Scand J Prim Health Care 1989; 7: 105-9

Information Needs and Information Seeking behaviour in

Primary Health Care
TOOMAS TIMPKA M.D..2.3,MARIE EKSTROM M.Sc. and PER BJURULF M.D. P.h.D.

Department of Medical Informatics, Department of Community Medicine, Department of Computer and Information
Science, Linkoping University
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Timpka T, Ekstriim M, Bjurulf P. Information Needs and Information Seeking behaviour in

Primary Health Care. Scand J Prim Health Care 1989; 7: 1059.
A questionnaire survey of 186 general practitioners in Sweden showed that 67% saw the
overall supply of medical information as less satisfactory or unsatisfactory, and that 80%
experienced major hindrances in seeking relevant information. The most frequent need for
information concerned general medicine, with respect to both diagnosis and choice of therapy.
Of situations which required additional information, only every second was completely resol-
ved. These results imply a need for a reorganization of the supply of information to general
practitioners. As they cannot depend on conventional medical libraries for day-to-day infor-
mation, personal libraries should be improved and updated regularly, and be readily to hand.
Computer technology should be considered for communication between health care providers,
and as support for differential diagnosis in general medicine.
For personal use only.

Key words: general practitioners, information needs, information sources, critical incidents,
system design.
Toomas Timpka M.D., Department of Community Medicine, Faculty of the Health Sciences,
Linkoping University, S-58183 Linkiiping, Sweden.

present use fo sources of information, and a descrip-

INTRODUCTION
General practitioners (GPs) often work far from
essential sources of medical information such as li-
braries and databases. It is important to know their
information needs and information-seeking habits in
order to design improved information supply sys-
tems. Few studies on this subject have been carried
out in primary care. An American study (1) showed
that specialist physicians in outpatient practice felt
the need to seek additional information on two ques-
tions for every three individual consultations (pa-
tients seen), and that they only got answers to 30%
of these questions during the consultation, mainly
from colleagues and other health care professionals.
However, the strategy of a GPs decision-making
differs from that of a specialist practice, since the G P
has to solve all types of medical problems.
The aim of the present study was therefore to
investigate the GPs decision-making habits with re-
spect to his need and search for information, his
tion of his information dilemma, his perceived
need for information. The word information is used
in its broad sense of enlightenment and advice.
The study was part of the LIMEDS project to
analyse the information needs of primary care doc-
tors and to design services to meet these needs (2).
Study population
Two groups of GPs were included in the study:
Group A, GPs at health care centers (HCs) in Os-
tergotland county in Sweden, and Group B , GPs at
all Swedish HCs with research and development ac-
tivities involving computer systems and registered by
the Informatics section of the Swedish Society of
General Medicine. The head GPs of all the HCs
were contacted by telephone. All agreed to partici-
pate, except for two in Group B. In all, question-
naires were sent to 119 GPs at 28 Group A HCs, and
to 94 GPs at 16 Group B research HCs.

S c a d J Prim Health Cure 1989: 7

 106 T o o m Timpka et al.

Table I. Number and percentage of GP information dilem- The data were analysedd with the SPSSX statisti-
mas recorded wing the critical incident questionnaire by cal package, using multiple regression and chi-
medical speciality and urgency.
square analyses.
Numbers (per cent)
Recorded Urgent RESULTS
dilemmas information need Eighty-seven per cent of the questionnaires were
returned, 92% from Group A, and 82% from Group
General medicine 71 (43) B. The respondents were 81 GPs from h e r g o t l a n d
Dermatology 21 (13)
Pharmacology 12 (7)
HCs, 56 GPs from research HCs, and 49 assistant
Orthopaedics 11 (7) GPs from both groups. Ninety-seven to 100% of
Surgery 9 (5) multiple choice queries were filled in, while only 86
Infectious diseases 8 (5) to 91% of the CI queries were completed and leg-
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Gy naecology 7 (4) ible.

