drug information communication via television by Don E. Nelson, Leonard T. Sigell, Robert A. Yokel, und Nancy Lorenzi
INTRODUCTION A picture, graph or table can often communicate a thought, concept or relationship more effectively than extensive use of the written word. This is particularly true with many types of important medical information. Over the past several years of providing information services t o medical personnel at some distance from this Medical Center, we have felt that communication might sometimes be more effective if the questioner could not only hear about but see the data being discussed. Television and other electronic visual media now on the horizon make it technically feasible to offer people in many different locations ready access to visual materials, and thus obviate the need to leave the patient care area in order to obtain important medical information. Such media can be employed to allow useful interactive discussions in spite of great distances between the information source and the user. The willingness of medical personnel to accept television as a substitute for hard copy, and telecommunications as a substitute for “curbside consultation” on the wards are but two of many factors that need to be evaluated if such approaches are to be proposed on a broad scale. This paper describes the development and the initial experiences of a research study undertaken to answer these and related questions.
THE PROJECT This research project is a cooperative venture of the Dr. Nelson is Associate Director of the Drug Information Center, University of Cincinnati Medical Center. Cincinnati. OH 45267. Presented at the Tweyth Annual Meeting, Drug Information Association. Son Francisco. June 23-26. 1976.
Health Sciences Library, the Drug and Poison Information Center (DPIC) and the Department of Biomedical Communications of the University of Cincinnati Medical Center. The project is funded by a research grant from the National Library of Medicine. The intent of all three groups is to explore television as a medium for communication of medical information. The DPIC is a 24-hour service for the medical and lay communities of the Greater Cincinnati Area. The DPIC functions as both a drug information center and a poison control center; it responded to more than 35,000requests for information in 1975. The Health Sciences Library is a combination of the libraries of the College of Medicine, Cincinnati General Hospital and the College of Pharmacy. An office in an ideal location in the library was allocated for this project. This we call the Resource Room. The telephone-coupled computer terminal which allows on-line searching of Medline, Toxline and other computer data bases is in the room immediately adjoining the Resource Room. The Resource Room is the point of origin for all television transmission from this project. At the present time, the Resource Room is connected via closed circuit television cable to four receiving locations and via over-the-air transmission to 10 area hospitals which are equipped with special down-converters to receive and unscramble the signal. Thus, the system can provide both cable and over-the-air transmission. A telephone operator-type headset is used by the information provider to allow discussions with both hands free to select and place materials under the camera. A high resolution 1000-line television camera is used as the point of origin of the television signal. Monitors with 800-line resolution capability are used in those locations connected directly via cable to the Resource Room: the
p132
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main office of the DPIC on the Medical Service floor of the Cincinnati General Hospital, the General Hospital Emergency Room, the Children's Hospital Emergency Room and the in-patient pharmacy on the medical ward at the Veteran's Hospital. Although drug information questions are handled by the DPIC on a 24-hour. 7 days per week basis, the television project currently operates on weekdays only. During this time period, calls may be received directly by the Resource Room staff or incoming calls to the Drug and Poison Information Center which require in-depth literature searches can be transferred to the Resource Room. Because of the transfer of DPIC calls, the project was able to begin operation with a reasonable number of inquiries being handled each week. The project is staffed by a librarian and a p harmacologist .
EVALUATION METHODOLOGY Evaluation methods of this project include both user and provider ratings of the information provided, as well as the usefulness of television in those cases where it was used. Intramural and extramural evaluation teams have visited the project and have shared with the researchers the results of their observations. Each time an inquiry is handled by the Resource Room a data collection form is completed* and data are sent to the computer center to be entered for subsequent retrieval and analysis. Information regarding the typq of caller presenting the question and the usefulness of consulted references in arriving at an answer, a rating by the staff of the value of the retrieved information, determination of the application of the information, and an evaluation of the utility of television from the viewpoint of both the user and provider of the information are collected on the documentation form. Special coding and/or rating systems have been established for classifying the specific type of question posed, the resources used, the role of all persons involved in the question, and the value of television in providing the response. A standard question code designed for this project allows the storage of questions in a format that could, in the future, provide the basis for an on-line computerized system to provide answers rather than references to pertinent drug information questions. At the end of each contact with the system the user is asked to respond to three questions on the data form. This part of the form is projected over the television system, and project staff record the verbal responses. The questions are designed to obtain the user's opinions of the service, the information, and the contributions made by television. While there are some biases introduced by such an approach, it is viewed as preferable to all other suggested methods of obtaining the user's reactions in a manner that would not discourage or extinguish future contact with the system. In some instances, project staff are also able to gather impact information from data gathered on wards or by interviews. *Copy available upon request.
