Abstract
Objectives: The study examines how Loansome Doc services are implemented and used by libraries in the Southeast Region and describe end users' experiences with and attitudes toward Loansome Doc.
Methods: 251 active DOCLINE libraries and 867 Loansome Doc users were surveyed.
Results: Roughly one half of the libraries offered Loansome Doc services. Of those that did not, most indicated no plans to offer it in the future. The majority had a small number of end users and experienced minimal increases in interlibrary loan activity. Problems were relatively rare. Satisfaction with Loansome Doc was high among all types of libraries. End users were usually physicians or other health care professionals who requested articles for research and patient care. Most learned about Loansome Doc through PubMed or Internet Grateful Med. End users appeared to be largely self-taught or received informal instruction in Loansome Doc. Loansome Doc filled document requests in a timely manner, and end users reported being satisfied with the service.
Conclusions: Greater promotion of what Loansome Doc is and how it can benefit libraries can increase the number of participating libraries. While satisfaction of Loansome Doc end users is high, satisfaction could be increased with more help on the PubMed screen, more library training, and faster delivery methods.
INTRODUCTION
In 1991, the National Library of Medicine (NLM) released Loansome Doc software to Grateful Med users. Loansome Doc expands the capacity of DOCLINE by adding a document delivery component aimed at health care professionals. With Loansome Doc, health care professionals have the ability to electronically order articles found on NLM databases from their designated library in a timely and cost-effective manner [1].
Health care professionals are required to register with a library to obtain this service. Originally, Loansome Doc was targeted to unaffiliated health professionals located in remote areas without adequate document delivery options. While health care professionals are the primary focus of Loansome Doc services, any user can establish an agreement with a participating library [2].
To encourage libraries to participate in Loansome Doc, many advantages have been promoted. Loansome Doc uses DOCLINE, an existing interlibrary loan system used by medical librarians. Hence, librarians do not have to learn a new complicated system. All citations are correct and legible. End-user information is attached to each request, and requests can be automatically transferred to other libraries without reentering citation and requestor information [3]. With Loansome Doc, librarians can electronically accept verified requests from their patrons through DOCLINE. This saves librarians time and paperwork, because the requests have already been entered into their interlibrary loan system by the end user. Loansome Doc potentially enhances end users' opinions of library services, because Loansome Doc uses time-saving technology to assist the end user in gathering information.
Although the potential for Loansome Doc is tremendous, its impact on libraries and their users has been addressed in only a few research studies [4–8]. Earlier studies focused on a small number of end users, and only one study looked at potential Loansome Doc libraries. The study that examined potential Loansome Doc libraries indicated there was great reluctance by staff to implement the program because of time and costs involved. Studies of end users indicated that many potential users did not register for or did not utilize the service. However, when end users did use Loansome Doc, satisfaction was high. Previous research indicated that obstacles to its use needed to be addressed before the full potential of Loansome Doc could be reached. The barriers included end users' insufficient training to use NLM databases, lack of time and expertise of end users, and reluctance of library staff to implement Loansome Doc services.
With wider access to PubMed afforded by Web implementation in 1998 and the increasing availability of training opportunities to learn these search systems, librarians need to look anew at the effects of Loansome Doc on libraries and users. To provide a detailed picture of Loansome Doc activities in the Southeast Region, this study sampled both libraries and registered end users beginning in the summer of 1999. The survey was designed to examine how Loansome Doc services were implemented and used by libraries. The effects of Loansome Doc services on the end user were explored, as were their levels of satisfaction with the service.
METHODS
Samples
Loansome Doc libraries
To provide a comprehensive picture of the use of Loansome Doc in the Southeastern Region, all 251 active DOCLINE libraries in the area of the Southern Chapter of the Medical Library Association were sampled. This area included six states—Alabama, Florida, Georgia, Mississippi, South Carolina, and Tennessee—and the Commonwealth of Puerto Rico and the U.S. Virgin Islands. One hundred and ninety responses were received from active DOCLINE libraries for an overall response rate of 76%.
Loansome Doc end users
The sample of end users was gathered from registered users of Loansome Doc in Florida and Tennessee. These two states had the highest number of Loansome Doc users in the areas surveyed. Permission from twenty-five libraries was obtained to survey 867 of their users. Five hundred and four end users responded for a response rate of 58%.
