In an age of open access to research policies [electronic resource] : physician research use and policy awareness

Introduction: Through funding agency and publisher policies, an increasing proportion of biomedical literature is being made open access, notably through the NIH Public Access Policy. Such an increase in access raises questions about the awareness and potential utilization of this literature by those working in health fields, notably physicians. In particular, this dissertation asks, what use, if any, will physicians make of biomedical research when offered relatively full access. The answer provides an opportunity to anticipate how full open access, though an ideal, might affect physician use of and perceptions about journal articles in patient care. Methods: A sample of physicians (N=336) licensed in the U.S. were provided with relatively complete access to the research literature indexed in PubMed, as well as access to the research summary service UpToDate, for up to one year, with their usage monitored through the tracking of data logs. The physicians, randomly assigned to two groups (n=168 each), also participated in a one-month trial of limited access. Upon completion of the online component of the study, semi-structured phone interviews, approximately 30 to 60 minutes in length, were conducted with 38 physicians about their priorities and use of journal articles in clinical, research, and other professional practices, as well as their awareness of the NIH Public Access Policy. Interview responses were analyzed both in their own right, as well as in conjunction with the data collected through the portal, with participant IDs facilitating the matching of each interview with the corresponding usage information from the portal. In particular, article clusters — instances when a participant viewed journal articles three times within a seven-day period — were generated from the participants' log files, first in aggregate (N=336) and then in greater detail for 38 physicians who were interviewed. Among those 38 with at least one article cluster (n=24), seven were considered more closely in terms of specific articles viewed. Results: The study found that physicians' research interests were not satisfied by article abstracts alone nor by a clinical summary service such as UpToDate. On average, a third of the physicians viewed research a little more frequently than once a week, with those who graduated prior to 1990 viewing significantly more articles than those with a more recent graduation date. Those articles were published since the 2008 adoption of the NIH Public Access Policy, as well as prior to 2008 and during the maximum 12-month embargo period. A portion of the articles in each period was already open access, but complete access encouraged a viewing of more research articles. Though this study began more than six years after the adoption of the NIH Policy in April 2008, the majority of physicians had never heard of the policy and its potential relevance in meeting their research needs. Conclusion: While physician use of research is considerable, it is unlikely that that publishers and institutions would be faced with widespread article use if research were more freely available. However, based on physician use of research, as seen through article clusters in web logs and heard through interviews from this study, physicians derive value from viewing research, a benefit often passed onto their patients and, more generally, society. When allowed complete access to research, they, in fact, viewed more research. This should bode well for the future of health care for two reasons: (1) physicians reported their use and sharing of research to be crucial in their care of patients and (2) more and more articles are being made open access through initiatives such as the NIH Public Access Policy.

Keywords: Education.
Advisor: Willinsky John
Hamilton James
Schwartz Dan