April 2013
The Cochrane Library is an internationally recognized online journal that provides clinicians, researchers, policy-makers and consumers with the best single source of reliable evidence about the effects of health care interventions (prevention, treatment and rehabilitation) and health care policies on the health system. The evidence syntheses that The Cochrane Library contains (almost 5000 reports, called Cochrane Reviews) are conducted by The Cochrane Collaboration - an international network of people (from experts to lay people) who prepare, update and promote the accessibility of Cochrane Reviews.
Cochrane Reviews are unique because they are both produced by, and relevant to, everyone interested in the effects of health care. Based on the best available evidence, healthcare policy-makers can decide if they should fund a particular drug; practitioners can find out if an intervention is effective in a specific clinical context, and patients and other healthcare consumers can assess the potential risks and benefits of their treatment. Cochrane Reviews are considered to be the gold-standard of their kind.
There has been a significant, although fragmented, investment in licensing The Cochrane Library across Canada, but it is estimated that only 10 per cent of Canadians are actually able to access its resources. Many of these are health providers working in environments that are already rich with information – large urban centres, academic health facilities, etc. Access is very limited for community and rural health care providers and for patients and their caregivers.
Access around the world through nationally-funded licenses
Residents in a number of countries and regions can access The Cochrane Library for free through a ‘provision’ or national license. Largely funded by governments, these exist for the following geographic areas:
Australia; Canada (only New Brunswick, Nova Scotia, Saskatchewan); Denmark; Finland; India; Ireland; Latin America and the Caribbean; Low-Income Countries (as defined by the World Bank); New Zealand; Norway; Pakistan; South Africa (through a Cochrane Centre sponsorship scheme); Spain; Sweden; United Kingdom (England, Northern Ireland, Scotland, Wales); the State of Wyoming (USA).
A 2009/2010 ‘Pilot’ License: Proof positive The Cochrane Library is used when open to all Canadians
It has been long advocated that usage of The Cochrane Library would increase if it were openly accessible to all Canadians, but, until the pilot license project, it was only speculation based on the experience of other countries. A partnership was formed between the Canadian Health Libraries Association and the Canadian Cochrane Centre, which made a pilot project possible in 2009/2010. The contributions of the health libraries, library networks and library consortia across Canada that license The Cochrane Library for their users was supplemented with a one-time ‘top-up’ contribution to extend the reach of the existing licensing from 10 per cent to 100 per cent of the nation.
An evaluation of the pilot project clearly demonstrated the impact and value of pan-Canadian access to The Cochrane Library and unequivocally demonstrated that it would be used if made available.
Access, use and reactions
During the 12 months that all Canadians had full access to The Cochrane Library:
- Full-text downloads of Cochrane Reviews increased by 90 per cent from 2008 to 2009 (the natural growth in usage was 35 per cent from 2007 to 2008)
- Abstract views increased by 25 per cent
- Searches increased by 26 per cent
- An estimated 50,000 ‘turn-aways’ were prevented (people who want full-text reviews but can’t access them)
After the ‘one-click’ access was de-activated on 1 April 2010, there were 11,500 ‘turn-aways’ within the first month. In 2008, before the pilot license, the average number of ‘turn-aways’ was 4,500 per month.
An interesting difference observed between 2008 and 2009 was in the top 10 most accessed reviews in Canada. In 2009 (the year of the pilot), the following Cochrane Reviews were among the most accessed in Canada – and have a much more ‘regular consumer’ focus than a clinical one:
- Vitamin C for preventing and treating the common cold
- Echinacea for preventing and treating the common cold
- Interventions for preventing falls in elderly people
- Cranberries for preventing urinary tract infections
The Canadian Cochrane Centre ran a survey after the de-activation of the pilot license, and here are some of the comments from people about losing it:
- “Having access to Cochrane is now seen as essential in the clinical setting I work in. Looking for evidence-based information is now becoming a standard requirement.”
- “It was wonderful to know that reliable, current and evidence-based information was available to anyone needing it. We must continue on this path.”
- A family doctor stated: “Cochrane is an essential tool for the family physician. The fact that the reviews are much less influenced by the pharmaceutical industry really helps the credibility.”
- A nurse said: “I think that it's important for all of us to have access to this, so we can continue to provide quality care to others and keep ourselves informed!!!”
In response to a user survey conducted during the pilot license, an individual with a health treatment question said:
“Access to best information is essential for patients to make informed decisions and take responsibility for managing their health care. Informed, involved patients make good decisions and increase compliance, thus getting best results from health care resources.”
The cost of a National License – providing one-click access to all Canadians
Funding to reinstate pan-Canadian access to The Cochrane Library is required. If the national license is reinstated, it would be critical to train public librarians and provide resources on how to find the information they are looking for in the Library, as well as to promote the resource itself. Some initial additional funding to conduct these support and promotional activities would be valuable to the success and use of The Cochrane Library in Canada.