Questionnaires
Separate questionnaires were prepared for libraries and end users (Appendixes A and B). For libraries, the survey focused on the current status of Loansome Doc activities at each institution (including marketing, training, fees, and types of Loansome Doc users), statistical data (including number of users and number of requests), and subjective assessments of problems with and usefulness of Loansome Doc. The library survey was made available to respondents in both Web-based and paper versions. Forty percent of the respondents completed the Web version. The questionnaire for Loansome Doc end users focused on (1) how they found out about Loansome Doc, (2) if they had received training, (3) how many requests they make, (4) what problems they encountered with Loansome Doc, and (5) what the reason or reasons were for choosing their Loansome Doc library.
RESULTS
Loansome Doc libraries
Characteristics of the sample
Hospital libraries constituted the lion's share of the sample. Well over half of the respondents (70%) were hospital libraries (including teaching hospitals). Medical school libraries made up 11% of the sample. There were very few academic (6%) or corporate libraries (3%). Ten percent of the respondents classified their libraries as other.
Loansome Doc services
Slightly less than half of the respondents (47%) offered Loansome Doc services to their patrons. Many of those libraries have offered the service for a long time. Sixty-four percent of the libraries initiated Loansome Doc prior to 1998. This result indicated those libraries were interested in Loansome Doc even before it became Web based and easily accessible to their patrons. Of the libraries that did not have Loansome Doc, only 20% indicated they were interested in getting it in the future.
The most frequently noted reason librarians gave for not being interested in setting up Loansome Doc services was a perceived lack of time or staff. They were concerned that Loansome Doc would increase their interlibrary loan activity. Also, many librarians were worried about the costs of having the program, because they were unable to charge the costs back to the end users. Librarians also felt that they did not need to have Loansome Doc. For example, several librarians noted that it was “faster to call me directly,” “procedures [were] in place to obtain article reprints,” or that they had “good systemwide communication … for sending requests.” Several librarians indicated they were unfamiliar with or did not understand Loansome Doc.
Number of Loansome Doc users
Contrary to the fears of overuse expressed by nonparticipating libraries, participating libraries did not seem overwhelmed by Loansome Doc patrons. A small number of the libraries (9%) had no Loansome Doc users registered, because they had just recently implemented Loansome Doc services or had not publicized them. Of the libraries that did have Loansome Doc users, more half (67%) had fewer than ten users. The majority (82%) had twenty-five or fewer.
Medical school libraries had more Loansome Doc end users than other types of libraries (Table 1). More than three-quarters of medical school libraries (83%) had eleven or more. This result was not surprising, because medical schools were more likely to focus on research, which was one of the most frequent reasons that Loansome Doc end users cited for utilizing the service. Their focus on research would make their patrons more apt to be interested in becoming Loansome Doc end users.
Table 1 Number of Loansome Doc end users by library type (N = 72)
In contrast, half of the teaching hospitals (50%) had ten or fewer end users. Almost all of the hospital libraries (87%) had ten or fewer. All of the academic libraries had ten or fewer. Academic libraries were probably not promoting Loansome Doc services as much as medical libraries because of their diverse patron population and difficulty in targeting specific populations to use Loansome Doc services.
Half of all the libraries (50%) that offered a Loansome Doc program denied services to potential end users. The most common client types denied services were members of the general public followed by students in non–health care fields and attorneys, respectively.
Charges
Costs to end users varied widely. Some libraries did not charge affiliated end users; others charged everyone. The most common method of charging was to pass along charges from the lending library. Charges ranged from $2.00 to $21.00 per article. One library instituted a one-time fee.
Change in interlibrary loan activity
Only about a third of the libraries (38%) indicated their interlibrary loan activity had changed in the previous six months because of Loansome Doc. Of the libraries that experienced a change in interlibrary loan activity, most said it increased, but the amount of increase was generally not large. Well over half of the libraries (57%) indicated interlibrary loan activity had increased 10% or less (Table 2).
Table 2 Increases in interlibrary loan activity (N = 28)
Medical school libraries had the largest increase in interlibrary loan activities (Table 3). A majority (63%) indicated their interlibrary loan activity had increased 11% to 100%. As noted earlier, medical school libraries might have the most Loansome Doc patrons because of their end users' commitments to medical research and publishing. Most teaching hospitals (75%) and hospital libraries (64%) had increases of less than 10%. These types of libraries did not have as many Loansome Doc patrons and were less likely to be involved in medical research.
Table 3 Percentage of increase in interlibrary loan activity by library type (N = 26)
Revoking services
When libraries implement new document delivery services, problems often arise. These problems may include patrons requesting an unreasonable amount of material or refusing to pay for the service. The survey results suggest that problems with Loansome Doc end users are not common. Very few libraries in our survey had to revoke Loansome Doc services to patrons. Only 10% of libraries had to discontinue end users.
