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J Med Libr Assoc. Jul 2003; 91(3): 337–340.
PMCID: PMC164396

Family physicians' interests in special features of electronic publication

Dario M. Torre, M.D., M.P.H.,1 Scott M. Wright, M.D., Assistant Professor of Medicine,2 Renee F. Wilson, M.S.,2 Marie Diener-West, Ph.D.,3 and Eric B. Bass, M.D., M.P.H.4

Abstract

Objective: Because many of the medical journals read by family physicians now have an electronic version, the authors conducted a survey to determine the interest of family physicians in specific features of electronic journal publications.

Setting and Participants: We surveyed 175 family physicians randomly selected from the American Academy of Family Physicians.

Results: The response rate was 63%. About half of family physicians reported good to excellent computer proficiency, and about one quarter used online journals sometimes or often. Many respondents reported high interest in having links to: an electronic medical text (48% for original articles, 56% for review articles), articles' list of references (52% for original articles, 56% for review articles), and health-related Websites (48% for original and review articles).

Conclusion: Primary care–oriented journals should consider the interests of family physicians when developing and offering electronic features for their readers.

INTRODUCTION

With the advent of the electronic information age, family physicians have seen a tremendous growth in the number of general medical journals that offer an electronic version. These journals offer a variety of special electronic features that are intended to enhance the usefulness of journal content for busy practitioners. For example, online journals may offer subscribers an advanced and customized notification of content and sophisticated literature searching capabilities [1–4]. As physicians become more avid users of electronic journals [5], they are likely to want access to those electronic publication features that will be most useful to them. Certainly with the proliferation of Internet connections and technologies and improved computer access and speeds, the potential exists for online journals to serve as the ideal interface of medical information in the future. Therefore, it becomes important to assess family physicians' information needs in this new multimedia-based health care environment.

This study sought to determine the interests of family physicians in selected features that could accompany electronic publication of a medical journal and to identify barriers that may prevent family physicians from using electronic journals.

METHOD

The authors conducted a cross-sectional survey of family physicians that was initiated in December 2000 and completed in March 2001. We surveyed a total of 175 family physicians randomly selected from the American Academy of Family Physicians (AAFP). We targeted members of the AAFP, because the AAFP is the largest organization of family physicians in the United States [6]. We asked the membership coordinator of the AAFP to randomly select from the membership list 175 individuals who were active members, currently practicing in the United States, and graduates of U.S. medical schools.

As described in a previous publication about a similar survey of academic general internists and family physicians, the survey instrument was developed and piloted among primary care physicians at the Johns Hopkins University School of Medicine. We also obtained input from the editors of selected primary care–oriented journals for the development of the questionnaire and incorporated some of the items they suggested. The instrument included questions about the respondent's use of online journals and the level of interest in having the following electronic features linked to an original article, review article, or editorial: links to article references, links to health-related Websites or an electronic medical text, links to appendixes and supportive material, links to peer reviewers' comments, and links to communicate with editors, authors, or other readers [7]. The questions assessing interest in specific electronic features used a 4-point Likert scale consisting of “no interest,” “little interest,” “moderate interest,” and “high interest.” The survey also included questions regarding interest in receiving customized alerts and advance tables of contents and queries regarding potential barriers to use of the online version of a journal. We also collected information about age at graduation from medical school, specialty type, faculty appointment, primary work activity, computer proficiency, and availability of Internet access.

We mailed questionnaires to the selected family physicians with a cover letter explaining the purpose of the study. The study protocol was approved by the Johns Hopkins University Joint Committee on Clinical Investigation.

Descriptive statistics were used to summarize characteristics of responding physicians and their survey responses. We used the chi-square test to assess the relationship of computer proficiency to online journal use and barriers. Analyses were performed using STATA Statistical Software version 6 (Houston, TX).

RESULTS

After three mailings, the response rate reached 63% (110 of 175 members). Overall, 68% of respondents were men, and 50% graduated from medical school after 1983.

The baseline characteristics of respondents in our sample (Table 1) appeared to be representative of the AAFP membership. According to a membership survey of the AAFP, 72% of active members were men, 38% had a faculty appointment, and 98% were involved in direct patient care [8].

