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.”
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.