A computer literacy skills profile of pharmacists residing in two counties of England
Abstract
Background: Pharmacy is an information intensive profession and a pharmacist has to be proficient in health care information management. The advance in information technology and the use of computers to access, retrieve and analyse this information is increasingly important. Yet little is known about pharmacists’ computer literacy or information technology skills.
Objectives: To gain a better understanding of pharmacists’ basic computer skills and their ability to use standard software.
Methods: Self-administered postal survey to 747 registered pharmacists residing in two counties of England.
Results: A total of 386 (52%) pharmacists responded after two mailings. Most responding pharmacists used computers at work and at home. They believed their basic computing skills to be high, although acknowledged that they were skill deficient in using certain software packages. Internet use at work was low (43%) as too was awareness and use of online medical databases; this was reflected in online medical database training being identified as of greatest need.
Conclusions: Pharmacists were confident in operating computer systems but identified a training need for particular software applications. Of concern is the limited knowledge they possessed and access they had on medical databases.
Introduction
The UK Government acknowledge the importance access to health care information has on delivering quality care in the National Health Service (NHS).1–3 Competencies have been devised for what information technology (IT) skills health care professionals, including pharmacists, should possess.4 In addition, the UK professional body for pharmacists, The Royal Pharmaceutical Society of Great Britain (RPSGB), have also specified the IT competencies pharmacists should hold.5 If pharmacists can achieve these competencies they will possess sufficient skills to access IT, which ultimately should allow them to provide information to clinicians and patients in decision making about medication.6
Computer literacy has been explored in other health care professions, in particular the nursing and medical profession.7 This has led to the development of ‘nursing informatics’ as a professional area of expertise.8 In contrast, pharmacy informatics is still very much an emerging field with little known about how pharmacists meet the competencies set out by the government and the RPSGB.9 One study, highlighted by the RPSGB, investigated the provision of Internet access and medical databases to 11 community pharmacists working in London and Essex over a 5-month period.10 Participants took part in focus groups and individual interviews before and after the study in which additional training in database searching was given. Technological competence was categorized from weak to strong; those pharmacists deemed weak were reported to have a lack of basic IT skills and the authors concluded that further IT training was required to support them in their day-to-day activities. A more recent study in 2004 by Balen and Jewson investigated the computer skills of 106 pharmacists working in a Canadian hospital.11 Findings showed that 79% of respondents had received no formal computer training and 41% rated themselves as being at level 3 with regard their own computer literacy (measured on a five-point Likert scale, where 1 equated to being illiterate and 5 being expert) Pharmacists indicated high levels of understanding in certain areas, such as their ability to access the Internet by typing in the URL but were less confident in areas such as Internet searching skills and online medical databases. The authors concluded that most pharmacists needed to upgrade their computer skills.
No work has been conducted on UK practising pharmacists with regard to determining pharmacists’ perceived confidence in the use of basic IT skills centring around the use of computers; their ability to handle certain software, including medical databases and the Internet; and what training they have had or require to improve their IT skills. These were the aims of this study.
Method
A piloted, self administered survey was distributed to all RPSGB registered pharmacists (n = 747) residing in two counties of southern England: Dorset (n = 489) and Somerset (n = 258). These two counties were chosen as they both had mixed urban and rural communities and were felt to represent a cross-section of the pharmacist population based on previous survey work.12
The survey consisted of five sections. Section A asked for demographic information; Section B explored basic computer skills and use of key software applications; Section C looked at Internet access and use; Section D determined the use of online medical databases; and Section E assessed the training needs of respondents. Questions were based on the RPSGB and the UK department of health's health care information competencies.4,5 Questions consisted of Likert rating scales and closed questions. Surveys were analysed using SNAP version 6 (Mercator, London, UK) questionnaire analysis package and statistical tests employed the χ2-test. The χ2-test was used as the data was non-parametric and categorical. Thus, this test allows differences between the actual and expected frequencies to be established.
Local research ethics committee approval was not required because of the type of data being collected.