Table thumbnail
Table 1 Characteristics of survey respondents

Of interest, among those physicians who had rarely or never used an online publication, respondents were more likely to report that they had never used an online journal if their computer proficiency was poor or fair (75%) compared to good or excellent (25%) (P < 0.05).

Interest in specific electronic features.

Participants reported high interest in having links to an electronic medical text, health-related Websites, and an article's list of references (Table 2). They reported low interest in having links to initiate dialog with other readers and communicating comments to authors or editors. They also reported moderate to high interest in receiving advance tables of contents and customized alerts.

Table thumbnail
Table 2 Interest in electronic features for original, review, and editorial articles

Barriers.

As shown in Table 3, the majority of respondents reported that the inability to read the journal anywhere and preference for print media were barriers to the use of electronic features. The inability to read the journal anywhere was considered to be a major barrier by 60% of family physicians with low computer proficiency but only by 40% with high computer proficiency. Similarly, preference for print media was felt to be a major barrier by 58% of family physicians with low computer proficiency but by only 41% with high computer proficiency.

Table thumbnail
Table 3 Barriers to the use of electronic publication features

DISCUSSION

Family physicians are interested in specific features of electronic publications that will enhance the usefulness of primary care–oriented journals. Our study confirms the results of previous research that showed high interest among physicians in the unique opportunities that electronic journals could offer, such as the ability to establish links with other areas of interest [9, 10]. These findings could be used to guide the development of new offerings by electronic journals, especially general medical journals that are read by large numbers of family physicians.

Previous research has shown that physicians learn in response to specific clinical problems generated by patients in their daily practice [11]. This learning may explain the strong interest in links to an electronic medical text, a potentially convenient feature to answer clinically related questions. However, the low interest reported by family physicians in communicating with editors, authors, or other readers is of some concern. This position may somewhat reflect isolation of family physicians from colleagues that could ultimately influence their professional and personal development.

Inability to read an electronic journal anywhere (unless you own a personal digital assistant [PDA] with wireless capabilities) and preference for print media are felt to be barriers by the majority of respondents in both groups. A higher level of computer proficiency, however, is associated with a lower likelihood of reporting barriers. This suggests that improvement of physicians' computer literacy will lessen barriers to the use of online publication. This seems likely to occur considering that primary care physicians identify knowledge and skills about computers and informatics as an area for improvement [12]. However, until electronic technology can make computers just like print media, manufacturing handheld electronic devices with voice and handwriting recognition and a friendly reading interface, print journals may never be replaced. The ability to feel, touch, or simply turn over the pages of a journal in a true three-dimensional milieu is a feature that technology might not be able to match.

In our report, physicians also indicate high interest in links to an articles' list of references. The potential to immediately obtain not only the proper reference on a specific topic but also the full text of an article of interest is undoubtedly one of the most intriguing and exciting possibilities offered to medical journals by the digital revolution.

Some of the limitations of this study deserve consideration. First, respondents may have expressed an opinion about electronic features they have not yet used. However, most of the respondents report fairly high computer proficiency and Internet access. Second, responders may have been more interested than non-responders in using online journals. Responders, however, are fairly representative of physicians from one of the largest organizations of family physicians in the United States. Third, due to rapid changes in the publishing world and electronic technology, it is hard to predict how family physicians will respond to such an evolving environment. Thus, it will be important to continue to gather information about family physicians' information needs.

In the future, family physicians may have available at their fingertips a number of electronic features that will allow them to rapidly access a linked and customized system of medical information, using a wide variety of electronic devices. Family physicians may need to enhance their computer proficiency to take full advantage of new online features. Future research could focus on evaluating the actual use of new electronic features as they become available by tracking use of specific resources, time spent online, and types of articles read or printed.

Furthermore online journals are adding new features that will allow users to download automatically tables of contents and abstracts onto their PDA devices [13], which may help overcome some of the barriers to the use of online journals. The advent of new portable devices may also revolutionize the way in which we plan to assess medical information needs as personal computers and portable computers (laptop) may not be the only electronic means of such access. Primary care–oriented medical journals, in turn, should consider the specific interests of family physicians when implementing changes and offering new features.

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