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Potential barriers to UpToDate use in resource-limited settings are surmountable

Valtis YK, Rosenberg J, Bhandari S, et al. 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. BMJ Glob Health 2016; 1(1):e000041. (PMID 28588926)

An analysis of UpToDate usage logs among recipients of donated subscriptions in resource-limited settings between 2013 and 2014 (including 45 institutional subscriptions and 405 individual users). Approximately 150,000 unique sessions were logged, and regular (at least weekly) usage was observed among 61 percent of recipients. Users in Africa represented 54 percent of the total usage but comprised 41 percent of the donation recipient pool. Search patterns reflected local epidemiology; the top search in Africa was “Clinical manifestations of malaria,” while the top search in Asia was “Management of hepatitis B.”

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Rosenberg J, Miller K, Pickard O, et al. Barriers and facilitators to use of a digital clinical decision support tool: a cohort study combining clickstream and survey data. BMJ Open 2022; 12(11):e064952. (PMID 36410838)

A cohort study provided UpToDate subscriptions to more than 1600 clinicians in sub-Saharan Africa and Southeast Asia and assessed barriers and facilitators to use of digital clinical decision support tools. The most significant barrier was fitting the tool into the workflow; facilitators included utility and a supportive professional context. The study concluded that complementary services to implementation of tools such as UpToDate should include a supportive professional context, helping clinicians to understand the utility of the tools, and working with health systems to better integrate digital clinical decision support tools into workflows.

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UpToDate has an important role for medical education in resource-limited settings

Valtis YK, Rosenberg JD, Wachter K, et al. Better evidence: Prospective cohort study assessing the utility of an evidence-based clinical resource at the University of Rwanda. BMJ Open 2019; 9(8): e026947. (PMID 31399450)

An observational study evaluating the impact of UpToDate on medical education among 547 trainees at the University of Rwanda. Senior students viewed 1.24 topics per day (on average) and continued to use UpToDate frequently after medical school graduation. In addition, graduating class exam performance was better after introduction of UpToDate than in previous years. At baseline, 92 percent of students reported ownership of an internet-capable device, and the majority indicated frequent use of free online resources for medical education.

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UpToDate improves clinical knowledge among healthcare workers in Africa

McNairy ML, Wurcel AG, Huang F, et al. Health care workers in Africa access a broad range of topics using evidence-based online medical information. Glob Public Health 2012; 7(8):823. (PMID 22621407)

A descriptive study of UpToDate use at four hospitals in Africa – two in Rwanda (Rwinkwavu District Hospital and Kirehe Hospital), one in Malawi (Neno District Hospital), and one in South Africa (McCord Hospital). More than 100 health care workers (HCWs) received training in UpToDate use and were surveyed over a six-month study period. A broad variety of medical topics were searched. About 78 percent of HCWs reported daily or weekly UpToDate use, and 70 percent felt the tool was very useful for teaching. All users reported that the tool increased their clinical knowledge.

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Ugandan partnership shows UpToDate uptake influenced by institutional support

Kinengyere AA, Rosenberg J, Pickard O, et al. Utilization and uptake of the UpToDate clinical decision support tool at the Makerere University College of Health Sciences (MakCHS), Uganda. African Health Sciences 2021; 21(2): 904.

UpToDate access was granted to Makerere University College of Health Sciences (MakCHS), Uganda in partnership with Better Evidence at Ariadne Labs; access occurred mainly through the mobile phone app. Meaningful usage was observed, with 43,043 log ins and 15,591 registrations between August 2019 and August 2020, and a broad range of topics was viewed. However, uptake was inconsistent; librarians can draw upon these results to encourage institutions to support uptake of point-of-care tools in clinical practice.

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UpToDate may be utilized in a variety of ways in resource-limited settings

Miller K, Rosenberg J, Pickard O, et al. Segmenting Clinicians’ Usage Patterns of a Digital Health Tool in Resource-Limited Settings: Clickstream Data Analysis and Survey Study. JMIR Form Res 2022; 6(5):e30320. (PMID 35532985)

The investigators defined clinician segments based on their UpToDate usage patterns (short-term, light users; short-term, heavy users; long-term, heavy users; long-term, light users; and never-users) to further elucidate drivers of digital health tool use.

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