RESULTS During the year ending April 15, 1976, television was used in a total of 207 inquiries. The monthly breakdown of total inquiries and inquiries in which television was used is shown in Figure I . As can be seen there is a general trend over time toward an increased use of the project and also toward increased use of television in responding to inquiries. There was no significant variation with respect to the day of the week on which calls presented. The distribution of calls with respect to time of day received is illustrated in Figure 2. There is a slight trend toward a heavier call load in the late morning hours. This may be related to questions being raised by ward teams during morning rounds. Table I presents information on the use or non-use of television in the 956 inquiries handled by the project. It can be seen that the television system was used in 21% of alt cases which presented to the project. It should be noted, however, that in 46.1% of the total questions there was no monitor available to the caller. Thus, in situations where monitors were available, television was used in 40.1% of the inquiries. Table I also shows the reasons for use or non-use of television in the 956 cases. In two-thirds of the cases where television was employed, its use had been suggested by the caller. The most common reason for non-use was that the caller did not have access to a monitor. A concern of the investigators had been that the time required to place materials under the TV camera might rule out its use in emergency situations. Our data show that this is a very rare event. In only one case did the provider feel that TV was too slow to use for an emergency inquiry. The frequency of television use by monitor location is shown in Table 2. The monitor on the Medical Service (7th) floor of the Cincinnati General Hospital, in the DPIC office, was by far the most frequently used. Table 3 shows the use of the CGH and Children's Hospital monitors by month during the year of the study. Table 4 shows the percent of use of television by various types of users. Combining this with the data in Table 2, it can be seen that the most frequent users of the system were physicians and pharmacists located on the Medical Service floor of the Cincinnati General Hospital. Figure 3 is a graph of television use in handling particular type's' of questions. There were minor trends toward a higher 'rate of use in questions involving choice or use of drugs, side effects, and identification of drugs and in questions involving nondrug substances, and toward lower rates in questions on safety, pharmacokinetics, interactions or incompatibilities, todcity, and sources of drugs. Table 5 summarizes what the users stated was the intended application of the information they requested. Regardless of the communication medium employed, users of the service most commonly asked questions pertinent to the selection of a treatment approach for a particular patient. The next two most frequent uses were to obtain aid in explaining observations in patients ahd to add to personal knowledge.
DRUG INFORMATION JOURNAL
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Octobcr/Decemkr 76 p133
FIGURE 1 Monthly Distribution of Total Inquiries and Use of Television Total area of bar represents all inquiries (number in parentheses); darkened area, inquiries in which television was used. Since April 1975 and April 1976 were half-months, their width has been halved but their height doubled to indicate a monthly approximation.
160
-
120
(123
NUMBER
OF INQU IRI ES 80
I
.
40
0
I 0
A
M
J
J
S
A
1976
197 5 MONTH
Evaluation
With respect to the total time required by all staff to answer questions presented to the project, 32.7% of the questions required less than 10 minutes, 3 1.3% required 10 to 30 minutes, 26.2% required 30 minutes to 2 hours, 7% required 2 to 8 hours, and 1% required more than 8 hours to answer. Table 6 shows the television transmission time involved in answering questions. About half of the questions required kss than 5 minutes of transmission time, one-third required 5 to 15 minutes, and about 18% required more than 15 minutes. Thest data show that, regardless of the length of time required to complete a n information search (some have required up to 40 hours), the user spent a n average of 9 minutes at the TV monitor to receive. discuss, and react to the information. We have begun to compare the kngth of time required to communicate drug information by telephone with that for telephone plus television. We are also gathering other data that we anticipate will allow us to make spesific costefficacy statements about the use of TV in communicating drug information.
