This post is written by Emerson Castillo, who completed the module EDM122 in October 2022-February 2023. He is a nurse educator and he chose to licence his work under a CC-BY NC Licence. Emerson writes: 

Since the turn of the century, the open access movement—in which research articles are made publicly accessible online rather than published in journals that require substantial subscription fees—has risen significantly (Ratcliffe, 2014). Nonetheless, according to a review by Piwowar et al. in 2018, only 28% of scholarly papers, are currently open access, this means numerous academic knowledge is still unavailable to the public without a paid individual or institutional subscription. This signifies that designing new clinical guidelines and protocols is still challenging for clinicians as they have restricted resources for related literature. In addition, this also affects clinicians’ capacities including myself as a clinical practice educator to conduct further and in-depth research studies.

This essay explores open access in health education and how can this impact clinical practice among healthcare providers while fostering safer and quality care for all.

 

 

What is Open Access?

Open access (OA) refers to a set of guiding principles and a variety of methods that allow for the free online distribution of research outputs (Suber, 2015). It is a term under open practice, which is a publication and distribution approach that facilitates scientific research literature—freely and unrestrictedly accessible to the public online. Likewise, the results of academic research are made available to an unprecedented number of researchers through open access, which democratizes information access while promoting innovation and discovery. Wagner (2022) stated that “when there are no financial, legal, or technical barriers to accessing a publication—that is when anyone can read, download, copy, distribute, print, search for and search within the information, use it in education, or use it in any other way that is permitted by the agreements—that publication is said to be open access (Wagner, 2022).

Most academic publications are only accessible to those who pay a subscription fee or who are members of an organization that does. Open Access makes research findings broadly accessible through digital technology. There are two ways to make work accessible: either by publishing in a journal that instantly makes the work freely available online or by depositing a copy of the published work in a repository (Kingsley, 2015). In a nutshell, free-to-read and free-to-reuse are the two elements of open access (Open Society Foundations, 2018).

 

The world’s response to Open Access

Open access accelerated dramatically in December 2001 when an open society foundation sponsored a meeting in Budapest, Hungary where the statement of principles on open access to research literature developed (Open Society Foundation, 2018). However, two following initiatives inspired by the Budapest Open Access Initiative—the Bethesda Statement from the Howard Hughes Medical Institute and the Berlin Declaration from the Max Planck Society—broadened and strengthened the basis of support for open access (Open Society Foundation, 2018). To apply the open access approach, scholarly academics, libraries, students, patient advocates, and small companies, among others, have organized their members and led the initiative (Suber, 2015).

Additionally, in April 2006, the European Commission urged: “Research funding agencies… should establish a European policy mandating published articles arising from EC-funded research to be available after a given period in open access archives…” Furthermore, the WHO judges that “universal access to publicly funded research, including research data, is fundamental to tackling the public health challenges of the 21st century”. With this, the organization mandated that all works written or financed by the organization submitted for publication in peer-reviewed journals after January 1, 2021, must first be published in an open-access journal or on an open-access platform (World Health Organization, 2021).

In the United Kingdom, the National Institute for Health and Care Research (NIHR) also addressed this widely concerning issue regarding open access. In 2021, the NIHR released the Open Access Publish Policy stating that all publications submitted for peer review after June 1, 2022, should comply with the four principles. Articles must be free and accessible to everyone, with no barriers to re-use and dissemination, freely discoverable and if necessary, NIHR will settle payment to allow immediate open access (National Institute for Health and Care Research, 2021).

Sadly, as the world extensively attempts to move forward in advancing open access, some low-socioeconomic countries still have limited access to recent studies and educational resources. Contrarily, the Electronic Information for Libraries (EIFL) collaborates with libraries all around the globe to supply developing and transitional nations’ citizens with access to digital information. Its primary goal is to negotiate, support, and enable the widespread accessibility of scholarly electronic content by library users from the education and research sectors, professional communities, governmental organizations, and civil society (Kupryte, Segbert-Elbert and Bernal, 2005).

 

Benefits of Open Access to clinicians and patients

Nowadays, in developed countries such as the United Kingdom, it is straightforward for clinicians to access newly published scientific studies. As I have noted earlier, most academic search engines like science.gov, PUBMED, and CINAHL are readily available to use for most clinicians. Furthermore, academic institutions also provide free access to various research databases. Some institutions push further by providing free training on how to maximize the use of these databases and efficiently search for useful and relevant studies to your research.

Conducting research studies is a fundamental role for clinicians and health leaders. Likewise, as a clinical practice educator, I am accountable for guaranteeing that clinical practice is aligned with standards established on recently completed studies. Presently, I am leading a study focusing on pre-operative assessment of bariatric patients and I am arranging to apply open access to it once it’s ready for publishing as the Royal Society stated that authors “who choose open access are likely to benefit from increased dissemination.” This implies that if I apply the principles of open access to my study, my research may potentially have high citation rates, thus, I will personally gain and benefit from it as a clinician and academe. Further, the Nuffield Department of Medicine – Centre for Tropical Medicine and Global Health (2003) specified that open access could benefit clinical practitioners as they can apply findings of research to clinical practice that improves patient care and medical management and could influence the creation of new policies and procedures in the healthcare setting.

