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McMaster PLUS: A Cluster Randomized Clinical Trial of an Intervention to Accelerate Clinical Use of Evidence-based Information from Digital Libraries

^a Health Information Research Unit, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, L8N 3Z5 Canada
^b Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, L8N 3Z5 Canada
^c Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, L8N 3Z5 Canada
^d Division of Nephrology, University of Western Ontario, London, Ontario N6A 4G5 Canada

^_* Correspondence and reprints: R. Brian Haynes, McMaster University, Epidemiology and Biostatistics, McMaster Health Sciences Centre, 1200 Main St West, Rm 2C10b, Hamilton, Ontario, Canada L8N 3Z5. (Email: bhaynes{at}mcmaster.ca).

Received for publication: 05/23/06; accepted for publication: 08/08/06.

BACKGROUND: Physicians have difficulty keeping up with new evidence from medical research.

METHODS: We developed the McMaster Premium LiteratUre Service (PLUS), an internet-based addition to an existing digital library, which delivered quality- and relevance-rated medical literature to physicians, matched to their clinical disciplines. We evaluated PLUS in a cluster-randomized trial of 203 participating physicians in Northern Ontario, comparing a Full-Serve version (that included alerts to new articles and a cumulative database of alerts) with a Self-Serve version (that included a passive guide to evidence-based literature). Utilization of the service was the primary trial end-point.

RESULTS: Mean logins to the library rose by 0.77 logins/month/user (95% CI 0.43, 1.11) in the Full-Serve group compared with the Self-Serve group. The proportion of Full-Serve participants who utilized the service during each month of the study period showed a sustained increase during the intervention period, with a relative increase of 57% (95% CI 12, 123) compared with the Self-Serve group. There were no differences in these proportions during the baseline period, and following the crossover of the Self-Serve group to Full-Serve, the Self-Serve group’s usage became indistinguishable from that of the Full-Serve group (relative difference 4.4 (95% CI –23.7, 43.0). Also during the intervention and crossover periods, measures of self-reported usefulness did not show a difference between the 2 groups.

CONCLUSION: A quality- and relevance-rated online literature service increased the utilization of evidence-based information from a digital library by practicing physicians.

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