Identification of sources from which doctors in the private sector obtain information on HIV and AIDS

Background: Doctors need to constantly update their knowledge and obtain information in order to practise high-quality medicine. Antiretroviral drugs have been available only since around 1996, therefore many of the doctors who were trained prior to 1996 would not have received any formal training in the management of HIV and AIDS patients. Where doctors source their general medical knowledge has been established, but little is known about where doctors source information on HIV/ AIDS. This study investigated where private sector doctors from the eThekwini Metro obtain information on HIV and AIDS for patient management.Methods: A descriptive cross-sectional study among 133 private general practitioners (GPs) and 33 specialist doctors in the eThekwini Metro of KwaZulu-Natal, South Africa, was conducted with the use of questionnaires. The questionnaires were analysed using SPSS version 15. A p value of < 0.05 was considered statistically significant.Results: The majority of the doctors (92.4%) obtained information on HIV and AIDS from journals. Continuing Medical Education (CME), textbooks, pharmaceutical representatives, workshops, colleagues and conferences were identified as other sources of information, while only 35.7% of doctors were found to use the internet for information. GPs and specialists differed significantly with regard to their reliance on colleagues (52.9% versus 72.7%; p < 0.05) and conferences (48.6% versus 78.8%; p < 0.05) as sources of HIV information. More than 90% of doctors reported that CME courses contributed to better management of HIV and AIDS patients.Conclusion: Private sector doctors in the eThekwini Metro obtain information on HIV from reliable sources in order to have up-to-date knowledge on the management of HIV-infected patients.Keywords: HIV/AIDS; source of information; private sector doctors; journal

Terveydenhuollon ammattilaisten internetin tiedonhaku infektioepidemioiden seurannassa

The aim of this study was to analyze online information seeking by healthcare professionals (HCPs) in order to both evaluate its extent and assess whether it can be used in clinically relevant settings, such as epidemiology. HCPs need reliable medical information to be used in daily clinical work. Physician’s Databases (PD) serve as online medical sources that are available throughout the Finnish healthcare system and provide medical information for HCPs performing the searches. Every query is included in the log files of PD. To analyze information needs among various HCPs, the queries in different healthcare sectors (primary care, specialized care, pharmacies, and private care) showed the known characteristics of each sector in terms of the time of day, weekdays, weekends, seasons, and quantities of HCPs working in a specific healthcare sector nationwide. To detect infectious disease epidemics, similar patterns were found between the diagnoses and queries of Lyme borreliosis (LB) performed by both HCPs and the general public. The media publications on LB only occasionally related to queries. HCPs’ queries on oseltamivir and influenza showed similar patterns annually compared with the diagnoses and laboratory reports on influenza. When detecting influenza epidemics, the queries on oseltamivir preceded influenza diagnoses by -0.80 weeks (95% CI: -1.0, 0.0, p = 0.000) with high correlation (tau = 0.943); and the queries on influenza preceded oseltamivir queries by -0.80 weeks (95% CI: -1.2, 0.0, p = 0.015) with high correlation (tau = 0.738) and influenza diagnoses by -1.60 weeks (95% CI: -1.8, -1.0, p = 0.000) with high correlation (tau = 0.894). Assessing the log files of PD, and comparing them with epidemiological registers on infectious diseases, heralds a new approach for using HCPs’ online queries from real-time databases as an additional source of information for disease surveillance when detecting epidemics.Väitöskirjan tavoitteena oli tutkia terveydenhuollon ammattilaisten tiedonhakua ja sen yhteyttä infektioepidemioihin. Duodecimin Terveysportin Lääkärin tietokannat on internetpohjainen tietolähde terveydenhuollon ammattilaisille, jotka hakevat luotettavaa lääketieteellistä tietoa potilaiden hoitoon. Jokainen haku tallentuu tietokannan lokitietoihin. Tutkimuksen tarkoituksena oli arvioida sekä tiedonhaun laajuutta että sen hyödynnettävyyttä esimerkiksi infektioepidemiologiassa. Tutkimuksessa (1) arvioitiin terveydenhuollon ammattilaisten tiedontarvetta tutkimalla eri terveydenhuollon sektoreilla (perusterveydenhuolto, erikoissairaanhoito, apteekit ja yksityissektori) tapahtuvaa tiedonhakua Lääkärin tietokannoista. Niin haun vuorokaudenajan, viikonpäivän, vuodenajan kuin sektorilla työskentelevien ammattilaisten määrän todettiin olevan ominaisia kullekin sektorille. Tämän jälkeen (2) verrattiin Lääkärin tietokantojen Lymen borrelioosi -hakuja ja Terveyden ja hyvinvoinnin laitoksen rekisterin borrelioosidiagnooseja toisiinsa. Niillä havaittiin ajallinen yhteys: haut ja diagnoosit ilmenevät samaan aikaan. Tämä tarkoittaa, että ammattilaisten hakuja voitaisiin hyödyntää epidemioiden seurannassa perinteisten rekistereiden rinnalla. Tutkimuksessa myös (3) verrattiin ammattilaisten Lääkärin tietokantojen Lymen borrelioosi -hakuja ja maallikoiden Terveyskirjaston Lymen borrelioosi -hakuja toisiinsa. Niissäkin toteutui samanlainen ajallinen yhteys, joka noudatti perinteistä infektioepidemiologista rekisteriä borrelioosista. Suurimpien suomalaisten medioiden verkkosivuilta kerättiin borrelioosiin liittyvät mediajulkaisut, ja ne olivat yhteydessä Terveyskirjaston Lymen borrelioosi -hakuihin vain ajoittain. Borrelioosin medianäkyvyys saattaa kuitenkin vaikuttaa sekä ammattilaisten että maallikoiden internetin tiedonhakuun. Lopuksi (4) tutkittiin terveydenhuollon ammattilaisten Lääkärin tietokantojen influenssahakuja ja Duodecimin lääketietokannan oseltamiviirihakuja. Niillä todettiin yhteys Terveyden ja hyvinvoinnin laitoksen influenssadiagnooseihin ja laboratoriolöydöksiin. Tämä tarkoittaa, että kun oseltamiviirihaut edelsivät ajallisesti influenssadiagnooseja ja kun influenssahaut edelsivät sekä oseltamiviirihakuja että influenssadiagnooseja, niin ammattilaisten hakuja tietokannasta voitaisiin hyödyntää influenssaepidemioiden seurannassa. Lokitietojen vertaaminen infektioepidemiologisiin rekistereihin tuo uutta tietoa terveydenhuollon ammattilaisten internetin tiedonhausta. Hakutietoa on mahdollista hyödyntää perinteisten rekistereiden rinnalla infektiotautien ennakoinnissa ja seurannassa