Overall, open access benefits patients by permitting clinicians to extend their knowledge and understanding of recent clinical trials. Remarkably, it allows all clinical practitioners to identify any new research gaps (Yoong et al., 2022).

 

Barriers to Open Access

Although there are many advantages to open-access publishing, most authors choose their publications based on the reputation of the journal. Due to false impressions of quality, open-access publications are at a disadvantage (Shah, 2017). In addition, a journal’s reputation in research and medicine is determined by its impact factor ranking. As a result, the reputation and worth of individual papers are frequently assessed using the journal’s impact factor (Wageningen University & Research, 2021). This is an unnecessary risk for an author because a research study may potentially be judged based on the open-access journal they disseminated it with. This can be deceiving for clinicians and the public since the quality and reliability of a study depends on which company published it and not the actual outcome and findings of the study. This may put patients and the public at risk as clinicians deliver medical treatments based on recent findings.

 

Open Access and Clinical Practice

We can all agree that the public’s social and health needs dramatically changed since Florence Nightingale founded nursing in the 1850s. These changes vary from clinical to social needs, for example, improvement in infection control and management and more complex medical conditions brought by globalization. The importance of open access in healthcare lies in providing a constructive way of solving problems and enhancing standards of care through research studies. Open access makes medical evidence widely disseminated and freely accessible to everyone, including academic researchers, medical professionals, policymakers, and laypeople (Barbour, 2006). This evidence can influence the laws and practices that affect public health.

Before the introduction of the open access model, nearly all scholarly study peer-reviewed articles were published in print journals with subscription costs that might be prohibitively expensive, even though writers received no compensation for their contributions. In addition, only well-funded university libraries, particularly in industrialized countries, had access to these magazines for the public. This implies that healthcare providers working in any remote region of a third-world country, for example, often could not access complete articles regarding the results of the latest medical research on the treatment and management of certain diseases.

Presently, on top of my research study, I am also formulating clinical guidelines for assessing patients with complex medical histories and clinical needs in Preoperative Assessment Unit. Thankfully, most of the resources nowadays are easily accessible using my NHS account in contradiction to what my colleagues experiencing in the Philippines.

I can remember a time when a friend of mine was writing his dissertation roughly 10 years ago. He was studying in a low-end school, consequently, his access to the latest medical literature was extremely limited. When I had a conversation with him to see how he was doing with his paper, he disappointedly mentioned that he spends almost 500 USD to acquire access to different studies. According to him, roughly 50% of his online purchases were insignificant in his research focus and was not able to use them at all. Regrettably, this access does not have a return policy. I think this is unnecessary especially if a clinician is researching to improve health practice or advance medical treatment. A question came into my mind, is it fair for researchers and clinicians to spend money in conducting studies to address the needs of the public and society?

Another scenario came to my attention when a colleague approached me a few months ago and asked about the importance of open access in nursing. I briefly discussed that open access is a way to communicate scholarly work and to be used and re-used. Thus, open access simply suggests free and readily accessible research studies that can be used as a basis for improving clinical practice or as a foundation for further investigation or study, therefore, affecting nursing practice. Moreover, I utilized the coronavirus pandemic that began in 2019 to highlight its significance because open access allowed for the free exchange of scientific knowledge, which has been incredibly valuable for modern-day scientific study. Researchers from all over the world have been positively impacted by easy access to scientific data and literature in terms of understanding the virus’ characteristics and key underlying mechanisms. This understanding has enabled pharmaceutical companies to develop vaccines and other treatments to prevent people from contracting the disease or minimizing the symptoms brought by the coronavirus (Bose, 2022) regardless of the call to suspend intellectual property rights for covid-19 vaccines (Krishtel and Malpani, 2021). On May 5, 2021, the United States startled the globe by announcing its support for a World Trade Organization (WTO) proposition that would temporarily suspend intellectual property rights on covid-19 vaccinations. This denotes that successful negotiation of an intellectual property waiver would guarantee that producers could not restrict access to raw materials and finished goods for covid-19 technology worldwide (Krishtel and Malpani, 2021). On contrary, some open-accessed research does not support the use of vaccination in tackling the pandemic. As reported by Peter Doshi (2020), Associate Editor at The BMJ today, “vaccines are being hailed as the solution to the covid-19 pandemic, but the vaccine trials currently underway are not designed to tell us if they will save lives”. This is the power of open access as it provides a scientific understanding of how we deal with different medical situations, and it provides facts about the edge and drawbacks of a specific medical treatment e.g., vaccination and other medications. Without these previous studies regarding coronavirus or acute respiratory distress syndrome, we might still be waiting for vaccines as you read this. We gather and analyze data from previous studies as a basis for developing a piece of new knowledge.