Results
Three hundred and eighty-six usable surveys (52%) were returned after two mailings. Response rates from each county were not significantly different [Dorset 65%n = 252; Somerset 52%, n = 134 (χ2 = 0.011, d.f. = 1, P = 0.916)]. Table 1 illustrates the demographic details of respondents. The gender profile was equally split and not significantly different from national pharmacy workforce statistics (χ2 = 2.027, d.f. = 1, P = 0.155).13 However, age (χ2 = 80.7, d.f. = 6, P ≤ 0.001) and ethnicity (greater proportion of Caucasian, χ2 = 56.7, d.f. = 1, P ≤ 0.001, and smaller proportion of Asian pharmacists, χ2 = 49.1, d.f. = 1, P ≤ 0.001) did differ.13 Most pharmacists worked primarily in a primary care setting (e.g. a community pharmacy) and this mirrors national statistics. Those pharmacists not in active employment constituted a significantly higher percentage (χ2 = 16.93, d.f. = 1, P ≤ 0.001) of respondents than the latest pharmacy workforce census and further sub-analysis of the demographic data revealed that almost all were retired (88 out of 91 respondents). Subsequent data pertain to only those respondents in active employment.
| Demographic variable | Number (%) |
|---|---|
| Sex (n = 386) | |
| Female | 197 (51%) |
| Male | 189 (49%) |
| Age distribution (n = 386) | |
| Less than 29 years | 26 (6.7%) |
| 30–39 years | 81 (21%) |
| 40–49 years | 67 (17.4%) |
| 50–59 years | 83 (21.5%) |
| 60–69 years | 62 (16%) |
| More than 70 years | 66 (17.1%) |
| Ethnic background (n = 381) | |
| All white | 361 (94.7%) |
| Black/Black British | 8 (2.1%) |
| Asian/Asian British | 7 (1.9%) |
| Other | 5 (1.3%) |
| Current work situation (n = 383) | |
| Values > 100% as respondents could choose more than one category | |
| Work entirely within pharmacy | 231 (59.8%) |
| Work both within pharmacy and out of pharmacy | 16 (4.1%) |
| Retired but still work in pharmacy in some capacity | 39 (10.1%) |
| Not in active employment | 91 (23.6%) |
| Work entirely outside of pharmacy | 6 (1.6%) |
Basic computing skills
Most respondents had access to either a computer at work (91%) or at home (92%) and their perceived confidence in basic computer operations are shown in Table 2. Fundamental to computer operations are the use of a mouse and keyboard and over 90% (aggregated points 3 and 4—confident and very confident) of respondents indicated they were confident in using both. Almost as many respondents (84%) expressed the same level of confidence when dealing with printers. Respondents’ perceived level of confidence decreases when they were asked about using software applications. They were most confident using word processing packages (64%) compared with spreadsheets (33%), databases (28%) and presentation (PowerPoint) packages (26%). It was thought that as age increased respondents would be less confident in all aspects of computer literacy compared with younger and employed respondents. However, statistical analysis showed there to be no differences (at the 0.05 level) between these groups for any variable.