Information Systems and Healthcare XXXIV: Clinical Knowledge Management Systems—Literature Review and Research Issues for Information Systems

Knowledge Management (KM) has emerged as a possible solution to many of the challenges facing U.S. and international healthcare systems. These challenges include concerns regarding the safety and quality of patient care, critical inefficiency, disparate technologies and information standards, rapidly rising costs and clinical information overload. In this paper, we focus on clinical knowledge management systems (CKMS) research. The objectives of the paper are to evaluate the current state of knowledge management systems diffusion in the clinical setting, assess the present status and focus of CKMS research efforts, and identify research gaps and opportunities for future work across the medical informatics and information systems disciplines. The study analyzes the literature along two dimensions: (1) the knowledge management processes of creation, capture, transfer, and application, and (2) the clinical processes of diagnosis, treatment, monitoring and prognosis. The study reveals that the vast majority of CKMS research has been conducted by the medical and health informatics communities. Information systems (IS) researchers have played a limited role in past CKMS research. Overall, the results indicate that there is considerable potential for IS researchers to contribute their expertise to the improvement of clinical process through technology-based KM approaches

NURSING STUDIES: PROMOTERS AND BARRIERS FOR ADHERENCE TO CLINICAL PRACTICE GUIDELINES AMONG NURSES

Clinical practice guidelines (CPGs) are designed to improve the care and safety of patients in hospitals. This thesis explores the promoters and barriers for CPG adherence among nurses. The research is based on a combination of a systematic literature review, qualitative research and a quantitative study. The systematic literature review included searching three data bases, namely, the British Nursing Index (BNI), Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The qualitative research study included one-to-one interviews and focus groups. The quantitative study consisted of a questionnaire distributed to nurses to extend and check the findings of the qualitative studies. The systematic literature review revealed that the attitude of doctors to any CPG is influenced most by the level of their agreement with the guideline and by its applicability in practice. The adherence of nurses to CPGs is influenced most by the support and feedback they receive and by team interactions. A previous framework for CPG adherence by doctors has been produced by Cabana (1999) based on a literature review. This thesis extends that framework to nurses, and adapts it on the basis of my original research findings. Three principal themes emerged from the qualitative studies; namely, nurses’ attitudes to CPGs, their knowledge of CPG and external factors that influence CPG adherence. Within these, the most prominent promoters of CPG adherence were nurses’ sense of their accountability, professional values and self-efficacy, as well as managerial monitoring and belief that a CPG would achieve the expected desirable outcome. The last of these depended to a large extent on nurses’ trust in the credibility of the guideline authors. The main barriers to CPG adherence were lack of knowledge about the guidelines caused by insufficient time to read them, poor presentation and inadequate dissemination of CPGs and the low priority given to training within a nurse’s schedule. Other barriers included lack of staff resources to apply CPGs, the exigencies of individual patient problems and wishes, the frequent movement of nurses between specialisms and a general failure to involve nurses in drafting the guidelines. All these results were confirmed by the results of a questionnaire survey. The revised framework presented here could help health care organisations, medical educators, policy makers and managers to develop better models for CPG development and awareness, especially among nurses, and to have a greater insight into the factors that promote or inhibit CPG adherence. Based on the framework, recommendations are made to help these groups of people, and nurses themselves, improve nurses’ adherence to CPGs. These are presented below, and are found as Table 7.1 in the thesis

Information behaviour of medical doctors and professional nurses in selected hospitals of OR Tambo Health District, Eastern Cape Province, South Africa.