Laboratory specialities 6 (4)
Paediatrics 4 (2)
Psychiatry 4 (2) Overall information supply
Other 13 (8) The overall possibilities for handling medical infor-
Complete responses 166 (100) mation were characterized as follows: very good,
Incomplete responses 20 1%; satisfactory, 32; less satisfactory, 52% ;unsatis-
Total 186 factory, 15%. A multiple regression analysis of satis-
faction with respect to availability of new informa-
tion against the GPs background variables pointed
towards the following information distress profile
METHODS (pcO.1):
Based on previous studies (3,4), questionnaires - practice at small H C
For personal use only.

were developed concerning 5 points: - no habitaul use of medical journals

1. background variables related to the GPs profes-
sional experience, part- and fulltime employ-
ment, work-load, size of HC, available library
facilities, information search habits, research ac-
tivities at HC, etc.
2. perceived overall practice update and informa-
tion search facilities.
3. nature of information dilemmas (i.e. medical
topic).
4. other characteristics of information dilemmas
(context, how quickly information was needed).
5. sources used to solve information dilemmas (type
and location, criteria, and reasons for choice).
- no habitual use of textbooks
- time constraints
- difficulties in using sources of medical information
- difficulties in defining problems in information di-
lemmas
Twenty per cent of the GPs saw no difficulties in
searching for information, while the remaining 8%
identified the following major hindrances: lack of
time, 65%; doubt choice of source, 25%; inaccessi-
bility of source, 10%. Multiple regression analysis
did not show significant differences with regard to
the GPs background variables.

Two types of questionnaires were combined for Information needs

points 3-5 to describe information dilemmas - a
multiple choice questionnaire and the critical in-
cident (CI) questionnaire (5), in which the GPs
were asked: Please tell us the most recent instance in
which you had a question in your practice for which
you needed additional information (i.e. information
beyond your personal knowledge of medicine for
which you had to consult another source of informa-
tion). The questionnaires were revised after a pilot
study that involved 10 GPs.
The urgency for obtaining information was recorded
as follows on the CI questionnaire: immediate, 21% ;
within 15 minutes, 19%; same day, 23%; a week or
more, 37%. Thus 40% of the information was re-
quired urgently (within 15 minutes). The type of
information was as follows: diagnostic, 62% ; ther-
apeutic, 21%; epidemiological, 4%; miscellaneous,
13%. There were no significant differences regard-
ing urgency between types of information.
On the multiple choice questionnaires the need

Scand I Prim Health Care 1989; 7

 Healt Care 107
Table 11. Number and percentage of unresolved GP information dilemmas categorized into speciality and type.

Numbers (per cent)

Diagnosis Therapy Other Total

General medicine 28 7 1 36 (48)

Dermatology 6 2 8 (11)
Orthopaedics . 6 1 7 (9)
Pharmacology 1 3 4 (5)
Gynaecology 4 4 (5)
Other 10 1 5 16 (21)
Complete responses 55 (73) 14 (19) 6 (8) 75 (loo)
!ncomplete responses 9
Total 84
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for information was classified as follows: choice of
therapy, 44%; diagnosis, 36% therapy control, 17%;
epidemiology, 5%. Assistant GPs expressed a signif-
icantly higher need for information (p < 0.001, chi-
square) on both therapy and diagnosis than their
more experienced colleagues.
The highest number of CI dilemmas (43%) were
related to general medicine, including neurology and
oncology (Table I), and the next highest to dermatol-
ogy (13%), followed by surgery and pharmacology.
For personal use only.
51% in dermatology, 45% in 'infectious diseases,
30% in pharmacology, but less than 25% in the
remaining specialities combined. Table I1 shows the
number and percentage of unresolved G P informa-
tion dilemmas, categorized into speciality and type.
The highest number concerned the diagnostic prob-
lems in general medicine.
Sources of information
To solve the CI dilemmas, 38% of the GPs chose a

Information was needed urgently (within 15 min) for
86% of gynaecological dilemmas, 76% of dermat-
ological, and 50% of pharmacological dilemmas. On
the multiple choice questionnaires, 75% of the GPs
stated that they routinely (on a weekly basis) en-
countered dilemmas in general medicine, 54% in
orthopaedics, 54% in other surgical specialities,
colleague, either at the HC (19%) or at the local
hospital ( lWO),37% their personal medical text-
books, 15% the library at the HC, 4% personal
notes, 2% medical journals, while other sources
were consulted by 6%. Fifty-two per cent of text-
book consultations and 35% of colleague consulta-
tions were made within 5 min. When consulting a

Table 111. Number and percentage of a) information source used, b ) time spent searching for information, and c) solved
dilemmas.

