MedlinePlus®: KEY RESOURCE FOR BOTH HEALTH CONSUMERS AND HEALTH PROFESSIONALS

Barbara F. Schloman, PhD, AHIP
Information Resources Editor

Keywords: MedlinePlus, consumer health information, Internet, World Wide Web

Launched in 1998, MedlinePlus® (http://medlineplus.gov) was designed to serve the information needs of health consumers as MEDLINE has done for health professionals. Ongoing refinements of the site have provided consumers with access to a greater breadth and depth of reliable content. These changes enhanced the site’s role as a key Web resource for health professionals. The MedlinePlus tagline--"Trusted Health Information for You"—applies to providers as well health consumers. MedlinePlus belongs on the core list of Web sites used by health professionals in directing their patients or clients to quality information.

What is it?

MedlinePlus is a gold-standard, Web-based consumer health information site. All materials have been carefully selected by health sciences librarians following evaluative guidelines. The quality content is presented free from advertising and commercial underwriters. User privacy is insured as laid out in the site’s detailed privacy statement (www.nlm.nih.gov/medlineplus/privacy.html).

Background

In 1997 the National Library of Medicine (NLM) began to provide free public access to MEDLINE with a Web-based version known as PubMed. Dr. Donald Lindberg, NLM’s director, reported that after one year the annual PubMed/MEDLINE activity increased from 7 million to 120 million searches. Interestingly, one-third of these searches were identified as being done by consumers. Renowned heart surgeon Dr. Michael E. DeBakey encouraged the development of a resource for consumers: "Not only health professionals, but also consumers, should have the most recent medical information at their fingertips" (National Library of Medicine, October 22, 1998).

MedlinePlus launched in 1998 with coverage of two dozen health topics and by June 2000 was receiving 2 million hits per month. As of this writing the site has over 700 topics and received over 170 million unique visitors in the second quarter of 2005 (National Library of Medicine, October 31, 2005).

From the outset, NLM worked to obtain user feedback to make the site more responsive to user needs (Lacroix & Mehnert, 2002). For example, visitors to the site sought information on specific conditions, wanted it to be easy to understand, and available as full-text at the site. This information led NLM to add licensed, full-text information resources such as current health news from Reuters, Associated Press, the A.D.A.M.Illustrated Medical Encyclopedia, Merriam-Webster Medical Dictionary. Because a significant number of all MedlinePlus searches were for drug information, NLM also licensed information from American Society of Health-System Pharmacists (ASHP) , the United States Pharmacopeia (USP), and Natural Standard.

NLM continues to employ several means to monitor the usage and usefulness of MedlinePlus, including log data, usage statistics, Web user surveys, usability tests. This resulted in the introduction of a new design and organizational structure of the site in 2002. A new search engine was deployed as well which is concept-based, offering retrieval based on the exact words inputted as well as on the related concept.

What does MedlinePlus offer for given health topics?

The "Health Topics" pages continue to provide the core content for MedlinePlus. The links for each topic are a highly selective collection directing users to the best material and minimizing the redundancy found on many other sites. Biomedical librarians make these selections using the quality guidelines outlined at www.nlm.nih.gov/medlineplus/criteria.html. Health Topic content includes a link to a pre-formatted PubMed/MEDLINE search for those users seeking more research-oriented information. These searches are typically limited to English language and a recent time period and draw upon reviews, practice guidelines, and patient education articles.

The following example for "anemia" shows typical coverage given to a topic:

What other kinds of information is provided?

The site was created to serve different kinds of information needs, enabling users to:

• Define medical terms and obtain a pronunciation guide
• Locate a doctor, dentist, or hospital
• Obtain health news from the past 30 days
• Get background information from an illustrated medical encyclopedia
• Find information on prescribed and over-the-counter medications, as well as evidence-based information about herbs and supplements.
• Connect to health-related databases and organizations
• Identify consumer health libraries providing services to local residents
• Utilize health check tools (quizzes, calculators, self-assessments, and decision guides) to check knowledge and health status.

Additionally, resources were developed to address the needs of specific user groups:

• Comparable Spanish version (MedlinePlus en español) available to address the needs of the growing Hispanic population in the U.S.
• Interactive tutorials (over 165 slideshows with sound and pictures) provide information accessible by low literacy users.
• Link to the NIH SeniorHealth.gov site which offers the capability to adjust text size and contrast, as well as providing an audio option.
• Prominent link to ClinicalTrials.gov for those seeking information on drug studies and treatments and to Surgery Videos showing captured Webcasts of specific surgical procedures.
• Links to Easy-to-Read pages (in both English and Spanish) and to resources for Low Vision Users are highlighted on the Health Topics page.