Doctor of Philosophy in Information Studies. University of KwaZulu-Natal, Pietermaritzburg, 2017.The purpose of this study was to investigate the information behaviour of medical doctors and professional nurses in five selected district hospitals of the OR Tambo Health District in the Eastern Cape Province of South Africa. The study addressed the following research questions: What role and tasks do medical doctors and professional nurses perform in the five selected hospitals? What are the information needs of medical doctors and professional nurses in the five selected district hospitals? What are the channels and sources of information preferred by the medical doctors and professional nurses in the five selected district hospitals? What factors facilitate or hinder information seeking by medical doctors and professional nurses in the five selected district hospitals? The study used Leckie, Pettigrew and Sylvain‘s 1996 information seeking model as the theoretical lens underpinned by a post-positivism paradigm and a mixed method approach. A descriptive exploratory design was conducted. The population of study consisted of medical doctors and professional nurses in the five district hospitals. District hospitals play a pivotal role in supporting primary health care and are also a gateway to more specialist care. Data was collected using in-depth interviews, non-respondent observation and a survey questionnaire. A total of 167 of 205 copies of the questionnaire were distributed to medical doctors and professional nurses in the district hospitals were completed and returned, giving a response rate of 81.5%. Professional nurses constituted 86.3% of the survey respondents whereas medical doctors constituted 13.8%. In addition, all targeted interview respondents who included; 5 clinical managers and 5 nursing service managers were interviewed, translating to 100% response rate. All hospital wards except theatres were covered through observation. The quantitative data was analysed using SPSS while qualitative data was analysed thematically. The findings revealed that roles and associated tasks of medical doctors and professional nurses in the five selected district hospitals for which they needed information included patient care, teaching, training, continuing professional development and research. Medical doctors and professional nurses in the district hospitals surveyed preferred clinical guidelines, colleagues, hospital procedure manuals, drug lists, and reference books as sources of information. The findings revealed that ward rounds, workshops, seminars and in-service training were other preferred sources of information by medical doctors and professional nurses. The findings showed that the characteristics of the information source such as accessibility, familiarity, trustworthiness and cost and personal attributes such as willingness to learn, exposure to information during undergraduate training, peer pressure, and youthful age motivated medical doctors and professional nurses to look for information. The lack of time, unavailability of computers, lack of internet connectivity, inadequacy, or unavailability of libraries, and lack of technological skills were found to hinder access to information sources. The study makes among other recommendations: the need for institutional and national policies for the provision of information services to medical doctors and nurses; regular information behaviour surveys; making documents available in electronic formats; requisite implementing capacity building programmes for medical nurses and doctors; and providing information access points close to or within reasonable distance to the work place of medical doctors and professional nurses. The study makes original contribution to the domain of information behaviour of medical doctors and nurses from a developing country context such as South Africa. The study also forms the basis upon which policies related to the provision of information for medical doctors and professional nurses in public hospitals in the South African context can be formulated. The study provides baseline information upon which more research can be undertaken on the information needs, preferred information sources as well as factors that facilitate or hinder information seeking behaviour of medical doctors and professional nurses in South Africa. Future research should be extended to cover information behaviour of medical doctors, medical specialists, and nurses in tertiary, regional, and specialised hospitals in South Africa

Information experiences and practices of paediatric physicians in Nigeria: a phenomenological case study

