Evidence-based information without the subscription: How much is free on the Internet?

Dr. John King, Milton Family Practice, searches for patient education materials

Public access to medical research publications is now a reality thanks to National Institute of Health (NIH) policies and recent legislation. NIH’s Public Access Policy requires that publications resulting from NIH-funded research are made publicly available on NLM’s open access repository PubMed Central (PMC) within 12 months of publication http://www.ncbi.nlm.nih.gov/pmc/. Health care professionals and community members seeking research-level information can often find credible evidence and resources using Google, Google Scholar or PubMed because these search engines index or search for information in PMC articles. Open access publishers such as PLoS (Public Library of Science) and BioMed Central also deposit full text articles on PMC without any waiting period. The National Library of Medicine provides a set of medical textbooks, clinical guidelines, and drug information free on the Internet. But is this free information sufficient to answer the many questions that arise in a clinical practice? So far, there is reason to think it isn’t.

Some of the best organized and most useful information is not free – far from it. Many journal articles or medical textbooks are not available online unless a hefty fee is paid to the publisher, often $50 or more for an individual article. Expert summaries like UpToDate and evidence-based reviews like DynaMed, that many physicians find convenient for point-of care, are developed by commercial publishers and require an annual subscription for individuals or institutions. Many individual practices and community hospitals are reluctant to pay the thousands of dollars required annually to subscribe to the electronic journal titles and clinical resources that providers might need.

While UVM/FAHC faculty, staff, and students have full electronic access to thousands of medical and health science electronic journal articles, clinical databases, textbooks and research engines, clinicians and researchers with no affiliation do not have this advantage. Community clinicians and the public are welcome to come to Dana Library to use subscription-based resources, but visiting is not a practical option for busy clinicians, even those in Chittenden or nearby counties.

Dana Library services support community hospitals and health care providers

How can unaffiliated Vermont clinicians obtain the evidence-based clinical information they need? As a Resource Library of the National Network of Libraries of Medicine and as part of UVM’s community service mission, Dana Library offers a set of services to health care providers, agencies and institutions that are unaffiliated with UVM or Fletcher Allen.  Journal article delivery service and literature search services are available at a reasonable cost (less than direct from the publisher). More information is found at http://library.uvm.edu/dana/services/unaffiliated.php. A web guide to resources with no license or subscription is also available: “Free Medical Resources to Support Clinical Care.”  http://danaguides.uvm.edu/freeresources. Some individual clinicians, practices and community hospitals in Vermont are already finding these services useful.

Marianne Burke.Mar29'07
Dana Director, Marianne Burke

What else can be done to integrate the medical and health content into clinical, community and public health services on a statewide basis? In some states, collaborations among AHECs, state library agencies, hospital administrators and librarians have developed mechanisms for statewide licensing of knowledge-based medical and health information for medical, professional and lay communities. Could it happen in Vermont? Dana Library and representatives of these organizations are exploring this sort of collaboration and feasibility. If the need can be established and institutional support gained, it may be possible.

Marianne Burke, MLS, AHIP
Director, Dana Medical Library

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.