An informaticist working in primary care: a descriptive study

Abstract

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.

A comparative case study of two models of a clinical informaticist service

“…The quantity and nature of the questions in the two projects are available as separate reports 10 11 and are summarised in the table on bmj.com. Both project groups found that relatively few primary care staff spontaneously submitted questions to the service.…”

A rapid evidence‐based service by librarians provided information to answer primary care clinical questions

“…The literature was reviewed for similar librarian consultation services to see if we could learn from others. Similar services were found both within and outside the library context, using either a clinical question and answer (Q&A) service [4][5][6][7][8][9][10][11] or virtual reference service. 12,13 All of the Q&A services were in primary care and while the virtual reference services included all types of health specialties.…”

Information needs of United Kingdom primary care clinicians1

“…While the Imperial project was running, a parallel service was being provided from a GP practice in Basildon, a town in the south‐east of England 29 . Although, in principle, the services were similar, and in each case the informaticist was a GP, the projects evolved in different ways.…”

“…While the Imperial project was running, a parallel service was being provided from a GP practice in Basildon, a town in the south-east of England. 29 Although, in principle, the services were similar, and in each case the informaticist was a GP, the projects evolved in different ways. The emphasis in the Imperial project was academically orientated, whilst that of the Basildon project was service orientated-conceptualized as a 'friendly local facilitator' rather than a 'laboratory testing service'.…”

“…Information services tend to be remote from the day-to-day reality of general practice-there is an obvious geographical divide, as they are traditionally located in the postgraduate library, but there is also a cultural divide, neither professional perhaps fully aware of how the other one works or the potential in working more closely together. 31 Table 1 A comparison between the Imperial and Basildon informaticist services Imperial 26,30,35 Basildon 29,30 'like a laboratory test service' 'friendly local facilitator' Low emphasis on personal contact High emphasis on personal contact Strong research component Strong service component Focus on academic rigour and technical excellence Focus on identifying important questions through face-to-face dialogue All relevant primary and secondary sources identified and appraised Pragmatic approach-'find out what we can and share it' using easily accessible sources None of project team involved in local service general practice Strong local links of project leader (a local GP) enabled integration into a clinical effectiveness unit There needs to be a greater partnership between information professionals and clinicians in primary care to fully realize the potential of information services. Whilst delivery of information via the Internet offers huge promise, there may be potential, alongside web-based initiatives such as the National Electronic Library for Health, for more personalized community-based services with an explicit aim of facilitating informationseeking behaviour and providing information which is tailored to the local primary care context.…”