The "Just-in-Time" (JIT) information librarian consultation service

Abstract

Background: This thesis is based on the “Just-in-Time information” (JIT) librarian consultation service project. The project was designed to test if a library-related service could be used to address an information gap in primary healthcare by assisting clinicians in answering their questions. The project specifically tested whether or not a librarian consultation service could have a positive impact in two delivery methods for primary care practice in Ontario, Canada. Design: Randomized controlled trial (RCT) with additional qualitative and quantitative evaluation. The literature review section includes two systematic reviews. Methods: The primary method of this thesis is RCT of clinical questions posed by primary care professionals who participated in the JIT librarian consultation service. The thesis also discusses the project’s service delivery model and its implementation, which was developed to support the RCT. Other elements broader than the RCT, such as a librarian survey, have also been developed and included to explore factors contributing to the success or failure of the librarian consultation service. It evaluates potential positive impacts in terms of costs (saving time, workload issues), patient care decision-making, and improved access to information by using such a service. Results: The JIT service was implemented and run for one year prior to the RCT phase of the project with 88 individuals who participated in the RCT. The primary outcome was time to receive a response; whether time for JIT librarians to locate information to provide a response to a question, or a participant’s time to search for the information. Librarians provided their responses to clinical questions in less than fifteen minutes. This time was quicker than the response time of the participants. Of the responses provided to intervention questions, participants rated 63% as having a highly positive impact. Of the responses provided to control questions, participants rated 24.8% as having no impact, and 44.9% as having a negative impact on decision-making. Most participants rated their level of satisfaction with the service as having a positive impact (86%) on the care they provided to their patients and 83% assessed the service as providing relevant information to their questions in an appropriate time frame. Most participants would consider using a similar service, and most participants preferred this service to be delivered by a hand-held wireless device or web interface. Discussion and conclusions: This thesis demonstrates the development and implementation of a cost-effective and user-friendly librarian consultation service that provided primary care professionals with information to assist them in answering their questions arising from patient visits. Using a librarian to respond to clinical questions may allow primary care professionals to have more time in their day, thus potentially increasing patient access to care. Participation in this RCT decreased the use of consultations with other practice physicians, return patient visits, referrals, and other actions in the control group; reductions in these areas decrease costs. The application of the RCT design by combining librarianship with health services research is unusual. The use of the response to a clinical question as the unit of randomization and allocation is also innovative.