The impact of library services in primary care trusts in NHS North West England: a large-scale retrospective quantitative study of online resource usage in relation to types of service

© 2009 The authors

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Journal compilation © 2009 Health Libraries Group.

Health Information and Libraries Journal

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DOI: 10.1111/j.1471-1842.2008.00789.x

Blackwell Publishing Ltd

The impact of library services in primary care trusts in NHS North West England: a large-scale retrospective quantitative study of online resource usage in relation to types of service

Katherine Bell*, Steven William Glover†, Colin Brodie‡, Anne Roberts§ & Colette Gleghorn†, *Primary Care Library, St Helens and Knowsley Informatics, St Helens and Knowsley Primary Care Trust, St Helens, †Kostoris Library, Christie Hospital NHS Foundation Trust, ‡PCT Library, Manchester Primary Care Trust and §Regional Athens Administrator, Christie Hospital NHS Foundation Trust, Manchester, UK

Abstract

Background

: Within NHS North West England there are 24 primary caretrusts (PCTs), all with access to different types of library services. This studyaims to evaluate the impact the type of library service has on online resourceusage.

Methodology

: We conducted a large-scale retrospective quantitative studyacross all PCT staff in NHS NW England using Athens sessions log data. Westudied the Athens log usage of 30 381 staff, with 8273 active Athens accountsand 100 599 sessions from 1 January 2007 to 31 December 2007.

Results

: In 2007, PCTs with outreach librarians achieved 43% penetration ofstaff with active Athens accounts compared with PCTs with their own libraryservice (28.23%); PCTs with service level agreements (SLAs) with acute hospitallibrary services (22.5%) and with no library service (19.68%). This pattern wasalso observed when we looked at the average number of Athens user sessionsper person, and usage of Dialog Datastar databases and Proquest full text journalcollections.

Discussion

: Our findings have shown a correlation of e-resource usage and typeof library service. Outreach librarians have proved to be an efficient model forpromoting and driving up resources usage. PCTs with no library service haveshown the lowest level of resource usage.

Introduction/background

This study is a quantitative study of online resourcesusage within the Primary Care Trusts (PCTs) inthe north-west of England, in 2007. LewishamPCT describes primary care and PCTs as:

‘Primary care is a term used to describe community-based health services ... It covers services providedby family doctors (GPs), community and practicenurses, community therapists (such as physioth-erapists and occupational therapists) communitypharmacists, chiropodists, optometrists anddentists.’

Primary Care Trusts are organizations, whichhave the potential to integrate primary, secondaryand community health services and social services

Correspondence: Steven William Glover, Kostoris Library, ChristieHospital NHS Foundation Trust, Manchester M20 4BX, UK. E-mail:[email protected]

Impact of library services in PCTs in NHS NW England,

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Within NHS North West (NHS NW) Englandthere are 24 PCTs, all of which have access to differenttypes of library services. This study aimed to evaluatethe impact that the type of library service providedto PCT staff has on online resource usage. Manyprevious studies of the impact of library and outreachservices on primary care in the UK have beenmainly qualitative with relatively small samples.

1–5

We conducted a large-scale retrospectivequantitative study across all PCT staff in NHSNW England using Athens sessions log data. Westudied the Athens log usage of 30 381 staff, with8273 active Athens accounts and 100 599 sessionsfrom 1 January 2007 to 31 December 2007.

Types of library service to PCT staff in NHS NW England in 2007

There are four models of library service includedin this study:

Library service (LS).

In NHS NW England,fourteen of the twenty-four PCTs have their ownlibrary service. This type of PCT library service isdefined as a library dedicated to providing a serviceto primary care staff and no other type of trust andone which is usually situated within that PCT.Four of the 14 PCTs have their own service,but it is based at another PCT. An example of thisis the library service for Oldham, Tamesideand Glossop PCTs. The library service is based atOldham PCT but also serves Tameside andGlossop PCT.

Outreach librarians but no physical library (OL-NPL).

Two out of the twenty-four PCTs have adedicated outreach librarian but have no physicalprimary care library. This may mean that they haveno access to a physical library or that they may haveaccess to an acute hospital library service but thereis no service level agreement (SLA). Robinson

1

describes an outreach service as:

‘library/information services provided proactivelyto health care workers in their working environment,by contrast with traditional on-demand servicesprovided in library settings.’

During the timeframe of our study, Wirral PCTand East Cheshire PCT operated within this kindof service. Some of the PCTs categorized as having

their own library service also have an outreachlibrarian—West Cheshire PCT is an example of this.

SLA from acute library service (SLA-A).