Ideally, one would like to be able to measure the impact of a medical information system such as is described above on patient care. However, such measurements are extremely difficult to obtain and are subject to broad individual interpretation. It is our feeling that ratings by both providers of information and users of the information reflect the usefulness of television as a means for communicating drug information. It is in this light that the following data are presented. The individuals providing the information via the television system were asked to rate its usefulness as a means for communicating the particular information required to answer each specific question. T a b k 7 shows that in over 95% of the instances where television was used the provider felt that it made some contribution to the communication of the information. It is interesting to note that as providers p i n e d experience in using television, there was a marked trend toward more favorable ratings of its contribution. The total absence of
Downloaded from dij.sagepub.com at SIMON FRASER LIBRARY on May 29, 2015
FIGURE 2
Hourly Distributlon of 956 Inquiries for Year Ending April IS, 1976.
20
1
PERCENTAGE
OF TOTAL
1
10
0 7
8
9
10
12
11
2
1
4
3
5
TIME OF DAY
Table 1
Table 2
-
TV USAGE 956 INQUIRIES
CALLS IN WHICH TV WAS USED % of 956
TV Used Suggested by provider User suggested or called from monitor site
7.7
13.9
21.6'
No. CGH 7th floor Child, Hosp. ER Good Sam. ICU
TV Not Used 1.9 46.1 9.4 0.1 1.5
Near monitor but not convenient No monitor nearby Provider felt TV not indicated Emergency no time for TV Equipment down Other
-
19.4
78.4
+40.1% of cases where monitor was available.
"excellent" ratings and the rating of 75% of cases as only "fair" during of the first two months of the project contrasts dramatically with 83.4% " g o o d or "excellent" ratings in the last two months. In addition to the provider ratings just described. the users of the service were asked to rate the service they received on a scale of very helpful, satisfactory or poor.
% of TV
% of Total
181
87.4
18.9
24
11.6
2.8
2 207
1 .o
0
21.7
Eighty-four per cent of users felt that the service was helpful, 15.2% felt it was satisfactory and none said that it was poor. The users were also asked to rate the information they received from the project: 76.4% rated the information as very helpful, 18% as satisfactory, and 5.6% rated it as poor. We have used two different approaches to the evaluation of user response to the usc of TV. The original approach, which covered the first nine months, involved asking users whether or not they felt television facilitated communication. One hundred and thirteen (89.7%) felt that television did facilitate communication, 13 (10.3%) felt that it did not. In order to obtain a user rating with greater discriminating power, a second method was employed in 1976, using a scale af critical to useless. Two (7%) felt that television was critical, 10 (37%) felt it was very helpful, I I (40%)felt that it was helpful, I (4%) felt it was of minimal usefulness and
DRUG INFORMATION JOURNAL
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October/Dccembcr 76 pl35
3 ( 1 1%) felt it was useless. Thus, 89% of the users of the system felt that television facilitated communication to some extent. Table 3 NUMBER OF TV USES BY MONTH IN TWO LOCATIONS 1975
1976
Month
A+
M
J
J
A
S
0
N
D
J
F
M
A*
CGH 7th floor
8
4
2
10
I5
4
16
22
7
28
27
31
16
5
1
0
3
3
4
0
3
3
3
Child. Hosp. ER
TV not available
*15 days Table 5 Table 4
USE APPLICATION OF INFORMATION
USEOFTVBYTYPESOFUSERS Use Total Type of Caller
#
%
#
Physician Medical Student Pharmacist Nurse Other
295 27 290 137 218
30.8 2.8 30.3 14.3 22.8
48
N = 967
TV %
10
65 41 49
23.2 4.9 31.4 19.8 23.7
N = 213
All Calls ~
Select treatment approach Explain observations in a patient Add to personal knowledge Teaching Change treatment approach Research Other
TV Only
~~
54.5%
52.2%
14.4% 14.2% 7.0% 2.4% 1.6% 5.4%
18.3%
N = 627
N = 186
7.5%
8.1% 5.9% 1.1% 7.0%
DISCUSSION
Our initial experiences with this project, which are reflected in the data presented, tend to indicate that with respect to one kind of medical information, i.e., drug information, television probably makes a measurable contribution to the effectiveness of communication. The fact that television was used in approximately 40% of the cases where a monitor was available to the user plus the fact that both the providers and users felt it facilitated communication in about 90% of the cases lead one to the conclusion that this additional communication medium is perceived as adding significantly to the efficiency and interactive nature of the exchange of drug information. The use trends for television seem to indicate that the visual medium is used more frequently as individuals gain experience with the system. The exploration of TV as a medical information conimunication medium is an interesting and challenging undertaking. Many questions remain to be answered.