Other Special Features

MedlinePlus makes local connections possible as well. The Other Resources section on the home page includes a listing of Consumer Health Libraries willing to serve local residents. This is an impressive listing indeed including many local hospitals as well as major health centers. Many Health Topic pages include a Go Local feature to connect to providers and services in a given locale. Only a few states, however, include more than hospital listings.

Attention to Health Terminology

Users can search in several ways to access Health Topic content: from an alphabetical listing, by broad topic, or by a user-defined search. Miller, Tyler, and Backus (2004) describe the attention paid to using terminology commonly used by health consumers to increase search success. For example, the user will find information using the phrase "breast cancer" and not need to use "breast neoplasms." Additionally, the MedlinePlus staff does extensive work to build linkages to other resources which use NLM’s highly developed Medical Subject Heading (MeSH) vocabulary. MeSH provides the search infrastructure for PubMed/MEDLINE and other databases such as ClinicalTrials.gov. By providing behind-the-scenes linkages, the health consumer can readily access these research and clinically oriented resources. The linkages work in the other direction as well, providing a means for a user of this professional literature to be directed to background information on a particular condition found through MedlinePlus.

Usefulness for Health Professionals

Physicians have reported using MedlinePlus to remain current on areas outside their specialty. Coleman (2003) drew upon sites such as MedlinePlus when creating a print pamphlet to guide consumers to high-quality Websites for information—in this case for drug information.

In 2003, NLM launched a pilot Health Information Rx (information prescription) program in conjunction with the American College of Physicians Foundation. The program’s objective is to facilitate physician referrals to their patients for quality health information on the Internet, believing that informed patients are more engaged in managing their health. The program includes providing physicians customized prescription pads that they can use to direct patients to quality information in MedlinePlus. An evaluation of the pilot project is underway (American College of Physicians Foundation, 2005).

Conclusion

The Pew Internet & American Life Project reported in 2005 that 80% of all Internet users—or 95 million Americans over 18 years--have sought information on health topics. The report found that many of these health seekers were "action-oriented and highly purposeful because there was a pressing medical issue for them to address." The increased availability of high-speed Internet access and users with more online experience contribute to the increased interest in seeking out online health information. In November 2004, it was estimated that 55% of Internet users had been online for six years or more.

This pattern of use can be expected to grow, calling upon health professionals to be aware of what health information the Internet has to offer. This should include a working understanding of the resources available through MedlinePlus to increase the likelihood that consumers will find the best information available.

THE AUTHOR

Barbara F. Schloman, PhD, AHIP
Associate Dean, Library Public Services
Libraries & Media Services
Kent State University
Kent, OH 44242
E-mail: schloman@kent.edu

Disclaimer: Mention of a Web site does not imply endorsement by the author, OJIN, or NursingWorld. Links to web sites are current at the time of publication, but are not subsequently updated.

REFERENCES

American College of Physicians Foundation. (2005). Information Rx Project: A joint project of the ACP Foundation and the National Library of Medicine. Retrieved on December 30, 2005, from http://foundation.acponline.org/healthcom/info_rx.htm

Coleman, B. (2003). Producing an information leaflet to help patients access high quality drug information on the Internet: A local study. Health Information and Libraries Journal, 20, 160-171.

Lacroix, E. M., & Mehnert, R. (2002). The U.S. National Library of Medicine in the 21st century: Expanding collections, nontraditional formats, new audiences. Health Information and Libraries Journal, 19, 126-132.

Miller, N., Tyler, R. J., & Backus, J. E. B. (2004). MedlinePlus: The National Library of Medicine brings quality information to health consumers. Library Trends, 53, 375-388. Retrieved on December 28, 2005, from www.nlm.nih.gov/pubs/staffpubs/lo/LibraryTrends_fall2004.pdf

National Library of Medicine. (2005, October 31). MedlinePlus use by quarter, fiscal year 1999 to present. Retrieved on December 28, 2005, from www.nlm.nih.gov/medlineplus/usestatistics.html

National Library of Medicine. (1998, October 22). Press announcement: Public library initiative/New consumer health site. Retrieved on December 30, 2005, from www.nlm.nih.gov/archive/20040831/news/press_releases/medplus.html

Pew Internet and American Life Project. (2005). Health information online. Retrieved on December 28, 2005, from www.pewinternet.org/pdfs/PIP_Healthtopics_May05.pdf

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