Six outof the twenty-four PCTs do not have their ownlibrary but have an SLA with a local acute libraryservice. The acute library will have a formalagreement to allow staff from the PCT to accesstheir resources and services. However, levels ofaccess and financial arrangements will vary acrossthe services. One such example in NHS NW is theservice supplied to Stockport PCT staff by theacute library service at Stockport Hospitals NHSFoundation Trust.

No library (NL).

For two NHS NW PCTs, TraffordPCT and Cumbria PCT, there is no access to alibrary, outreach librarian or library servicesprovided by an SLA from an acute hospital libraryservice.

Electronic resources available to primary care staff in England

PCT staff in NHS England have access tonational, regional and local resources providedover the Internet by vendors. Athens authenticationis the popular method of access control for e-resources provided by libraries and suppliers.However, authentication by Internet Protocol(IP) address is difficult for most NHS organizationsas the NHSnet is behind a firewall whichprotects the information needed by suppliers totreat each of the NHS trusts as individualcustomers.

Typical resources supplied to primary care staffinclude those products purchased by NationalCore Content (NCC), including the bibliographicdatabases such as

medline

,

embase

and

cinhal

provided by Dialog Datastar. Other resourcesinclude full text journals provided by ProquestHealth, Cochrane Library and electronic booksvia Coutts’ My I Library.

In addition to the NCC resources, local contentcan be purchased at Strategic Health Authority(SHA) level, by primary care libraries or by acutelibrary services with an SLA to provide a libraryservice to a PCT. Within NHS NW, StockportHospitals NHS Foundation Trust library servicehas purchased resources and licensed those resourcesto Stockport PCT.


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In 2007, the LIHNN Primary Care LibrariansGroup formed a consortium and purchased a setof online journals for PCT staff.

Methodology

For the purpose of this study we looked at resourcesprovided by NCC which were available to all NHSEngland staff regardless of whether their organizationhad a library service or not. The resources chosen wereAthens authentication, Dialog Datastar databasesand full text articles provided by Proquest.

Primary care trusts in NHS NW England varyin terms of population served and number of staffemployed. We used figures from the Departmentof Health census from 2006. The largest PCTpopulation was 495 000 served by Cumbria PCT.The smallest population was 140 000 served byBlackburn and Darwen PCT. We measured thenumbers of PCT staff by whole-time equivalent(WTE). The PCT with the largest staff numbers byWTE was Cumbria with 2566 WTEs and thesmallest was Blackpool with 480 WTE.

After establishing a correlation of size of PCTto WTE, we used Athens session per WTE as ameasure of activity and percentage of WTE withan active Athens account as a measure of outreachwithin the organization.

We searched Library and Information ScienceAbstracts (

lisa

),

medline

,

embase

, CumulativeIndex of Nursing and Allied Health Literature(

cinhal

) and hand searched the

Health Informationand Libraries Journal.

We used the terms ‘primarycare’, ‘library’, ‘PCT’, ‘family doctors’, ‘informationneeds’, ‘general practitioners’ and ‘allied healthprofessional’ Fig. 1.

The NHS NW Regional Athens Administratorprovided information for the number of active

Athens accounts. We used the figures for activeAthens accounts and discarded expired accounts.We used active Athens accounts to rule out theinfluence of housekeeping practices of localadministrators in weeding out expired accounts.The figures for active accounts were taken on27 December 2007.

The period of resource activity used for thestudy was 1 January 2007 to 31 December 2007.

Results

For the purpose of displaying the results, wegrouped PCTs by type of library service availableto staff. PCTs with a library service (LS), PCTswith an outreach librarian but no physical library(OL-NPL), PCTs with an SLA from one or moreacute hospital libraries (SLA-A) and PCTs withno physical library or SLA (NS).

Figure 2 shows the percentage of staff with anactive Athens account. We measured penetrationof organizational staff numbers with active Athensaccounts to ascertain the proportion of staff thathad being given an account to access resources.This measure could potentially highlight anorganization’s awareness of the availability ofresources. Libraries may vary their strategies onhow accounts are rolled out. This could be carriedout at induction, on request, through creation bylibrary staff or by self registration. When welooked at PCTs and grouped them by the type oflibrary service staff receive, we found that PCTswith an outreach librarian but no physical library(OL-NPL) achieved a 43% penetration of theorganization. PCTs with a library service (LS)achieved a 28.23% penetration, PCTs with an SLAwith an acute library service (SLA-A) achieved22.5% and where there was no library service (NS)

Figure 1 Shows relative size of primary care trust (PCT) population to whole-time equivalent (WTE) staff numbers


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the penetration of active Athens accounts waslowest at 19.68%.