For example, does the use of TV increase or decrease the length of time required to communicate interactively with a member of the health care team who feels a need for drug information? Further, the psychological effect of the use of visual media in medical information communication needs to be carefully researched. Supported in part by NIH grant LMI#O2350 from the National Library of Medicine, and by the Hoflman-La Roche Foundation and the Hamilton County Mental Health and Mental Retardation Board.
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FIGURE 3 Frequency of Question Types; Total vs. TV by percentage Frequency of presentation of various categories of questions is shown for all calls (empty bars), those involving higher rates of television use (striped bars) and lower rates to television use (solid bars). Categories: drug use, safety, kinetics, side effects (s.e.), interactions (intxn.), toxicity (tox.), identification (I.D.) and sources, and non-drug-related questions.
2 oa
101
on
Table 6 TV TIME INVOLVED IN ANSWERING QUESTIONS All TV Calls 5’ 5-15’ 15’ Avg. TV Time (min.)*
APRMAY
48.8% 33.3% 17.9%
JUNAUC
SEPNOV
DECFEB
MARAPR
66.7% 33.3% 0
30.4% 56.5% 13.0%.
31.1% 42.2% 26.7%
60.3% 26.W0 13.7%
5 1.9% 25.9% 22.2%
6.6%
9.0%
9.7%
7.6%
8.6%
*Calculations based on 5, 10, and 15 minutes respectively.
Table 7
-
TV USEFULNESS PROVIDER RATING (as percentage) All TV Calls Not Useful
Poor Fair Good Excellent
3.9 3.4 18.4 30.0 44.4
APR JUN SEPDEC MAR MAYAUGNOV FEB APR 0 0 6.7 4.1 0 0 2.2 4.1 75.0 30.4 17.8 13.7 25.0 47.8 37.8 24.7 0 21.7 35.6 53.4
3.7 5.6 7.4 24.1 59.3
D R U G INFORMATION JOURNAL
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October/Deccmber 76 p137
INTRODUCTION A picture, graph or table can often communicate a thought, concept or relationship more effectively than extensive use of the written word. This is particularly true with many types of important medical information. Over the past several years of providing information services t o medical personnel at some distance from this Medical Center, we have felt that communication might sometimes be more effective if the questioner could not only hear about but see the data being discussed. Television and other electronic visual media now on the horizon make it technically feasible to offer people in many different locations ready access to visual materials, and thus obviate the need to leave the patient care area in order to obtain important medical information. Such media can be employed to allow useful interactive discussions in spite of great distances between the information source and the user. The willingness of medical personnel to accept television as a substitute for hard copy, and telecommunications as a substitute for “curbside consultation” on the wards are but two of many factors that need to be evaluated if such approaches are to be proposed on a broad scale. This paper describes the development and the initial experiences of a research study undertaken to answer these and related questions.
THE PROJECT This research project is a cooperative venture of the Dr. Nelson is Associate Director of the Drug Information Center, University of Cincinnati Medical Center. Cincinnati. OH 45267. Presented at the Tweyth Annual Meeting, Drug Information Association. Son Francisco. June 23-26. 1976.
