Academic journal article Journal of the Medical Library Association

Using the Turning Research into Practice (TRIP) Database: How Do Clinicians Really Search?*

Academic journal article Journal of the Medical Library Association

Using the Turning Research into Practice (TRIP) Database: How Do Clinicians Really Search?*

Article excerpt

Objectives: Clinicians and patients are increasingly accessing information through Internet searches. This study aimed to examine clinicians' current search behavior when using the Turning Research Into Practice (TRIP) database to examine search engine use and the ways it might be improved.

Methods: A Web log analysis was undertaken of the TRIP database-a meta-search engine covering 150 health resources including MEDLINE, The Cochrane Library, and a variety of guidelines. The connectors for terms used in searches were studied, and observations were made of 9 users' search behavior when working with the TRIP database.

Results: Of 620,735 searches, most used a single term, and 12% (n = 75,947) used a Boolean operator: 11% (n = 69,006) used "AND" and 0.8% (n = 4,941) used "OR." Of the elements of a well-structured clinical question (population, intervention, comparator, and outcome), the population was most commonly used, while fewer searches included the intervention. Comparator and outcome were rarely used. Participants in the observational study were interested in learning how to formulate better searches.

Conclusions: Web log analysis showed most searches used a single term and no Boolean operators. Observational study revealed users were interested in conducting efficient searches but did not always know how. Therefore, either better training or better search interfaces are required to assist users and enable more effective searching.


Clinicians continually encounter clinical questions for which they need to find answers. For example, 350 million general practice National Health Service (United Kingdom) consultations per year take place [1], and, with a conservative estimate of one question per four primary care consultations [2], there could be at least 80 million consultation-related questions per year. Of the questions primary care physicians recognize, they have been shown to pursue only one-third [3].

Currently, real-time information needs in clinical care are often poorly addressed or ignored [4]. A consequence is that high-quality evidence is underused by clinicians to the detriment of patient care. Reflecting this issue, one study indicates that approximately half of recommended processes for health care are actually delivered to patients [5]. The causes of the gap between clinicians' information needs and meeting the needs include information overload (more than 1,800 research papers, including at least 55 randomized trials, are published per day), insufficient knowledge synthesis, and ineffective methods of continuing medical education [6, 7].

Though most health care workers would like to apply evidence more consistently, several practical barriers exist. These include failure to recognize or record important questions about patient care that arise in consultations and the lack of sufficient time, skills, knowledge, or confidence to search and appraise relevant research at the point of clinical decision making [8-1O]. Therefore, better recognition of information needs and greater ease of access to evidence-based resources at the point of care is critical to the use of evidence in practice and improved care and outcomes for patients.

Search and meta-search engines are now widely available and are designed to improve clinicians' access to available information. These engines allow clinicians to search several electronic evidence resources at once, the aim being to save time and enable more efficient searching of up-to-date information. A focused question is crucial to providing the evidence to facilitate change in practice [11]. The elements used in evidence-based question formulation are population, intervention, comparator, and outcome (PICO) [9]. Boolean operators such as "AND" and "OR" should be used to combine the PICO elements and increase the sensitivity (ORs) and specificity (ANDs) of a search.

The Turning Research Into Practice (TRIP) database-launched in 1997 as a result of the work of the founders, Jon Brassey and Chris Price-is a meta-search engine widely used in the United Kingdom and internationally [12]. …

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