Publicity and training
As with any service, the usefulness of Loansome Doc depends in part on whether potential users are aware of it. This survey explored if and how librarians publicized Loansome Doc. Informal contact with patrons was the most commonly used method to make patrons aware of the service. Library orientations and PubMed or Internet Grateful Med classes were other common ways to inform patrons of the service. Many libraries have PubMed or Internet Grateful Med classes available for their patrons, but only 3% percent of Loansome Doc libraries offered classes targeted to Loansome Doc.
Satisfaction
In general, libraries had positive assessments of the Loansome Doc system. Librarians found they liked the convenience of having their patrons electronically requested articles already verified. Almost all of the librarians (88%) liked the convenience of Loansome Doc. Well over half of the librarians (65%) were satisfied with the system. Satisfaction with and assessment of the convenience of Loansome Doc did not vary by type of library.
Problems and suggestions
While the majority of librarians are satisfied with Loansome Doc, a small number of librarians indicated they had problems or that the system could be improved. Several librarians indicated that they or their patrons did not understand the system or had trouble registering. For example, librarians noted that, “it is hard to understand some of the concepts … there is a fear of being charged more for [a Loansome Doc] request than for a regular request”; “patrons not understanding ‘refer on’ ”; “lack of understanding by patrons of how the system works”; “confusion of patrons about its function”; “doc[tors] experienced trouble with getting registered”; or “setting … up … was a little troublesome…. Manuals [were] not terribly helpful.” One librarian said, “I don't have time to teach patrons how to use it.” Some librarians indicated that first-time users would inundate the system with requests until they were familiar with Loansome Doc. For example, “First time users get ‘carried away,’ ” or “We received a very large volume of requests from one [first-time] patron (200 +).”
To improve Loansome Doc, several librarians offered suggestions. Many wanted more information for the end user at the PubMed screen. For example, “Explanation up front” or “Patrons need more instruction as to the function of various fields on the registration form.” Another librarian indicated that PubMed should be better explained on the opening Web page; there are “no guidelines” and they should be “more appropriate for health professionals.” Finally, one librarian believed that more libraries should participate in Loansome Doc. “We are overburdened by requests, because none of the libraries in the area would participate.”
Loansome Doc end users
Characteristics of the sample
Not surprisingly, physicians and other health care professionals were the most common types of end user to respond to the survey (Table 4). Thirty percent of the respondents were physicians, interns, or residents, and 30% were some other type of health care professional. Nineteen percent of the respondents classified themselves as other. The most common type of end users who classified themselves as other described themselves as researcher, followed by professor. Attorneys and administrators used Loansome Doc; 6% of the respondents fell into each of these categories. Students in health care and non–health care programs constituted 3% of the sample. A very small proportion of the sample (4%) was general public clients.
Table 4 Types of Loansome Doc end users (N = 496)
Because well over half of Loansome Doc users were physicians and other health care professionals, research and patient care were the predominant reasons for using this service. Other reasons for using Loansome Doc were (in order of preference) education, paper presentation, current awareness, education in a new field, and administrative and legal issues.
Usage
As expected for a new service that has just been placed on the Web, a majority of Loansome Doc end users reported they had been using it a year or less. Almost three-fourths (72%) had registered for it in the past year. Twenty percent of users had used it two to five years, and only 7% had used it longer.
Loansome Doc end users actually made rather modest use of the system. Most (76%) used it less than three times per month. Those who used the service frequently (every month) usually did not order many articles. Well over three-fourths (85%) ordered nine or fewer articles in an average month. Of those who utilized the service infrequently (less than once a month), a significant number (81%) ordered nine or fewer articles in a six-month period (Table 5).
Table 5 Loansome Doc articles ordered by end users
Timeliness
Libraries providing Loansome Doc services appeared to be filling requests in a timely manner. Well over three-fourths of the users (76%) received their articles in less than a week. About three-fourths were very satisfied or satisfied with the time it took to get articles. Patrons indicated they were satisfied with the timeliness of delivery, even though most users received their documents via mail. Sixty-six percent of end users chose mail as their normal delivery method. Although most received articles by mail, many indicated they were interested in email or electronic delivery, but their libraries did not have the capabilities to provide that service.
Awareness of Loansome Doc
The most common way end users found out about Loansome Doc was from searching PubMed or Internet Grateful Med rather than from their librarians. The second most common way to find out about Loansome Doc was from librarians. The third most common way respondents found out about Loansome Doc was through colleagues. This finding suggested potential users might be unaware of Loansome Doc services.
Training
Survey results indicated most end users were either teaching themselves how to use PubMed and Internet Grateful Med or receiving informal instruction. Only 12% of the end users had taken a class in PubMed or Internet Grateful Med. More than one-fourth (26%) wanted more instruction. This may indicate that users were not aware of Loansome Doc's full capabilities.
