Physicians and Their Use of Information: A Survey Comparison between the United States, Canada, and the United Kingdom *
Davies, Karen S., Journal of the Medical Library Association
Previous research has compared physicians' use of electronic resources [1-3], use of MEDLINE search features , preferred source type for clinical information [4-6], perceived barriers to accessing information for patient care in specific countries [1, 7, 8], attitudes toward evidence-based medicine (EBM) [9, 10], and understanding of EBM terms [9, 1O]. These published research papers were included in a review by Davies  of the evidence on the informationseeking behavior of doctors, during which comparison across different countries was identified as an area needing further research. The study reported here compares these aspects, focusing on EBM resources across three countries: Canada, the United Kingdom, and the United States.
An online questionnaire (Appendix, online only) was utilized to determine the information needs and the use of EBM resources by qualified physicians in these three countries. The questionnaire was designed by the author and piloted as a Microsoft Word document on three medical librarians, two nurses, and three doctors (two general practitioners and one consultant; all recently retired) prior to the uniform resource locator (URL) being released. SurveyMonkey hosted this online questionnaire . The survey questions covered the topics of physicians' information needs; use of technologies and electronic EBM resources; attitudes toward and understanding of EBM; and barriers to accessing health information.
As part of the author's doctoral thesis, the survey was administered to physicians in the United Kingdom from December 2006 to May 2007 . To compare responses with physicians in Canada and the United States, the same survey was promoted to physicians in these countries from March to May 2007. The email addresses of physicians in Canada, the United States, and the United Kingdom were identified from websites, and an email inviting them to complete the questionnaire was sent to each. Medical websites were identified through a general Internet search and then individually searched for the email contact details of physicians (Table 1, online only). Emails were sent to all the physicians listed on the websites who had active, current email addresses. The emails explained that these data were being collected for a doctoral thesis and were intended to be published in a peerreviewed journal. There was no incentive offered to encourage completion of the questionnaire. There was no method for determining who responded to the emails, as the questionnaire responses were anonymous. This meant there was no opportunity to send out second follow-up reminder emails. The larger concurrent survey in the United Kingdom received 636 completed questionnaires, so an online research randomizer  was utilized to select 80 responses.
The data were analyzed using Excel. Ethical approval was obtained from Loughborough University.
Four hundred and ninety-eight emails were delivered to US physicians and 416 to Canadian physicians. Eighty responses were received from both US and Canadian physicians, which was a response rate of 16% and 19%, respectively. In the United Kingdom, 2,351 emails were delivered, with 636 questionnaires completed, representing an approximate response rate of 27%.
The percentages of responses from physicians working in general practice were similar for 2 of the countries: 31.30% for the United Kingdom and 32.50% Canadian responses, but 30.00% of the US responses were from physicians in general practice and 12.50% from family medicine specialists (which is a term not used in the United Kingdom). The remaining responses were evenly distributed among the medical specialties listed on the questionnaire, though both Canada and the Uniteci States had 6.25% "other" responses, possibly due to the different terminologies utilized in the United Kingdom.
Significant numbers of UK and Canadian physicians responded that they never used electronic resources for diagnosis, 20. …