Health Sciences Library, the Drug and Poison Information Center (DPIC) and the Department of Biomedical Communications of the University of Cincinnati Medical Center. The project is funded by a research grant from the National Library of Medicine. The intent of all three groups is to explore television as a medium for communication of medical information. The DPIC is a 24-hour service for the medical and lay communities of the Greater Cincinnati Area. The DPIC functions as both a drug information center and a poison control center; it responded to more than 35,000requests for information in 1975. The Health Sciences Library is a combination of the libraries of the College of Medicine, Cincinnati General Hospital and the College of Pharmacy. An office in an ideal location in the library was allocated for this project. This we call the Resource Room. The telephone-coupled computer terminal which allows on-line searching of Medline, Toxline and other computer data bases is in the room immediately adjoining the Resource Room. The Resource Room is the point of origin for all television transmission from this project. At the present time, the Resource Room is connected via closed circuit television cable to four receiving locations and via over-the-air transmission to 10 area hospitals which are equipped with special down-converters to receive and unscramble the signal. Thus, the system can provide both cable and over-the-air transmission. A telephone operator-type headset is used by the information provider to allow discussions with both hands free to select and place materials under the camera. A high resolution 1000-line television camera is used as the point of origin of the television signal. Monitors with 800-line resolution capability are used in those locations connected directly via cable to the Resource Room: the
p132
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main office of the DPIC on the Medical Service floor of the Cincinnati General Hospital, the General Hospital Emergency Room, the Children's Hospital Emergency Room and the in-patient pharmacy on the medical ward at the Veteran's Hospital. Although drug information questions are handled by the DPIC on a 24-hour. 7 days per week basis, the television project currently operates on weekdays only. During this time period, calls may be received directly by the Resource Room staff or incoming calls to the Drug and Poison Information Center which require in-depth literature searches can be transferred to the Resource Room. Because of the transfer of DPIC calls, the project was able to begin operation with a reasonable number of inquiries being handled each week. The project is staffed by a librarian and a p harmacologist .
EVALUATION METHODOLOGY Evaluation methods of this project include both user and provider ratings of the information provided, as well as the usefulness of television in those cases where it was used. Intramural and extramural evaluation teams have visited the project and have shared with the researchers the results of their observations. Each time an inquiry is handled by the Resource Room a data collection form is completed* and data are sent to the computer center to be entered for subsequent retrieval and analysis. Information regarding the typq of caller presenting the question and the usefulness of consulted references in arriving at an answer, a rating by the staff of the value of the retrieved information, determination of the application of the information, and an evaluation of the utility of television from the viewpoint of both the user and provider of the information are collected on the documentation form. Special coding and/or rating systems have been established for classifying the specific type of question posed, the resources used, the role of all persons involved in the question, and the value of television in providing the response. A standard question code designed for this project allows the storage of questions in a format that could, in the future, provide the basis for an on-line computerized system to provide answers rather than references to pertinent drug information questions. At the end of each contact with the system the user is asked to respond to three questions on the data form. This part of the form is projected over the television system, and project staff record the verbal responses. The questions are designed to obtain the user's opinions of the service, the information, and the contributions made by television. While there are some biases introduced by such an approach, it is viewed as preferable to all other suggested methods of obtaining the user's reactions in a manner that would not discourage or extinguish future contact with the system. In some instances, project staff are also able to gather impact information from data gathered on wards or by interviews. *Copy available upon request.
RESULTS During the year ending April 15, 1976, television was used in a total of 207 inquiries. The monthly breakdown of total inquiries and inquiries in which television was used is shown in Figure I . As can be seen there is a general trend over time toward an increased use of the project and also toward increased use of television in responding to inquiries. There was no significant variation with respect to the day of the week on which calls presented. The distribution of calls with respect to time of day received is illustrated in Figure 2. There is a slight trend toward a heavier call load in the late morning hours. This may be related to questions being raised by ward teams during morning rounds. Table I presents information on the use or non-use of television in the 956 inquiries handled by the project. It can be seen that the television system was used in 21% of alt cases which presented to the project. It should be noted, however, that in 46.1% of the total questions there was no monitor available to the caller. Thus, in situations where monitors were available, television was used in 40.1% of the inquiries. Table I also shows the reasons for use or non-use of television in the 956 cases. In two-thirds of the cases where television was employed, its use had been suggested by the caller. The most common reason for non-use was that the caller did not have access to a monitor. A concern of the investigators had been that the time required to place materials under the TV camera might rule out its use in emergency situations. Our data show that this is a very rare event. In only one case did the provider feel that TV was too slow to use for an emergency inquiry. The frequency of television use by monitor location is shown in Table 2. The monitor on the Medical Service (7th) floor of the Cincinnati General Hospital, in the DPIC office, was by far the most frequently used. Table 3 shows the use of the CGH and Children's Hospital monitors by month during the year of the study. Table 4 shows the percent of use of television by various types of users. Combining this with the data in Table 2, it can be seen that the most frequent users of the system were physicians and pharmacists located on the Medical Service floor of the Cincinnati General Hospital. Figure 3 is a graph of television use in handling particular type's' of questions. There were minor trends toward a higher 'rate of use in questions involving choice or use of drugs, side effects, and identification of drugs and in questions involving nondrug substances, and toward lower rates in questions on safety, pharmacokinetics, interactions or incompatibilities, todcity, and sources of drugs. Table 5 summarizes what the users stated was the intended application of the information they requested. Regardless of the communication medium employed, users of the service most commonly asked questions pertinent to the selection of a treatment approach for a particular patient. The next two most frequent uses were to obtain aid in explaining observations in patients ahd to add to personal knowledge.
