Objectives To describe and evaluate two different models of a clinical informaticist service. Design A case study approach, using various qualitative methods to illuminate the complexity of the project groups' experiences. Setting UK primary health care. Interventions Two informaticist projects to provide evidence based answers to questions arising in clinical practice and thereby support high quality clinical decision making by practitioners.

A regional R and D grant was used to explore how an informaticist could stimulate and respond to questioning behaviour in primary care clinicians. Training needs for the informaticist were identified and provided for. Nurses and doctors working in primary care were approached individually. They were encouraged to think about their clinical behaviour and to identify topics where they thought they might like to have more evidence either to justify their current practice or to stimulate change. The personal approach was labour intensive but seemed to provide a good yield in questions. The project took two years and the informaticists have tackled over 125 topics. The project is being evaluated by the Department of Primary Care at University College Hospital Medical School, London. A number of the GPs who used the service were interviewed and there was a high level of satisfaction. There was some informal feedback that the answers to the questions actually changed clinical behaviour but so far, audits of reported changes have not been carried out. Funding to continue and expand the service has now been secured through the access to evidence initiatives.

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