Evidence based librarianship : the role of research in health librarianship

Bruce Madge,
Head of the Health Care Information Service,
The British Library, London, U.K.

Introduction

[Slide 1]The move towards Evidence based medicine or health care, has been seen as a great benefit to health care librarians. The need for literature searches and critical appraisal of the results has led to librarians taking on new skills and relearning old ones. [Slide 2]In the United Kingdom, the Government has supported evidence based medicine and clinical effectiveness in two white papers.[BM1]i,ii The idea behind Evidence based health care, which is steadily becoming multidisciplinary, is to base treatment decisions on "the evidence", of which the randomised controlled trial is considered the gold standard. The work of the Cochrane Collaboration in seeking out the gold standards is well known and has led to the creation of the Cochrane Library and the Database of Reviews of Effectiveness (DARE) produced by the National Health Service Centre for Reviews and Dissemination.

[Slide 3]The Health Libraries Group in the United Kingdom is a group representing 2,500 health care librarians from both the National Health Service, the University sector and independent health libraries.[Slide 4] In 1997 a Research Working Party was set up to look into a number of ways of promoting research in the health information sector in the United Kingdom and of getting research into practice, an aim of evidence based medicine.

[Slide 5] With the increasing pressure put upon libraries to justify their worth, the Group felt that work should be done on beginning the move towards "evidence based librarianship" and attempts should be made to stimulate an interest in research and the research process. Co-incidentally both the British Library Research Innovation Centre (BLRIC) and the Library and Information Commission, two research funding bodies, were looking to fund research into the areas that the Group was investigating and BLRIC is about to launch a call for proposals for research in the areas of value and impact of information services.

[Slide 6] Four areas were identified as priority for the group and these were:

A methodology for carrying out systematic reviews of library literature

Putting into place some course to stimulate interest in research

[Slide 7] Looking at tools used in research by other disciplines.

Finding a method to reward health information professionals.

[Slide 8] Library Orientated Reviews of Effectiveness (LORE) The first area we tackled and which has shown the most success was directly derived from evidence based medicine. The use of systematic reviews of the literature has been demonstrated in the DARE database and the Group took this as a basis to commission a study into the methodology for producing systematic reviews in the literature of health information. We used the literature of end user vs. mediated user searching as a basis for the study and Systematic searches were carried out using library (LISA, ISA & Library Literature), health (CINAHL, EMBASE & MEDLINE), general sciences (Social Science Citation Index & Science Citation Index) and computing science (INSPEC & COMPENDEX) bibliographic databases together with library book catalogues and the Internet in general.

The study was completed in December 1997 and findings from the work were as follows:

[Slide 9] Generally, the range of databases required for systematic searching will be prohibitive for any one institution.

There is extensive overlap between Library Literature, Information Science Abstracts and Library and Information Science Abstracts.

The three main biomedical databases MEDLINE, EMBASE and CINAHL are also essential in identifying candidate studies.

[Slide 10] The computing databases INSPEC and COMPENDEX resulted in a high proportion of false drops.

Science and Social Science Citation Indexes provided useful coverage of both subject area (i.e. health) and the discipline (i.e. librarianship).

The Internet played a minimal role in the identification of useable materials.

[Slide 11] Relevance judgements based purely on bibliographic data and subject indexing were almost impossible and coverage of abstracts is very sketchy.

Abstracts from the library literature are very poor at describing study design and methodology.

The heterogeneity of articles makes extraction of comparable data very difficult.

[Slide 12] There do not seem to be enough similar studies of high methodological quality to conduct a Cochrane-type review.

A pragmatic paradigm, seeking best available data rather than only highest quality studies is therefore required.

A primary product would be evidence based guidelines indicating recommendations of research and strength of supporting evidence.

Having carried out the work, a number of recommendations were made to help future users of the methodology:

[Slide 13] Encourage movement towards systematic reviews that use a pragmatic approach.

Promote a standardised review process and training of potential reviewers.

Disseminate evidence based guidelines as an agenda for discussion and local action.

Encourage publishers to improve identification of experimental studies e.g. via structured abstracts.

[Slide 14] Build up a retrospective register of experimental studies from the three principal health library journals.

Improve access to the health information knowledge base for potential reviewers.

Instigate discussion on desirability of broad versus narrow reviews ("lumping" versus "splitting").

Invite debate relating to quality of included studies; few high quality studies versus more numerous, less rigorous studies?

[Slide 15] Identify priorities for review and feed these into library schools.

Promote an exemplar review together with the LORE protocol as a model of good practice.

Invite guest editors or authors to conduct reviews or to contribute commentaries on issues of current interest or to critically appraise a recent article.

Promote more rigorously conducted experimental research studies.

It is planned that the work will be published in some format in the near future and reviewers will be encouraged to use the methodology to create systematic reviews of the health information literature.

Encouraging interest in Research [Slide 16]

It was felt by the Group that there was interest in research amongst health information professionals working in the field and that to encourage that interest would be beneficial in the long run to our profession. To this end we have already planned a study day on the basics of Research methodology and we are planning to liaise with the NHS Regional Librarians Group to add a health module to a series of research courses run by the University of Leeds. A recent study by Jane Farmer and Amanda Richardson at Robert Gordon University underlined the need for greater liaison between library schools carrying out research and practitioners working on the groundiii The question of accreditation of librarians was also discussed within the Group and although up to this point little has been done, we are looking closely at the work of the Academy of Health Information Practitioners (AHIP) in the United States of America as a template for where the U.K. health information profession shou!

ld be heading.

Clinical Librarianship - a neglected art in the United Kingdom? [Slide 17]

It was interesting to note that whilst the group was working that the question of clinical librarianship should again be on the agenda. In the U.K. this is a prime example of research not being put into practice until 17 years after the studies that were carried out suggested that it was viable. In 1980, two studies were carried out at Guys Hospital into the applicability of clinical librarianship in the United Kingdomiv,v In the USA, clinical librarianship had been seen as a viable way of getting information to both the clinical team and the patient but has failed to be taken up in the U.K. However a paper by Professor David Sackett from the Centre for Evidence Based Medicine in Oxford, England, has proposed the idea of an evidence cart which replicates the work done previously on clinical librarianship and is being trialled extensively in the John Radcliffe Hospital in Oxfordvi.

Acknowledgements

I would like to thank the Research Group of the Health Libraries Group for their help in preparing this paper,,,, they should certainly be named: Andrew Booth, Jane Farmer and Enid Forsythe.

References

Department of Health. A Service with Ambitions, The Stationery Office, London 1996

Department of Health. The New NHS, The Stationery Office, London, 1997

Farmer. J., Richardson A. Attitudes to Librarianship and Information Science education and academic practitioner liaison. The Robert Gordon University School of Information and Media, Aberdeen, 1997

Childs S. The experience of a clinical librarian in medicine. London: British Library Research and Development Department, 1980

Moore A. The clinical librarian in the department of surgery; a report of two years' experience. London: British Library Research and Development Department, 1980

Sackett D: The Evidence Cart. Personal communication Sept 1997 [BM1]