DRUG INFORMATION JOURNAL
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Octobcr/Decemkr 76 p133
FIGURE 1 Monthly Distribution of Total Inquiries and Use of Television Total area of bar represents all inquiries (number in parentheses); darkened area, inquiries in which television was used. Since April 1975 and April 1976 were half-months, their width has been halved but their height doubled to indicate a monthly approximation.
160
-
120
(123
NUMBER
OF INQU IRI ES 80
I
.
40
0
I 0
A
M
J
J
S
A
1976
197 5 MONTH
Evaluation
With respect to the total time required by all staff to answer questions presented to the project, 32.7% of the questions required less than 10 minutes, 3 1.3% required 10 to 30 minutes, 26.2% required 30 minutes to 2 hours, 7% required 2 to 8 hours, and 1% required more than 8 hours to answer. Table 6 shows the television transmission time involved in answering questions. About half of the questions required kss than 5 minutes of transmission time, one-third required 5 to 15 minutes, and about 18% required more than 15 minutes. Thest data show that, regardless of the length of time required to complete a n information search (some have required up to 40 hours), the user spent a n average of 9 minutes at the TV monitor to receive. discuss, and react to the information. We have begun to compare the kngth of time required to communicate drug information by telephone with that for telephone plus television. We are also gathering other data that we anticipate will allow us to make spesific costefficacy statements about the use of TV in communicating drug information.
Ideally, one would like to be able to measure the impact of a medical information system such as is described above on patient care. However, such measurements are extremely difficult to obtain and are subject to broad individual interpretation. It is our feeling that ratings by both providers of information and users of the information reflect the usefulness of television as a means for communicating drug information. It is in this light that the following data are presented. The individuals providing the information via the television system were asked to rate its usefulness as a means for communicating the particular information required to answer each specific question. T a b k 7 shows that in over 95% of the instances where television was used the provider felt that it made some contribution to the communication of the information. It is interesting to note that as providers p i n e d experience in using television, there was a marked trend toward more favorable ratings of its contribution. The total absence of
Downloaded from dij.sagepub.com at SIMON FRASER LIBRARY on May 29, 2015
FIGURE 2
Hourly Distributlon of 956 Inquiries for Year Ending April IS, 1976.
20
1
PERCENTAGE
OF TOTAL
1
10
0 7
8
9
10
12
11
2
1
4
3
5
TIME OF DAY
Table 1
Table 2
-
TV USAGE 956 INQUIRIES
CALLS IN WHICH TV WAS USED % of 956
TV Used Suggested by provider User suggested or called from monitor site
7.7
13.9
21.6'
No. CGH 7th floor Child, Hosp. ER Good Sam. ICU
TV Not Used 1.9 46.1 9.4 0.1 1.5
Near monitor but not convenient No monitor nearby Provider felt TV not indicated Emergency no time for TV Equipment down Other
-
19.4
78.4
+40.1% of cases where monitor was available.
"excellent" ratings and the rating of 75% of cases as only "fair" during of the first two months of the project contrasts dramatically with 83.4% " g o o d or "excellent" ratings in the last two months. In addition to the provider ratings just described. the users of the service were asked to rate the service they received on a scale of very helpful, satisfactory or poor.
