal with unexplained variations in clinical practice
  • to encourage health professionals to increase the proportion of clinical practice based on validated research evidence
  • to reduce the delays in translating research evidence into clinical practice
  • to provide more effective and cost effective health services to patients based on optimal research based evidence
  • to support the development of consumer health information services for the purpose of ensuring that the general public have access to reliable health information and advice.
If evidence based practice is to take root in Ireland, all health professionals will need to use the best possible knowledge and evidence on a routine basis. This requires all health professionals – to have ready access to the whole of their knowledge base including new information tools specifically being developed to support evidence based practice
  • to develop the necessary technical skills to access that knowledge base and to have readily available library services supervised by professional librarians which can facilitate such access
  • to understand the nature of research evidence
  • to understand the principal information types (including systematic reviews, randomised controlled trials, quantitative and qualitative research, experimental and non experimental studies, expert opinion etc.)
  • to understand how to retrieve information by information type
  • to understand how to appraise critically the research literature and evidence. This will include understanding the concepts underpinning health gain notations, odds ratios, NNTs (numbers needed to treat) etc.
  • to understand how to develop methodologies to translate research evidence into clinical practice. (This will include understanding the issues relating to change management and how to interact effectively with patients)
  • to understand how to share knowledge and evidence with colleagues
  • to understand how to update one’s own knowledge and practice
Health Librarians who are intermediaries in the provision of much of the evidence base are already making a significant contribution to the delivery of effective healthcare by the provision of knowledge and information. More specifically this support encompasses clinical practice, education and training, research, continuing professional development and health service management. Their role continues to develop as new initiatives in the areas of evidence based practice, clinical governance and effectiveness, quality, consumer health and accreditation are introduced to Ireland’s health care system. They have been particularly active in developing the hybrid model of library in which traditional paper based library services are increasingly being complemented by the development of a managed electronic information environment and a new emphasis on training users in the effective use of information and evidence.

In order to establish an even approach across the state to the delivery of library services, health librarians are also:

  • drawing up new professional standards for the delivery of effective health library services
  • developing a generic programme for the delivery of health information skills training programmes
  • including a tool kit to aid librarians in the delivery of such programmes
  • in recognition that health information literacy is a key skill in a modern health service
Recommendations 1. There should be a nationally organised electronic health evidence system, for all professional groups in the health service, providing access in the workplace, the ward, the laboratory, the A&E unit, the IC unit and at home to a suite of information resources. This should particularly take into account the needs of house doctors for whom ready access to an extensive knowledge base is particularly important to support their decision-making. It would be overseen by an advisory panel with substantial representation from librarians and information specialists as well as public health consultants, clinicians and health managers and it would incorporate:
  • a range of databases across a broad range of healthcare
  • full text electronic journals
  • electronic text books
  • evidence based clinical guidelines
  • care pathways guidance
  • evidence based drug information
  • a national research register
  • validated evidence summaries
  • a managed information environment validating health information sites on the World Wide Web and the internet
  • a register of voluntary groups relating to the provision of health and social care
  • a register of expert groups in the health and social care sectors
2. The Minister of Health and Children should consider endorsing the standards for health libraries currently being produced to provide a basis for the future development of libraries to support patient care, education and research and to facilitate the provision of evidence for knowledge based clinical and managerial decision making.

  1. A professionally qualified librarian should be appointed to the Department of Health and Children to provide information, advice and guidance to the Government and to coordinate library and information services for health across the state.

  2. A National Health Information Management Unit should be established under the direction of an experienced public health consultant and with substantial input by information scientists and librarians to develop a centralised approach to the provision of optimal evidence in key areas. Major problems for health professionals under considerable time constraints include how to utilise the masses of published evidence and ensure that their clinical practice is based on best evidence. The Unit would develop methodologies to synthesise this evidence and to produce evidence summaries of the most up to date published research. These summaries would be relied on to inform health policy making, management and clinical practice as well as the health care curricula and would facilitate the identification gaps in the research base of health care and so assist in decision making about the funding of new research.

  3. Health Boards should provide stable budgets for the health libraries in their areas and prepare strategic plans for the development of library and information services in relation to their supporting roles in the areas of education, training, research, continuing professional development, evidence based practice and health services management.

  4. A “training of the trainers” programme should be established to encourage the development of methodologies for translating optimal research evidence into clinical, managerial and policymaking practice. This should include the establishment of a cascade system and mentoring arrangements to encourage the widest possible uptake of such methodologies and should involve all professional groups in the health service.

  5. New methods of accessing evidence should be explored to provide critical information in the interface between the clinician and the patient. Ovid@Hand – a hand held evidence support device is particularly commended as a system that could provide dramatic improvements in information support. The IAIMS (Integrated Advanced Information Management Systems) concept developed in the USA is also worthy of consideration.

  6. In order to provide reliable health information for patients, carers and the general public consumer health information (CHI) services should be developed to international standards in line with the recommendations of the MacDougall Report (1998)3. In this context it is suggested that mutually beneficial cooperative partnerships be developed between health boards and public library authorities as well as university and hospital libraries, with the aim of facilitating wider access to CHI for the public. A good example of this is the recently introduced All-Ireland Cochrane Library access facilitated jointly by the Health Research Board and the Northern Ireland Research and Development Office.

References:

  1. MacDougall, Jennifer (1995) Information for Health: Access to Healthcare Information Services in Ireland. Dublin: Library Association of Ireland. ISBN: 0-946037-29-9

  2. The Rochester Study that was published in the Bulletin of the Medical Library Association 1992: 80 (2) 169-178 demonstrated very clearly that when the knowledge base of healthcare is used directly to inform clinical decision making, its impact on health care is statistically very significant. The study demonstrated that 80% of the physicians sampled “probably or definitely handled some aspect of patient care differently than they would have handled it otherwise. Changes in the following specific aspects of care were reported by the physicians: diagnosis (29&), choice of tests (51%), choice of drugs (45%), reducing length of hospital stay (19%) and advice given to the patient (72%). Physicians also said that the information provided by the library contributed to their ability to avoid the following: hospital admission (12%), patient mortality (19%), hospital acquired infection (8%), surgery (21%) and additional tests or procedures (49%). The physicians rated the information provided by the library more highly than that provided by other information sources such as diagnostic imaging, lab tests, and discussions with colleagues.” This study has been further replicated, for example in the Value Study undertaken at the University of Wales, Aberystwyth in 1995 by Christine Urquhart and John Hepworth (published by the British Library Research and Development Department). In the study it was demonstrated that library based information had an impact on the decision making of clinicians in 89% of cases.

  3. MacDougall, Jennifer. (1998) WELL READ: Developing Consumer Health Information in Ireland. Dublin: Library Association of Ireland. ISBN 0-946037-345