Assessment of Loansome Doc
Overall, end users were satisfied with Loansome Doc and liked its convenience. Most (86%) were very satisfied or satisfied with the service. A small number were neutral (5%) or not sure (4%) how they felt. Dissatisfaction among users was low. Only 4% were dissatisfied with the service. Satisfaction did not vary over type of user. Levels of satisfaction were the same among physicians, nurses, attorneys, students, and others.
Problems and suggestions
While satisfaction was high, several end users reported problems. The most common was delays in getting articles. Some indicated they received illegible or hard-to-read copies, did not receive all the pages, or received incorrect articles, duplicate articles, or articles they had never ordered.
Cost was a factor for a number of end users, and some wanted cost information up front. Also, several end users thought the status function could be easier to use. Several end users indicated problems understanding or negotiating the process due to inexperience or confusing and unclear instructions.
Loansome Doc end users had several suggestions for improvements in the system. The overwhelming suggestion for improvement was for email or electronic delivery of articles. Lowering the cost of the services was another popular suggestion, and some users suggested that discounts for quantity should be given. Several users wanted more billing or payment options such as online billing and libraries that accepted credit cards. Several end users wanted the option to order articles or books that were not included in the PubMed system. One such user suggested a text box that could be filled out to initiate an order for an article not on PubMed. Several end users wanted the status check improved and confirmation that the library had shipped the articles. Several end users wanted more training, more documentation, and a clearer registration process than the current system had.
DISCUSSION
Fewer than half of the libraries the authors surveyed have instituted Loansome Doc services. A large number of librarians who do not have the service are not interested in offering it in the future. Our results may imply that the use of Loansome Doc is reaching its peak. Unless more libraries see advantages in implementing this service, the number of Loansome Doc libraries will not significantly expand. Helping librarians understand and implement Loansome Doc could increase the number of libraries offering Loansome Doc service. This increase would spread out the workload among libraries and not put an unfair burden on participating libraries.
Librarians' reasons for not implementing Loansome Doc services suggest that more concrete information should be made available about what to expect when implementing Loansome Doc services. This study indicates that the actual amount of increase that librarians have experienced in interlibrary loan activity is usually not large. If librarians see that their time and staff would not be stretched beyond a reasonable limit, more may become interested in offering Loansome Doc. Having statistics on the effect of Loansome Doc participation may help other libraries decide on the feasibility of offering the service.
Also, more efforts could be made to educate librarians about how Loansome Doc works and what the advantages of using the system are over traditional methods. These efforts may include training classes for librarians in conjunction with PubMed classes or more information for librarians on the PubMed Website. These strategies may help to increase the number of libraries willing to participate in Loansome Doc.
Efforts to increase usage by potential Loansome Doc end users also could be instituted. By offering training classes, librarians could be more proactive in publicizing Loansome Doc services rather than relying on informal contact with patrons, because many end users find out about Loansome Doc through PubMed or Internet Grateful Med rather than through librarians. Few people in this study find out about Loansome Doc through training classes, Web pages, brochures, library orientations, inhouse newsletters, or medical meetings. These underutilized methods of advertising Loansome Doc could be explored to attract new users. Librarians interested in expanding the end-user base should consider more aggressive publicity efforts.
Librarians also could target Loansome Doc services to particular groups to increase the number of end users. Medical school libraries have more Loansome Doc end users, probably because of the emphasis on research. Loansome Doc publicity could target staff who actively research and publish. Because teaching hospitals and hospital libraries have fewer Loansome Doc end users than medical school libraries, more efforts could be made by hospital librarians to promote Loansome Doc services for patient care. Specifically, hospital librarians could promote Loansome Doc as enabling doctors to expedite information gathering to provide better patient care.
Because many Loansome Doc end users have not been formally trained in PubMed or Loansome Doc, users may not be aware of Loansome Doc's full capabilities. For Loansome Doc services to be truly effective and to maximize patron satisfaction, librarians need to train their end users in searching PubMed and ordering articles via Loansome Doc. While many libraries offer PubMed classes, whether Loansome Doc is covered in those classes is unknown. More libraries may consider offering classes specifically on Loansome Doc. The classes would serve to increase end users' knowledge of the system and decrease potential frustration and dissatisfaction. In addition to training classes and informal contact with patrons, library handouts could answer some end users' questions. Ultimately, face-to-face instruction could prove to be the most effective method for users unfamiliar with the system or with computers in general.