 

Conclusion

Open access is like opening a door for new discoveries as it allows clinicians to gain new knowledge and understanding of the complex world of human health. It is important in advancing research studies that influence the management and treatment of progressing clinical needs of the patients and the public. During the discussion, I discussed several advantages and disadvantages of open-accessed research studies. With this, I believe open access is a necessity in health practice. However, clinicians and health leaders must be keen and critical in assessing the reliability and credibility of all research studies we are exploring as they can either positively affect the public and patients or put them in danger. In a nutshell, open access is advantageous in improving clinical practice and competencies among healthcare providers when used with high caution.

 

References:

Barbour, V. (2006). The impact of open access upon public health. Bulletin of the World Health Organization, 84(5), pp.339–339. doi:10.2471/blt.06.032409.

Bose, P. (2022). How Will Open Access Research Help Tackle Future Pandemics? [online] News Medical Life Sciences. Available at: https://www.news-medical.net/health/How-will-Open-Access-Research-Help-Tackle-Future-Pandemics.aspx [Accessed 10 Jan. 2023].

Doshi, P. (2020). Will covid-19 vaccines save lives? Current trials aren’t designed to tell us. BMJ, [online] 371(8265). doi:10.1136/bmj.m4037.

Doyle, G. and McCutcheon, J. (2015). Clinical procedures for safer patient care. [online] Victoria, B.C.: BCcampus, p.1. Available at: https://opentextbc.ca/clinicalskills/ [Accessed 5 Jan. 2023].

European Commission (2006). Scientific publication: Policy on Open Access. [online] commission.europa.eu. Available at: https://commission.europa.eu/research-and-innovation_en [Accessed 6 Jan. 2023].

Kingsley, D. (2015). Open Access. [online] osc.cam.ac.uk. Available at: https://osc.cam.ac.uk/open-access [Accessed 24 Jan. 2023].

Krishtel, P. and Malpani, R. (2021). Suspend intellectual property rights for covid-19 vaccines. BMJ, [online] 373(8296), p.n1344. doi:10.1136/bmj.n1344.

Kupryte, R., Segbert-Elbert, M. and Bernal, I. (2005). The eIFL.net Initiative: Access and Management of Electronic Resources by Library Consortia in Developing and Transition Countries. Serials Review, [online] 31(4), pp.256–260. doi:10.1016/j.serrev.2005.09.001.

Masnick, M. (2022). Huge News: Biden Administration Announces All Publicly Funded Research Should Be Available For Free To The Public. [online] Techdirt. Available at: https://www.techdirt.com/2022/08/26/huge-news-biden-administration-announces-all-publicly-funded-research-should-be-available-for-free-to-the-public/ [Accessed 8 Jan. 2023].

‌National Institute for Health and Care Research (2021). NIHR Open Access publication policy – for publications submitted on or after 1 June 2022. [online] www.nihr.ac.uk. Available at: https://www.nihr.ac.uk/documents/nihr-open-access-publication-policy-for-publications-submitted-on-or-after-1-june-2022/28999 [Accessed 8 Jan. 2023].

Nuffield Department of Medicine – Centre for Tropical Medicine and Global Health (2003). Benefits of Open Access. [online] Nuffield Department of Medicine. Available at: https://www.tropicalmedicine.ox.ac.uk/sops/ndm-cghr-open-access-guide/benefits-of-open-access [Accessed 24 Jan. 2023].

Open Society Foundation (2018). Your Taxes Fund This Research. Shouldn’t You Have Access to It? [online] Opensocietyfoundations.org. Available at: https://www.opensocietyfoundations.org/explainers/what-open-access [Accessed 20 Jan. 2023].

Open Society Foundations (2018). What Is ‘Open Access’? [online] Opensocietyfoundations.org. Available at: https://www.opensocietyfoundations.org/explainers/what-open-access [Accessed 7 Jan. 2023].

‌Piwowar, H., Priem, J., Larivière, V., Alperin, J.P., Matthias, L., Norlander, B., Farley, A., West, J. and Haustein, S. (2018). The state of OA: a large-scale analysis of the prevalence and impact of Open Access articles. PeerJ, [online] 6(1), p.e4375. doi:10.7717/peerj.4375.

Ratcliffe, R. (2014). What’s the biggest challenge facing open access? [online] The Guardian. Available at: https://www.theguardian.com/higher-education-network/blog/2014/oct/27/-sp-whats-the-biggest-challenge-facing-open-access [Accessed 30 Jan. 2023].

Shah, D.T. (2017). Open Access Publishing: Pros, Cons, and Current Threats. Marshall Journal of Medicine, 3(3). doi:10.18590/mjm.2017.vol3.iss3.1.

Suber, P. (2015). Peter Suber, Open Access Overview (definition, introduction). [online] Earlham.edu. Available at: http://legacy.earlham.edu/~peters/fos/overview.htm [Accessed 20 Jan. 2023].

Wageningen University & Research (2021). Open Access: pros and cons. [online] Wageningen University & Research. Available at: https://www.wur.nl/en/library/researchers/open-access/open-access-pros-and-cons.htm [Accessed 29 Jan. 2023].

Yoong, S.L., Turon, H., Grady, A., Hodder, R. and Wolfenden, L. (2022). The benefits of data sharing and ensuring open sources of systematic review data. Journal of Public Health, 44(4). doi:10.1093/pubmed/fdac031.