Numbers (per cent)

Time spent Total use Solved dilemmas

<5 min 5-20 min >20 min

Colleagues 23 26 16 65 (38) 37 (57)

Personal textbooks 33 27 3 63 (37) 28 (44)
Library at HC 10 10 1 21 (12) 10 (48)
Personal notes 3 2 2 7 (4) 3 (43)
Journals 1 2 1 4 (2) 3 (75)
Local protocols 1 0 1 2 (1) 1(50)
Hospital library 0 1 1 2 (1) 0 (0)
Pther 3 3 0 6 (4) 4 (67)
Complete responses 74 71 25 170 (100) 86 (51)
Incomplete responses 16
Total 186

Scand J Prim Health Care 1989; 7

 108 Toomas Timpka et al.
Table IV. Numbers and percentage of the GPs reasons for choice of an information source, recorded from the critical
incident questionnaire. Several alternatives were allowed.
Reliability Quick use Availability Completeness Low costs
Colleagues 43 36
Personal textbooks 19 47
Library at HC 7 10
Personal notes 2 6
Journals 2 1
Local protocols 1 2
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Complete responses 74(46) 102 (64)
Incomplete resonses
Total
textbook. the information dilemma was completely
resolved in 44% of incidents, and in 57% when
contacting a colleague (Table 111).
The reasons (several were allowed) for choice of
source of information (Table IV) were convenience
(64%) and availability (50%). Other factors were
reliability (46%), completeness (lo%), and low cost
For personal use only.
(6%). Own textbooks were chosen for quick use
(75%), the HC library for availability (79%), and
colleagues for reliability (67%).
DISCUSSION
The present study showed a need for an improve-
ment of information supply to primary health care
centers, since only one of three of the responding
GPs found that their supply of medical information
was acceptable, and four of five were dissatisfied
with the available information services.
The information distress profile showed three
components in a satisfactory information supply:
availability of sources of information, and an interest
in and the possibility of using them.
Like previous studies (3,4), the present study
showed that diagnostic dilemmas were the most fre-
quent. However, in the multiple choice question-
naire the GPs recorded their need for therapeutic
information higher. In explanation, it is possible that
some GPs might not expect to find answers to their
diagnostic dilemmas from any source, and therefore
did not record them as such.
Since half of the dilemmas were related to general
medicine and pharmacology, and the remaining 50%
Sciiiid J Prim Health Care 1989; 7
Numbers (per cent)
Reason for choice of source Total use
15 4 4 64 (40)
45 5 4 63 (40)
15 1 1 19 (12)
2 0 0 7 (4)
2 0 0 4 (3)
1 0 0 2 (1)
80 (50) 10 (6) 9 (6) 159 (100)
27
186
were divided among the other specialities, the GPs
were in need of information on most specialities,
including the commonest.
The amount of urgent information needed for der-
matological and gynaecological dilemmas may be
difficult to deliver by conventional media - in der-
matology because the major part of the information
must be pictorial, in gynaecology because the prob-
lems are related to difficulties with the physical ex-
amination, i.e. a practical skill.
That 50% of dilemmas recorded as CIS could
eventually be resolved implies that these dilemmas
might be solved by increasing the amount of in-
formation by conventional media, i.e. a quantitative
problem. For the remaining dilemmas there was a
qualitative problem, since the existing sources of
information were deficient.
Possible ways to resolve the diagnostic and ther-
apeutic dilemmas in the various specialities would be
continued medical training, including both practical
skills, and computer-based diagnostic support. How-
ever, since 40% of the information was needed
within 15 min, any computerised support should be
designed with this in mind.
In conclusion, there is a need for GPs to organize
their search for information, since they, unlike hos-
pital doctors, can not depend on institutionalised
information services. Therefore, in their planning,
time must be set aside for such searches. Personal
libraries should be regularly up-dated, indexed, and
kept ready to hand. Second opinion contacts with
colleagues should be regarded as routine. Relevant
information is usually available, but its source is not
always known to the GPs. Computer technology

should be considered for communication between
health care providers, as well as for distribution of
up-to-date medical texts, e.g. journals and books o n
inexpective optical storage media (2). Medical jour-
nals are seldom used today as sources of information
in primary health care. Computer programs should
also be considered for diagnostic support, especially
for differential diagnosis in general medicine (6).
ACKNOWLEDGEMENTS
The work reported in this paper was supported by
grant no. B88-27X-07215-04B from the Swedish
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Medical Research Council.
For personal use only.
Healt Care 109
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Received June 1988
Accepted February 1989
Scand I Prim Health Care 1989: 7