| 4 | 3 | 2 | 1 | 0 | Never used | |
|---|---|---|---|---|---|---|
| Basic computing and software use | ||||||
| Mouse (n = 284) | 77.1 (n = 219) | 16.5 (n = 47) | 5.3 (n = 15) | 0.3 (n = 1) | 0.3 (n = 1) | 0.3 (n = 1) |
| Keyboard (n = 285) | 67.5 (n = 192) | 24.9 (n = 71) | 5.5 (n = 16) | 1.7 (n = 5) | 0.3 (n = 1) | 0 |
| Printer (n = 285) | 58.3 (n = 166) | 26 (n = 74) | 9.1 (n = 26) | 3.1 (n = 9) | 3.5 (n = 5) | 0 |
| Word-processing (n = 285) | 40.3 (n = 114) | 23.6 (n = 67) | 16.7 (n = 48) | 8.7 (n = 25) | 3.5 (n = 10) | 7.3 (n = 21) |
| Spreadsheets (n = 285) | 17.1 (n = 49) | 15.7 (n = 45) | 22.3 (n = 64) | 18.1 (n = 52) | 10.8 (n = 31) | 15.3 (n = 44) |
| Databases (n = 285) | 11.8 (n = 34) | 15.7 (n = 45) | 24 (n = 68) | 19.9 (n = 56) | 11.8 (n = 34) | 16.7 (n = 48) |
| Presentation packages (e.g. PowerPoint) (n = 285) | 11.5 (n = 33) | 15 (n = 43) | 14.3 (n = 41) | 11.1 (n = 32) | 10.8 (n = 31) | 37.3 (n = 106) |
| Confidence using the Internet | ||||||
| Logging on (n = 284) | 76.6 (n = 206) | 14.5 (n = 39) | 5.6 (n = 15) | 1.9 (n = 5) | 1.5 (n = 4) | 0 |
| Typing web address (n = 269) | 77.7 (n = 209) | 14.1 (n = 38) | 4.1 (n = 11) | 3 (n = 8) | 1.1 (n = 3) | 0 |
| Searching the Internet (n = 275) | 55.3 (n = 152) | 21.8 (n = 60) | 16.4 (n = 45) | 2.9 (n = 8) | 0.4 (n = 1) | 3.3 (n = 9) |
| Searching within a page (n = 275) | 48.7 (n = 134) | 20 (n = 55) | 17.8 (n = 49) | 5.1 (n = 14) | 2.5 (n = 7) | 5.8 (n = 16 |
| Saving a web page (n = 274) | 32.5 (n = 89) | 17.9 (n = 49) | 18.6 (n = 51) | 8.4 (n = 23) | 8 (n = 22) | 14.6 (n = 40) |
| Bookmarking pages (n = 274) | 28.1 (n = 77) | 13.1 (n = 36) | 11.3 (n = 31) | 12 (n = 33) | 9.1 (n = 25) | 26.3 (n = 72) |
| Using e-mail (n = 275) | 58.2 (n = 160) | 21.5 (n = 59) | 9.8 (n = 27) | 2.9 (n = 8) | 2.6 (n = 7) | 5.1 (n = 14) |
| Sending mail attachment (n = 275) | 44.4 (n = 122) | 16 (n = 44) | 13.5 (n = 37) | 9.8 (n = 27) | 5.1 (n = 14) | 11.3 (n = 31) |
| Opening attachment (n = 275) | 48.7 (n = 134) | 20 (n = 55) | 11.3 (n = 31) | 5.8 (n = 16) | 6.6 (n = 18) | 7.6 (n = 21) |
In respect to Internet access, more than 86% (n = 245) of respondents had access to the Internet at home but only 43% (n = 122) had access at their workplace.
Table 2 also shows that respondents were either very confident or confident at logging on (91%) and typing in the web addresses (92%); however, they were less confident when searching the Internet for information (77%), searching within a web page (69%), saving web pages (50%), and bookmarking web pages (41%). Their confidence in using an e-mail system was high (79%), as too was their ability to send and open e-mail attachments (60% and 69%, respectively).
When respondents were asked about access to various online medical databases (those hosted by the National Library for Health and two pharmacy-specific databases, Pharmline and International Pharmacy Abstracts) it was apparent that most were unaware of those listed (Table 3). Of those respondents that were aware, the majority did not have access to them. The four online medical databases respondents most accessed were medline, cochrane, pharmline and embase, whether from work or at home, although they were more frequently accessed from work; for example, cochrane (17.4% in the workplace compared with 11.5% at home) and medline (21.0% in the workplace compared with 14.1% at home). Sub-analysis of the data showed hospital pharmacists had greatest access (31% of respondents) whilst at work and is in stark contrast to community pharmacists (4%).
