Updating Hospital Reference Resources in the United States-Associated Pacific Basin: Efforts of the Pacific Islands Continuing Clinical Education Program (PICCEP)*
Johnson, Karin E., Skillman, Susan M., Ellsbury, Kathleen E., Thompson, Matthew J., Hart, L. Gary, Journal of the Medical Library Association
This article describes a project by the Pacific Islands Continuing Clinical Education Program (PICCEP) at the University of Washington (UW) to supplement hospital reference materials in six jurisdictions in the US-associated Pacific Islands. It outlines a model for cooperatively developing a suite of clinical reference materials suitable to low-resource settings.
The US-associated Pacific Islands encompass the US flag territories of American Samoa, the Commonwealth of the Northern Mariana Islands (CNMl), and Guam, as well as the independent countries, "freely associated with the United States,"[double dagger] of the Federated States of Micronesia (FSM), the Republic of the Marshall Islands (RMI), and the Republic of Palau. The region contains 104 inhabited islands that cover an area of the Pacific that is larger than the continental United States. Nearly 500,000 total residents live in the jurisdictions. Gross domestic product per capita in 2000 varied from $1,600 in RMI to $21,000 in Guam. English is an official language throughout the region, although many people speak one or more other languages [I]. The United States serves as the region's primary funder of social and health services. Each jurisdiction has one or more secondary hospitals, with bed sizes ranging from under 50 to over 200. Only a few of them offer advanced specialty services.
In 1998, the federal Institute of Medicine (IOM) found numerous health care challenges in the region: deteriorating health infrastructure, high health care costs, serious health problems on some islands such as high rates of substance abuse and infant mortality, and particularly "shortages of adequately trained health care personnel" . The IOM recommended an emphasis on health workforce improvement, in large part through continuing medical education (CME). The federal government responded, in part, by funding PICCEP, a four-year effort implemented by the UW Center for Health Workforce Studies.
PICCEP conducted a needs assessment and concluded that, among other problems, the region's health care providers lacked current clinical reference materials . Most hospitals did not have libraries or librarians. They all had at least a small collection of reference materials, but most physicians felt these materials were too limited to help solve specific clinical problems or maintain skills. Personal computers were few in number and not readily available for most clinicians. In addition, limited, slow, and expensive Internet access made computerized references impractical in all but the most developed jurisdictions, such as Guam and the Republic of Palau.
THE PACIFIC ISLANDS CONTINUING CLINICAL EDUCATION PROGRAM TO IMPROVE HOSPITAL REFERENCE RESOURCES
Given the need for reference materials expressed by regional physicians and observed by PICCEP staff, PICCEP sought to improve access to key clinical reference resources as part of its overall CME program. During 2000-2001, it obtained $40,000 for this purpose. Because most health systems in the US-associated Pacific Islands were divided distinctly into a central hospital and a public health system, PICCEP targeted hospitals, where most physicians were based. To distribute available resources equitably in the region, PICCEP divided the funding roughly equally among the eleven major hospitals. PICCEP sought to coordinate its program supplementing reference materials with other organizations engaged in similar efforts. An investigation revealed no preexisting programs in the region and only one documented program in the world, the Blue Trunk Program run by the Library of the World Health Organization (WHO). This program provided African district health centers with about 100 books on medicine and public health and a few medical journal subscriptions . WHO worked with local trainers to help deliver, publicize, and monitor the collection.
Book donation programs can fail for reasons including materials that do not reach their intended audience or are inappropriate to local conditions, placement of materials where few potential users know about them, materials that are removed for personal use and not returned, resources for updating that are missing, and recipients who are unaccustomed to using books and journals as information sources . …