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Online access to MEDLINE in clinical settings: impact of user fees
R B Haynes1, M F Ramsden, K A McKibbon
1Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Insights
Introducing user fees for physicians significantly reduced the quantity of MEDLINE searches, but not the quality. This suggests that cost recovery may hinder access to valuable clinical information resources.
Area of Science:
- Medical Informatics
- Health Services Research
- Information Science
Background:
- Physicians increasingly rely on online databases like MEDLINE for clinical decision-making.
- Previous studies indicated free access to MEDLINE searching tools like GRATEFUL MED facilitated usage.
- The impact of introducing user fees on physician search behavior and information access quality remained unclear.
Purpose of the Study:
- To evaluate the effect of user fees on the frequency and quality of MEDLINE searches conducted by physicians.
- To determine if cost recovery mechanisms influence physicians' utilization of clinical information resources.
- To assess the impact of user fees on search quality metrics such as recall and precision.
Main Methods:
- A randomized controlled trial was conducted with 59 physicians after an initial period of free MEDLINE access.
- Participants were assigned to either a 'pay group' (incurring search costs) or a 'no pay group' (continuing free access).
- Search frequency, recall, precision, and impact on clinical decisions were compared between the two groups.
Main Results:
- Physicians in the 'pay group' searched significantly less frequently than those in the 'no pay group', particularly among prior frequent searchers.
- For less frequent searchers, only 48% of the 'pay group' conducted searches compared to 85% in the 'no pay group'.
- No significant differences were observed in search quality (recall, precision) or the proportion of searches influencing clinical decisions between the groups.
Conclusions:
- Imposing user fees for MEDLINE searching in clinical settings after free access adversely affects search quantity.
- User fees did not significantly impact the quality of searches or their influence on clinical decisions.
- Healthcare organizations and MEDLINE providers should carefully consider the potential negative impact of user fees on information access and utilization.
Abstract:
The effect of introducing user fees on the frequency and quality of MEDLINE searching with GRATEFUL MED by physicians in clinical settings was tested. After training and free use (prior study), consenting participants were randomly allocated to pay searching costs (pay group) or continue without fees (no pay group). Fifty-nine physicians participated. Among the prior study's frequent searchers, the pay group searched at less than one third of the rate of those assigned to no pay. For less frequent searchers in the prior study, only 48% of those assigned to pay did any searches, compared with 85% for the no pay group (P = 0.006), and for those who did search, their frequency was almost half. However, there was no significant difference in the quality of searches; both groups demonstrated about equivalent recall (P = 0.77), but significantly lower precision (P = 0.03) than for the librarian's independent searches. Similarly, there was no difference in the proportion of searches affecting clinical decisions for the two groups. Thus, imposing user charges for online searching in clinical settings after a period of free use adversely affects searching quantity, but not quality. MEDLINE providers should consider whether user fees will undermine its benefits.
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