Evidence-based medicine for all: what we can learn from a programme providing free access to an online clinical resource to health workers in resource-limited settings

Abstract

The rapidly changing landscape of medical knowledge and guidelines requires health professionals to have immediate access to current, reliable clinical resources. Access to evidence is instrumental in reducing diagnostic errors and generating better health outcomes. UpToDate, a leading evidence-based clinical resource is used extensively in the USA and other regions of the world and has been linked to lower mortality and length of stay in US hospitals. In 2009, the Global Health Delivery Project collaborated with UpToDate to provide free subscriptions to qualifying health workers in resource-limited settings. We evaluated the provision of UpToDate access to health workers by analysing their usage patterns. Since 2009, ∼2000 individual physicians and healthcare institutions from 116 countries have received free access to UpToDate through our programme. During 2013–2014, users logged into UpToDate ∼150 000 times; 61% of users logged in at least weekly; users in Africa were responsible for 54% of the total usage. Search patterns reflected local epidemiology with ‘clinical manifestations of malaria’ as the top search in Africa, and ‘management of hepatitis B’ as the top search in Asia. Our programme demonstrates that there are barriers to evidence-based clinical knowledge in resource-limited settings we can help remove. Some assumed barriers to its expansion (poor internet connectivity, lack of training and infrastructure) might pose less of a burden than subscription fees.

Better evidence: prospective cohort study assessing the utility of an evidence-based clinical resource at the University of Rwanda

“…This could be particularly beneficial for clinicians caring for a large number of complex patients without access to specialists. We have previously reported on a programme, which provides donated UpToDate subscriptions to clinicians in LMICs, in which we found that most use UpToDate with high frequency, and many report changing their clinical decision making as a result of having access to UpToDate 17…”

Understanding the needs of low‐income countries: how urologists can help

“…The potential for their development does exist as there are several associations that could constitute member committees to formulate them and initiate data collation; the Pan‐African Association of Urology, The South African Urology Association, Urological Association of Zambia, and the Egyptian Urological Association all have this capacity. If they developed context‐based, local and regional guidelines, available from a freely available open‐access source [34], an increased uptake of locally relevant data would possibly encourage the provision of a more evidence‐based practice [34, 35].…”

Advices On Search And Critical Appraisal Of Biomedical Literature Part I, General Workflow

“…For users from certain regions (often referred to as "resource-limited settings"), the Up-ToDate database offers topics pertinent to Global Health (https://www.uptodate.com/home/uptodateresource-limited-settings). In addition, various discounts are given to countries in acute need (such as, following a natural disaster) [7]. Furthermore, subscription options may be different between different countries, so it is worth checking the coun-try-specific pricing for subscription (https://www.…”