Adequate access to and appropriate use of medical evidence by clinicians have been posited as influencing the quality of clinical decisions and outcomes of patient care. The broad aim of this case study of a tertiary hospital was to provide understanding of how the information experiences and practices of paediatric physicians in Nigeria influenced their information practices and the potential implications for patient care. To achieve the research aim and objectives, a qualitative exploratory study was conducted using multiple sources of data: interviews, diaries, observation and social network chats. Overall, twenty semi-structured interviews were conducted, and seven clinicians provided a week-long information activity self-reports through diaries. Supplementary data were gained via the researcher's personal observation and social media chats with some participants. Paediatricians in the cadre of: Consultants, Senior Registrars, Registrars and Residents provided the data which was analysed using the interpretative method. The results indicate that the paediatricians' information needs were on: managing challenging cases, supporting diagnostic decisions, managing evolving diseases, managing illnesses in the tropical context, drugs and dosage, refreshing the memory, keeping updated, and passing professional examinations. In general: i)there was haphazard approach to information literacy tuition for the clinicians during professional education resulting in varied information capabilities, and inadequacy of knowledge and skills for good information practice; ii) obtaining medical information from colleagues was the predominant feature of paediatricians' information practices; iii) printed textbooks were the paediatricians preferred source for obtaining medical evidence, however, there was a growing popularity in the use of electronic medical information sources, including at the point of care; iv) a perception of inadequacy of the hospital library services resulted in the paediatricians developing rejection behaviour towards the services, labelled in this study as information service rejection behaviour (ISRB); v) there was general perception by the paediatricians that access to, and use of medical information supports patient care and achievement of better treatment outcomes. This perception instilled a sense of value for information use, demonstrated through the clinicians' dedication to the self-provision of information resources; vi) a dearth of medical resources germane to the contextual management of illnesses led to inadequate clinician knowledge in a good number of cases. A new model of information behaviour entitled 'the knowledge production model of the paediatricians' information behaviour has been developed from the findings of this study, thereby extending existing scholarly perspectives on people's information behaviour. The Kpro model enunciates the concept of 'knowledge-based information behaviour' (KIB) which was exhibited by the paediatricians. The study recommends that i) the information literacy skills training (ILST) model developed from the findings, be used as a practical tool for inculcating information literacy to the paediatricians at the level of residency training; ii) the hospital management/librarians prioritise the improvement of information resources, services and infrastructure e.g. reliable internet service, e-library at wards and consulting rooms, and clinical librarian services, to enhance good information practices among the clinicians; iii) retraining of the hospital librarians for increased service delivery effectiveness; iv) increased local research through the establishment of Journal Clubs by the paediatricians to enhance local publishing of medical literature

Clinical information sources used by hospital doctors in Mongolia

BACKGROUND: Information technology presents new opportunities to facilitate clinicians' access to up-to-date clinical information. Developing countries have special needs in this area and the problems encountered in obtaining clinical information have not been well researched, particularly for hospital doctors. No previous study has examined which clinical information sources Mongolian hospital doctors' use and the problems they may encounter in obtaining information. This study addressed an important knowledge gap by examining clinical information-seeking practices of Mongolian hospital doctors. The objectives of the study were to ascertain: (a) which clinical information sources were used in clinical decision-making; (b) the level of confidence in these information sources, and (c) the impact these information sources had on clinical decision-making. Also investigated was proficiency in English language and computer skills, as these factors could influence ability to obtain clinical information electronically. METHODS: Self-administered questionnaires were given to 263 doctors from the two largest hospitals in Ulaanbaatar, the capital city of Mongolia. Respondents answered questions about 10 information sources: colleagues; local and foreign textbooks; local and foreign journals; personal notes; computer-aided literature searches; Mongolian clinical practice guidelines; and brief updates and health policies developed in Mongolia. Parameters of interest included: frequency of use; confidence in the sources; and perceived impact of the sources on clinical decision-making. RESULTS: The response rate was 87% (229). The respondents indicated that discussion with colleagues was the most frequently used information source, foreign medical textbooks most commonly inspired high confidence, and discussion with colleagues was the source most often perceived as having a high impact on clinical decision-making. For all sources, high confidence and high impact were strongly associated with each other. Only 26% of respondents understood English well, and only 41% had excellent/good computer skills. English language and computer skills were strongly associated with undertaking computer-aided literature searches and with age. Female respondents were less likely than males to have excellent/good computer skills and less likely to undertake computer-aided literature searches. CONCLUSIONS: Satisfying the clinical information needs of doctors in less developed countries is particularly challenging and even though improvements in information technology can facilitate access to knowledge, there still exist barriers. Health policies which promote computer skills and English language among doctors may contribute substantially to best medical practice in Mongolia.7 page(s