Some of the problems of registering and understanding Loansome Doc could be resolved by improving Loansome Doc information on the Web. Also, improving access to that information on the PubMed screen where users first enter the system would be helpful. Presenting ample information for Loansome Doc end users to easily complete the registration process, navigate the system, and understand the process is essential.
While problems with patrons are infrequent, establishing clear policies and expectations may decrease even further the small number of end users who must be dropped. For example, less than half of the Loansome Doc libraries have formal contracts for end users to initiate services. Having a contract could eliminate confusion about libraries' and end users' responsibilities. Especially when libraries charge for Loansome Doc services, end users need to understand their liabilities (almost half of the libraries charged for Loansome Doc services).
Certainly, receiving articles more quickly will increase end users' satisfaction, especially because many of the end users request articles for patient care problems. Librarians should investigate ways of delivering articles more quickly, either by email or via the Web.
More efforts to promote Loansome Doc services should be instituted for several reasons. Libraries that offer Loansome Doc overwhelmingly like the convenience. Satisfaction levels are also very high among all user types. Loansome Doc does not appear to overburden libraries with requests. As more libraries institute Loansome Doc services, the burden on each library may decrease. Loansome Doc is appropriate for a wide range of users who have different reasons to use the service. Most importantly, end users seem to like the service. End users seem to appreciate librarians employing technology to support their activities.
CONCLUSION
Even though Loansome Doc has become more visible with Web access, barriers to achieving its full potential still exist. Many of the problems with implementing Loansome Doc services and difficulties of Loansome Doc end users identified in previous studies are still present.
The present study extends the literature by quantifying the effects of providing Loansome Doc service on libraries and quantifying the usage patterns and satisfaction of end users. The results indicate that providing Loansome Doc does not significantly overburden libraries with requests. In fact, more efforts to promote the service and train librarians unfamiliar with the service are needed for the program to expand. Additional medical libraries participating in the program will reduce the burden on individual libraries. Further improvements with Loansome Doc, along with increasing the number of libraries offering the system, will only improve overall satisfaction with the system.
Further research should focus on other regions of the country to see if the findings are comparable. Researchers should also examine if Loansome Doc training efforts by librarians are effective in increasing end users' knowledge of and satisfaction with Loansome Doc.
Acknowledgments
The authors would like to thank Janet S. Fisher, Quillen College of Medicine at East Tennessee State University, for her comments on an earlier draft.
APPENDIX A
Loansome Doc questionnaire for libraries
Part I
Part II: Loansome Doc services.
Part II: Loansome Doc services
Part III: User registration
Part IV: Statistics
Part V: Assessment of Loansome Doc program.
Part V: Assessment of Loansome Doc program
APPENDIX B
Loansome Doc questionnaire for end users
Loansome Doc questionnaire for end users
Footnotes
* This work was supported in part by a grant from the Southern Chapter of the Medical Library Association, 1999.
† Based on a presentation at the Annual Meeting of the Southern Chapter of the Medical Library Association, Greenville, South Carolina; October 16, 1999.
REFERENCES
- Fishel MR. Loansome Doc: push a button, get a document. National Library of Medicine News. 1991 Mar–Apr. 463–4. 1–3. [Google Scholar]
- Burnham JF, Perry M. Promotion of health information access via Grateful Med and Loansome Doc: why isn't it working? Bull Med Libr Assoc. 1996 Oct. 84(4):498–506. [PMC free article] [PubMed] [Google Scholar]
- Fishel MR. Loansome Doc: push a button, get a document. National Library of Medicine News. 1991 Mar–Apr. 463–4. 1–3. [Google Scholar]
- Burnham JF, Perry M. Promotion of health information access via Grateful Med and Loansome Doc: why isn't it working? Bull Med Libr Assoc. 1996 Oct. 84(4):498–506. [PMC free article] [PubMed] [Google Scholar]
- Dorsch JL. Equalizing rural health professionals' information access: lessons from a follow-up outreach project. Bull Med Libr Assoc. 1997 Jan. 85(1):39–47. [PMC free article] [PubMed] [Google Scholar]
- Lovas I. A look at LOANSOME DOC service. Bull Med Libr Assoc. 1994 Apr. 82(2):176–80. [PMC free article] [PubMed] [Google Scholar]
- Press N. Loansome Doc satisfaction survey results. Supplement. 1993 Jul. 24(4):6–7. [Google Scholar]
- Robishaw SM, Roth BG. GRATEFUL MED—LOANSOME DOC outreach project in central Pennsylvania. Bull Med Libr Assoc. 1994 Apr. 82(2):206–13. [PMC free article] [PubMed] [Google Scholar]