| Database | No access % (n) | Access at home % (n) | Access at work % (n) | Not heard of database % (n) |
|---|---|---|---|---|
| Allied and complementary medicine (n = 273) | 29.7 (n = 81) | 0.7 (n = 2) | 2.9 (n = 8) | 66.7 (n = 182) |
| British nursing index (n = 275) | 29.4 (n = 81) | 2.9 (n = 8) | 4.8 (n = 13) | 62.9 (n = 173) |
| Cumulative index to nursing and allied health literature (n = 273) | 29.3 (n = 80) | 1.5 (n = 4) | 6.2 (n = 17) | 63.0 (n = 172) |
| cochrane (n = 287) | 29.6 (n = 85) | 11.5 (n = 33) | 17.4 (n = 50) | 41.5 (n = 119) |
| embase (n = 280) | 31.8 (n = 89) | 3.6 (n = 10) | 12.8 (n = 36) | 51.8 (n = 145) |
| medline (n = 290) | 27.9 (n = 81) | 14.1 (n = 41) | 21.0 (n = 61) | 36.9 (n = 107) |
| pharmline (n = 271) | 36.4 (n = 99) | 5.9 (n = 16) | 16.5 (n = 45) | 41.2 (n = 112) |
| International pharmacy abstracts (n = 271) | 32.8 (n = 89) | 1.1 (n = 3) | 0 | 66.1 (n = 179) |
| Zetoc (n = 272) | 29.8 (n = 81) | 0.7 (n = 2) | 1.8 (n = 5) | 67.7 (n = 184) |
- Zetoc provides access to the British Library's electronic table of contents.
Respondents were asked if they had received any formal training on computer literacy with regard to hardware and software (Table 4). Most respondents reported that they had no training on basic computer operations (76%, 217/287), file management (83%, 241/289) or backing up data (86%, 248/289). Similarly, software training was also infrequently reported: only 19% (56/289) had received word-processing training; 15% (43/289) on spreadsheets; 10% (30/289) on presentation packages; and 8% (22/276) on online database searching. The final part of the survey ascertained what training respondents believed they required to improve their work performance (Table 4). The three areas identified as being most needed were searching online medical databases (77%, 191/248), presentation packages (48%, 118/245) and spreadsheets (47%, 115/244). Respondents’ preferred training method was via one-to-one training sessions (34%, 93/273) provided by the Centre for Pharmacy Postgraduate Education (CPPE).
| % (n) | |
|---|---|
| Respondents who had received no formal training on hardware and software | |
| Basic computer skills (n = 287) | 76 (n = 217) |
| File management (n = 289) | 83 (n = 241) |
| Backing up data (n = 289) | 86 (n = 248) |
| Word-processing training (n = 289) | 81 (n = 233) |
| Spreadsheets (n = 289) | 85 (n = 246) |
| Presentation packages (n = 289) | 90 (n = 259) |
| Online medical database searching (n = 276) | 92 (n = 254) |
| Training needs | |
| Basic computer skills (n = 246) | 24 (n = 60) |
| Word-processing | 31 (n = 76) |
| Spreadsheets (n = 244) | 47 (n = 115) |
| Presentation packages (n = 245) | 48 (n = 118) |
| Introduction to the Internet (n = 246) | 24 (n = 58) |
| Using e-mail (n = 246) | 23 (n = 56) |
| Searching online medical databases (n = 248) | 77 (n = 191) |
| Preferred method of training | |
| One-to-one (n = 273) | 34 (n = 93) |
| Self-tutoring training pack (n = 275) | 23 (n = 64) |
| CD–ROM (n = 275) | 11 (n = 31) |
| Interactive online training (n = 275) | 10 (n = 28) |
| Preferred training provider | |
| Centre for Pharmacy Postgraduate Education (CPPE; n = 268) | 60 (n = 160) |
| Local pharmacy branch network (n = 268) | 6 (n = 16) |
| School of pharmacy (n = 268) | 11 (n = 30) |
| Training organization unrelated to pharmacy (n = 268) | 23 (n = 62) |
Discussion
Computer literacy will vary between individuals in the same way that basic literacy skills vary. An individual might be good at using a keyboard but not a computer mouse or their word processing skills might be better than their spreadsheet skills; in essence, a person's skills will vary depending on what they need to know to perform their job role. However, the Department of Health have already outlined proposed key IT developments to support increased NHS services and to make better use of pharmacists’ skills.14 These proposals, if implemented, will demand pharmacists to have a high level of basic computer skills, both in primary and secondary care settings regardless of their job role; for example, new IT initiatives affecting pharmacy such as electronic transmission of prescriptions between doctors and pharmacists. Findings from this study suggest that respondents do feel confident using computers but are less confident with the associated software applications. This poorer ability in software management could affect the ability of pharmacists to implement and run these new services.