Information needs and information-seeking behaviour of practising medical doctors at Katutura and Windhoek central state hospitals in Namibia

This study investigated the information needs and information-seeking behaviour of practising medical doctors at Katutura and Windhoek Central hospitals in Namibia. Anchored on Wilson’s (1996) model of information-seeking behaviour, the purpose of the study was to establish the information required by practising medical doctors to carry out their work, how they seek information, the information sources and resources they use, and the factors that affect them as they do so. Understanding users’ information needs and the way information is disseminated in hospitals is necessary in developing an effective information provision system and ensuring the quality of information services in the hospitals. A mixed-methods research approach was used to meet the objectives of the study. Questionnaires were administered on 140 practising medical doctors at Katutura and Windhoek Central state hospitals, while fifteen doctors were interviewed telephonically, using a semi-structured interview guide. IBM SPSS (Version 25) was used to analyse quantitative data from the questionnaires, while content analysis was used to analyse qualitative data from the interviews. The findings of this research are that practising medical doctors need information mainly for improving clinical decision-making, keeping up-to-date, improving professional knowledge, and continuing education. The study also revealed that medical doctors use a variety of information sources and resources. However, the degree to which information sources are xiii used depends on the clinical context (outpatients, wards and casualty/emergency). Some contextual factors (organisational context, socio-cultural context, and information sources) can either support or hinder doctors in seeking the information they need. The patient is one of the primary information sources for medical doctors. However, language problems are a significant challenge in communicating with patients or patients’ relatives. Lack of patients’ understanding of medical terms and unavailability of properly run libraries in hospitals are some of the factors that affect doctors’ information-seeking behaviour. Participants recommended health education for patients, training of medical doctors on the use of the Internet and ICT, provision of properly run hospital libraries, and improved communication with other international hospitals as some of the ways to improve health information sources and services. Three related models were drawn from the study’s findings, based on Wilson’s (1996) model and literature, namely, the doctors’ decision-making model (DDmM), the clinical context information sources model (CCISM), and the model of information needs and information-seeking behaviour of medical doctors (MINISBMD). The thesis concludes with practical recommendations to enhance the provision of information at Katutura and Windhoek Central hospitals and suggestions for further research

Information needs and information-seeking behaviour of practising medical doctors at Katutura and Windhoek central state hospitals in Namibia

This study investigated the information needs and information-seeking behaviour of practising medical doctors at Katutura and Windhoek Central hospitals in Namibia. Anchored on Wilson’s (1996) model of information-seeking behaviour, the purpose of the study was to establish the information required by practising medical doctors to carry out their work, how they seek information, the information sources and resources they use, and the factors that affect them as they do so. Understanding users’ information needs and the way information is disseminated in hospitals is necessary in developing an effective information provision system and ensuring the quality of information services in the hospitals. A mixed-methods research approach was used to meet the objectives of the study. Questionnaires were administered on 140 practising medical doctors at Katutura and Windhoek Central state hospitals, while fifteen doctors were interviewed telephonically, using a semi-structured interview guide. IBM SPSS (Version 25) was used to analyse quantitative data from the questionnaires, while content analysis was used to analyse qualitative data from the interviews. The findings of this research are that practising medical doctors need information mainly for improving clinical decision-making, keeping up-to-date, improving professional knowledge, and continuing education. The study also revealed that medical doctors use a variety of information sources and resources. However, the degree to which information sources are xiii used depends on the clinical context (outpatients, wards and casualty/emergency). Some contextual factors (organisational context, socio-cultural context, and information sources) can either support or hinder doctors in seeking the information they need. The patient is one of the primary information sources for medical doctors. However, language problems are a significant challenge in communicating with patients or patients’ relatives. Lack of patients’ understanding of medical terms and unavailability of properly run libraries in hospitals are some of the factors that affect doctors’ information-seeking behaviour. Participants recommended health education for patients, training of medical doctors on the use of the Internet and ICT, provision of properly run hospital libraries, and improved communication with other international hospitals as some of the ways to improve health information sources and services. Three related models were drawn from the study’s findings, based on Wilson’s (1996) model and literature, namely, the doctors’ decision-making model (DDmM), the clinical context information sources model (CCISM), and the model of information needs and information-seeking behaviour of medical doctors (MINISBMD). The thesis concludes with practical recommendations to enhance the provision of information at Katutura and Windhoek Central hospitals and suggestions for further research