Librarians could, in effect, issue an Athens accountwhether the users request one or not. To supportour findings with active accounts we measured theaverage number of sessions per WTE. This wouldallow us to measure resource use by demand on alarge scale. When we looked at the average numberof Athens sessions per WTE we observed a similarpattern to the percentage of active Athens accounts.The PCTs with the OL-NPL had an average of 4.65sessions, PCTs with LS 3.89, SLA-A 2.13 and NS 1.4.

As with previous measures, it could be arguedthat PCTs with libraries may have access to a widerrange of resources than PCTs with no service. Toact as a control we measured Dialog and Proquestsessions. Dialog databases and Proquest full textjournals are available to all staff in NHS England.Use of these resources should be of equal importanceto staff in PCTs with or without access to a libraryservice. Differences in usage patterns again correlatedto the previous measures.

Table 1 shows the breakdown by PCT with WTEfigures, total Athens sessions and average sessionsper WTE. Again, when we rank the usage byaverage session per WTE, the PCTs with OL-NPLand LS outperform services with an SLA from anacute or no service. However, usage at StockportPCT who have an SLA with Stockport HospitalsNHS Foundation Trust acute library service wasnot typical of other PCTs with SLAs from acutelibrary services. West Cheshire PCT and ManchesterPCT staff averaging 6.90 and 6.67 session perWTE were the highest average/WTE. CumbriaPCT and Heywood, Middleton and Rochdale

PCT had the lowest sessions/WTE at 1.22 and1.21, respectively.

Methodology limitations

While this study looked at a large geographicalarea, 30 381 WTEs and 100 599 Athens user sessions,there were some limitations.

In the study, figures for the number of employeesfor each PCT were taken from the Department ofHealth census in 2006, prior to much of the PCTrestructuring that has taken place over the last 1–2 years. In addition, the figures were only for PCTemployed staff and did not include independentcontractors such as GPs or agencies working withthe PCTs who will have been eligible for an NHSAthens account.

Consequently, these figures may have affectedthe AS/WTE ratios and may not be an exactrepresentation of the Athens usage within eachPCT. However, although employee figures mayhave changed, the authors believe that, because ofthe large scale of the study (30 000 WTEs/100 000sessions), the ratio scale is still relevant andprovides a good indication of the comparativeimpact of library services.

Discussion

The conception of this study methodology was tostudy a large geographical population (all PCTstaff in NHS NW England) over a completecalendar year (2007). We chose those resourcesavailable to all staff from NHS core content toascertain usage patterns within PCTs withdifferent models of library service provision. Ourfindings have shown a correlation of e-resourceusage and type of library service.

The study found that in the NHS NW regionthose PCTs with a dedicated library service havethe greatest uptake of electronic resource usage.Seven out of the top 10 PCTs shown in Table 1have their own library service. The two PCTs withan outreach librarian, but no physical library, alsoappear in the top 10, showing that this service modelalso has a significant impact on e-resource usage.When we grouped services by type and averaged outthe figures, the model of using an outreach librarianproved to be the most efficient in terms of percentage

Figure 2 Percentage of whole-time equivalent (WTE) staff with an active Athens account. LS, library service; NL, no library; OL-NPL, outreach librarians but no physical library; SLA-A, service level agreement from acute library service


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of WTE staff with an active Athens account and alsonumber of session per WTE across all our measures.In 2007 Dowse and Sen

3

published a qualitativestudy that describes the impact that an outreachlibrarian has on the usage of online resources; thisquantitative study backs up those findings.

There are a large number of papers on libraryservices and primary care, most of which arequalitative,

1–5

and the small number of quantitativestudies

6,7

have been with small sample groups.Postal surveys and questionnaires are popularmethodologies but tend to return small samples.

This study presents strong evidence to suggestthat PCTs with their own library service or adedicated outreach librarian have the greatest impacton electronic resource usage, compared with thosewith no library service or an SLA with an acutetrust. With the sole exception of Stockport PCT,all services in these two categories appear in thebottom eight (Table 1). This is also evident in thepolarization that occurs in Figs 3 and 4 between

the PCTs with a library service or outreachlibrarian, compared with those without a serviceor with an SLA with an acute trust.

Our study demonstrated the efficiency of usingoutreach librarians in providing library andinformation services to staff working in a primarycare setting. Primary care staff tend to be dispersedin the community and therefore present challengesto traditional methods of delivering library services,such as those used by postgraduate medical librariesbased in acute teaching hospitals. Outreach librarianscan target their efforts to reaching relevant staffgroups without the administrative burden of staff-ing and resources of a collection-based libraryservice. Outreach librarians employ informationskills training as a method of reaching theircustomers and literature has shown benefits ofthese services in the use of bibliographic databasesand other e-resources.

