Finding the answers in primary care: Information seeking by rural and nonrural clinicians

Background: Information systems for rural practice may assume that rural clinicians have different information needs, but studies have not directly compared rural and nonrural information needs using common methodology. Obiective: Compare rural and non-rural: 1) information needs; 2) information seeking- 3) effectiveness of information seeking; and 4) use of information resources. Design: Observation and interviews during one halfday of office practice; telephone follow-up 2-10 days later. Participants & Setting: Primary carephysicians (39), nurse practitioners (42), and physician assistants (22) in ambulatory practices in rural and nonrural Oregon. Measures: 1) number of questions asked, 2) number of questions pursued, 3) number of questions answered), and 4) use of knowledge resources. Results: Rural clinicians practiced in smaller groups, but were otherwise similar to nonrural clinicians. During half-day interviews, clinicians cared for an average of 8.2 patients (95% CI 7.5 - 8.8) and asked an average of 0.83 questions per patient seen (95% CI 0.73 - 0.92). At follow up, they had pursued an average of 4 7% of their questions (95% CI 40 - 53%), and reported being successful in finding an answer to 7 7% of those they pursued (95% CI 70 - 84%). There were no statistically significant differences between rural and nonrural clinicians for any of these variables. Conclusions: Rural and nonrural clinicians had similar information needs, information seeking, knowledge resource use, and effectiveness at finding answers to their questions. Human consultants, digital resources, and library-based resources were less available, but these differences in availability had little impact on their use.