Furthermore, the government wish to maximize pharmacists’ knowledge on medicines to help patients and clinicians make decisions on effective treatments. To do this, pharmacists’ must base decisions on evidence-based practice using the most up-to-date information. Increasingly, information is now accessed via the Internet. Almost all respondents had access to the Internet, but surprisingly less than half could do so from their place of work. Anecdotal evidence from employee community pharmacists suggests that some employers, most notably those employers who are part of national multiple chains, limit or deny their pharmacists Internet access. This limited access does raise concerns over the quality of information provided by pharmacists, especially community pharmacists, if Internet access is needed to retrieve the most current data and warrants further investigation. With regard to retrieving data from the Internet, respondents showed only partial confidence in navigating through and saving web pages. This could hinder their ability to locate pertinent information and retrieve it at a later date, thus impacting on the quality of information they can provide.
Key to any health care professionals’ ability to provide good patient care is the quality of information they use to base their decisions and the commonest way of storing data, in a searchable format, are databases. The ability to use online medical databases is therefore essential for the practice of evidence-based medicine. Yet this study showed respondents had a very limited awareness of medical databases and, for those that had heard of the online medical database, they had limited access to them either at home or work.
Community pharmacists in particular appear to access online medical databases rarely. This is possibly because of the type of day-to-day work community pharmacists undertake compared with their hospital counterparts. In a hospital setting, pharmacists are more commonly involved in initiating medication regimens, dealing with medicine incompatibilities and establishing policies on prescribing, which necessitates greater use of up-to-date information. In addition, hospital pharmacists have greater opportunities to use medical databases as they have access to the NHSnet via the National Core Content Collection (i.e. databases identified as being essential for all health care professionals), whereas community pharmacists do not as they are not NHS employees but contracted to provide NHS services and are therefore denied access. If the proposed IT changes in ‘A vision for pharmacy in the new NHS’14 go ahead, then community pharmacists will also need similar access to ensure patients receive optimal care.
Although issues surrounding online medical databases and searching for information were areas which showed respondents to be least confident, respondents were aware of their skills shortage and clearly highlighted that training on database skills were of greatest need and this is consistent with other study findings.11,15 Respondents favoured one-to-one training using CPPE, although the viability of this method of training is questionable given the resources given to CPPE by the government. An alternative strategy for delivery would be to use the existing CPPE national network of local tutors to run evening sessions, as they already do for therapeutics training. However, it is also questionable whether all pharmacists require such high levels of skill in online medical database searching as a national network of medicines information centres, based in secondary care and manned by pharmacists, already exists in the UK. This network aims to support the safe, effective and efficient use of medicines by the provision of evidence-based information and advice on their therapeutic use. The current service is provided by a network of 260 local medicines information centres, 16 regional centres and two national centres (Northern Ireland and Wales). Pharmacists from these centres possess the prerequisite clinical informatic skills as identified by Coiera.16 Perhaps greater utilization of these centres by pharmacists should be encouraged or their expertise used to facilitate training hosted by CPPE.
Conclusion
The NHS is committed to a programme of reform and development of IT systems for improved patient care. This study suggests that, if pharmacists are to play a substantive part in an IT-led NHS, then they must improve their IT skills. As continuing professional development will be mandatory for all UK pharmacists from 2008, then the responsibility for gaining better IT skills rests with each individual but should be supported by NHS and non-NHS employers.
Key Messages
Implications for Policy
- •
NHS policy on IT must be all inclusive and involve all sectors of the pharmacy profession.
- •
Upgrading pharmacists’ IT skills is required and should be integrated in to future government IT plans.
Implications for Practice
- •
A shortage of knowledge and access to use on-line medical databases might compromise pharmacists ability, especially in community pharmacy, to provide up-to-date evidence on medicines to patients and doctors.