1,3

It should be noted at thispoint that some PCT libraries in the NW, such asBury PCT and Western Cheshire PCT, have a

Table 1 Breakdown by primary care trust (PCT) of average total Athens sessions per whole-time equivalent (WTE)

Name of PCT WTE total Total sessions As/WTE

West Cheshire (LS) 861 5945 6.90Manchester (LS) 2345 15 641 6.67Wirral (OL-NPL) 1079 6227 5.77Stockport (SLA-A) 904 4573 5.06Bury (LS) 757 3667 4.84Halton & St Helens (LS) 1228 5814 4.73Tameside and Glossop (LS) 810 3394 4.19Oldham (LS) 888 3544 3.99East Cheshire (OL-NPL) 1249 4609 3.69Salford teaching (LS) 1426 5183 3.63Knowsley (LS) 928 3352 3.61Liverpool (LS) 2496 8121 3.25Bolton (LS) 1490 4000 2.68East Lancashire (LS) 2138 5656 2.65Ashton Leigh and Wigan (LS) 1707 4470 2.62Blackburn (LS) 597 1544 2.59Blackpool (SLA-A) 480 1115 2.32Trafford (NL) 666 1395 2.09North Lancashire (SLA-A) 934 1660 1.78Sefton (SLA-A) 1046 1857 1.78Central Lancashire (SLA-A) 2008 3275 1.63Warrington (LS) 680 1097 1.61Cumbria (NL) 2566 3137 1.22Heywood, Middleton and Rochdale (SLA-A) 1098 1324 1.21

LS, library service; NL, no library; OL-NPL, outreach librarians but no physical library; SLA-A, service level agreement from acute library service.


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library service and employ librarians in an outreachcapacity. For this study those services were catego-rized as having a library service.

Our study also shows a positive correlationbetween PCT-based library services and increasedusage compared with services supplied by acutetrusts via an SLA. This result was to be expected asa visible library service provides awareness, marketingand promotion of resources in addition to training.

Robinson and Bawden noted that the locationof library service can also have an effect on usage.

1

This study describes an interesting trend for thosePCTs with a library service based at anotherPCT—the majority of them have a lower usage.This could indicate that a library off site has less ofan impact or simply that the library staff use anAthens account from the PCT in which they arebased. An anomaly to this trend was Tamesideand Glossop PCT, which has higher use than

Oldham PCT, although the library is actuallybased at Oldham PCT. This may be because thestaff use both Athens accounts.

This quantitative study looks at usage of twoelectronic resources (Dialog Datastar and ProquestHealth) as a measure for the impact of libraryservices in primary care trusts. Clearly, this is onlyone indicator for the impact of library services andother factors do need to be taken into consideration.Other quantitative factors, such as number oftraining sessions, requested literature searches orinter library loans could be analysed. As well asa qualitative study looking at the quality of thedifferent library services provided in PCTs, theseother factors combined with how PCT librarystaff use resources could be examined by futurestudies.

The positioning of the two service models (LSand OL-NPL) in the results demonstrates thatthese should be the preferred options in order tomaximize the impact of online resources availableto PCT staff. PCTs using service level agreementswith acute library services need to ensure they aregetting a level of service comparable with PCTswith their own library services.

Key Messages

Implications for Policy

• A trust-based library service or an outreachlibrarian provides the maximum impact onuse of library electronic content by PCT staff.

• Staff at PCTs without library services displaya low level of use of electronic content whichis provided to support evidence-based practice.

• PCTs using service level agreements withacute library services need to ensure they aregetting a level of service comparable withPCTs with their own library services.

Implications for Practice

• Outreach librarians raise awareness ofelectronic content available to PCT staff.

• Training is an important component in PCTstaff usage and awareness of electroniccontent.

• Use of e-resources are higher at PCTs with adedicated library service.

Figure 3 Average number of Athens sessions per whole-time equivalent (WTE). LS, library service; NL, no library; OL-NPL, outreach librarians but no physical library; SLA-A, service level agreement from acute library service

Figure 4 Average number of Dialog/Proquest sessions per whole-time equivalent (WTE). LS, library service; NL, no library; OL-NPL, outreach librarians but no physical library; SLA-A, service level agreement from acute library service


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Received

19 April 2008

; Accepted

23 June 2008

Documents

The impact of library services in primary care trusts in NHS North West England: a large-scale retrospective quantitative study of online resource usage in relation to types of service