% of TV
% of Total
181
87.4
18.9
24
11.6
2.8
2 207
1 .o
0
21.7
Eighty-four per cent of users felt that the service was helpful, 15.2% felt it was satisfactory and none said that it was poor. The users were also asked to rate the information they received from the project: 76.4% rated the information as very helpful, 18% as satisfactory, and 5.6% rated it as poor. We have used two different approaches to the evaluation of user response to the usc of TV. The original approach, which covered the first nine months, involved asking users whether or not they felt television facilitated communication. One hundred and thirteen (89.7%) felt that television did facilitate communication, 13 (10.3%) felt that it did not. In order to obtain a user rating with greater discriminating power, a second method was employed in 1976, using a scale af critical to useless. Two (7%) felt that television was critical, 10 (37%) felt it was very helpful, I I (40%)felt that it was helpful, I (4%) felt it was of minimal usefulness and
DRUG INFORMATION JOURNAL
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October/Dccembcr 76 pl35
3 ( 1 1%) felt it was useless. Thus, 89% of the users of the system felt that television facilitated communication to some extent. Table 3 NUMBER OF TV USES BY MONTH IN TWO LOCATIONS 1975
1976
Month
A+
M
J
J
A
S
0
N
D
J
F
M
A*
CGH 7th floor
8
4
2
10
I5
4
16
22
7
28
27
31
16
5
1
0
3
3
4
0
3
3
3
Child. Hosp. ER
TV not available
*15 days Table 5 Table 4
USE APPLICATION OF INFORMATION
USEOFTVBYTYPESOFUSERS Use Total Type of Caller
#
%
#
Physician Medical Student Pharmacist Nurse Other
295 27 290 137 218
30.8 2.8 30.3 14.3 22.8
48
N = 967
TV %
10
65 41 49
23.2 4.9 31.4 19.8 23.7
N = 213
All Calls ~
Select treatment approach Explain observations in a patient Add to personal knowledge Teaching Change treatment approach Research Other
TV Only
~~
54.5%
52.2%
14.4% 14.2% 7.0% 2.4% 1.6% 5.4%
18.3%
N = 627
N = 186
7.5%
8.1% 5.9% 1.1% 7.0%
DISCUSSION
Our initial experiences with this project, which are reflected in the data presented, tend to indicate that with respect to one kind of medical information, i.e., drug information, television probably makes a measurable contribution to the effectiveness of communication. The fact that television was used in approximately 40% of the cases where a monitor was available to the user plus the fact that both the providers and users felt it facilitated communication in about 90% of the cases lead one to the conclusion that this additional communication medium is perceived as adding significantly to the efficiency and interactive nature of the exchange of drug information. The use trends for television seem to indicate that the visual medium is used more frequently as individuals gain experience with the system. The exploration of TV as a medical information conimunication medium is an interesting and challenging undertaking. Many questions remain to be answered.
For example, does the use of TV increase or decrease the length of time required to communicate interactively with a member of the health care team who feels a need for drug information? Further, the psychological effect of the use of visual media in medical information communication needs to be carefully researched. Supported in part by NIH grant LMI#O2350 from the National Library of Medicine, and by the Hoflman-La Roche Foundation and the Hamilton County Mental Health and Mental Retardation Board.
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FIGURE 3 Frequency of Question Types; Total vs. TV by percentage Frequency of presentation of various categories of questions is shown for all calls (empty bars), those involving higher rates of television use (striped bars) and lower rates to television use (solid bars). Categories: drug use, safety, kinetics, side effects (s.e.), interactions (intxn.), toxicity (tox.), identification (I.D.) and sources, and non-drug-related questions.
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Table 6 TV TIME INVOLVED IN ANSWERING QUESTIONS All TV Calls 5’ 5-15’ 15’ Avg. TV Time (min.)*
APRMAY
48.8% 33.3% 17.9%
JUNAUC
SEPNOV
DECFEB
MARAPR
66.7% 33.3% 0
30.4% 56.5% 13.0%.
31.1% 42.2% 26.7%
60.3% 26.W0 13.7%
5 1.9% 25.9% 22.2%
6.6%
9.0%
9.7%
7.6%
8.6%
*Calculations based on 5, 10, and 15 minutes respectively.
Table 7
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TV USEFULNESS PROVIDER RATING (as percentage) All TV Calls Not Useful
Poor Fair Good Excellent
3.9 3.4 18.4 30.0 44.4
APR JUN SEPDEC MAR MAYAUGNOV FEB APR 0 0 6.7 4.1 0 0 2.2 4.1 75.0 30.4 17.8 13.7 25.0 47.8 37.8 24.7 0 21.7 35.6 53.4
3.7 5.6 7.4 24.1 59.3
D R U G INFORMATION JOURNAL
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October/Deccmber 76 p137
