Academic journal article Journal of the Medical Library Association

Promoting MedlinePlus Utilization in a Federally Qualified Health Center Using a Multimodal Approach

Academic journal article Journal of the Medical Library Association

Promoting MedlinePlus Utilization in a Federally Qualified Health Center Using a Multimodal Approach

Article excerpt


Inadequately informed decision-making by patients is common in primary care [1-4]. Many patients-particularly those with low health literacy, low education, or limited English proficiency-lack the relevant knowledge about their medications or health conditions that is necessary to engage in informed decision-making or self-management [5-13]. In a study of underserved patients, only half could cite their medication names, indications, and frequency, while only 25% knew their doses and none could report potential side effects [14]. African American patients experience more medication problems that are potentially related to worse access to high-quality health information [15, 16]. Clinicians often misjudge patients as being more informed than patients actually are [17], while patients believe that they understand more than they actually do [18].

MedlinePlus is a high-quality health information website produced by the US National Library of Medicine (NLM) of the National Institutes of Health. Information on the website is continuously updated, scientifically vetted, and free of advertisements and product endorsements [19]. The website covers more than 975 diseases and conditions, drugs, and supplements in addition to providing access to videos and tools. The full website is available in English and Spanish and includes easy-to-read sections written at 5th to 8th grade reading levels. MedlinePlus also offers Connect, an application programming interface that can be integrated with selected electronic health records (EHRs) and portals. The program provides relevant information on diagnoses, medications, and lab tests at the point of care [20].


This case study describes the authors' experience in promoting the use of MedlinePlus among poor and minority patients and their clinicians in a federally qualified health center (FQHC). Our project had three major goals: (1) improve web access to MedlinePlus for poor or minority patients; (2) improve patients' knowledge, attitude, and skills related to accessing online health information; and (3) improve clinicians' use of MedlinePlus at the point of care.


Our project involved collaboration between an academic medical center and a large urban FQHC. FQHCs are independent, nonprofit organizations that serve low-income populations. At this FQHC, 78% of patients live at or below 100% of the federal poverty level. The FQHC comprises 4 major sites that provide patient care throughout the community. The University of Rochester Institutional Review Board reviewed the project and determined it to be exempt from review. An NLM grant (G08 LM011524-01) provided resources that supported equipment and staff. The funders had no role in study design, data collection, analyses, or decision to publish the manuscript.

Project steering committee

We created a project steering committee consisting of the project director, project coordinator, research assistant, consulting medical school librarian, and health center staff(including the health center's director of clinical operations, practice managers, and key nursing staff). Using Carman et al.'s [21] framework as a guiding principle, the committee identified three levels (i.e., patients, clinicians, and the organization) for targeting in order to improve use of MedlinePlus. The committee brainstormed various strategies based on behavioral and organizational principles, feasibility, and likely yield. The committee settled on seven strategies of implementation, focusing on our three project goals (Table 1). The committee met regularly throughout the project to oversee implementation, assess progress, problem-solve barriers, and recommend adjustments. The medical school librarian compiled resources, provided advice to the group, compiled curricular materials, assisted in training clinicians and nurses in the use of MedlinePlus, and served as resource for ongoing questions about the use of MedlinePlus. …

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