Do you study or practice medicine in a resource-limited setting?
Select the appropriate program link for your location:
Responding to urgent need
Total providers reached by 2022 donations, mapped.
In partnership with Better Evidence, Wolters Kluwer continues to provide free UpToDate access and/or distribute UpToDate content to individuals and institutions in resource-limited settings or in regions with urgent need following natural disasters, infectious disease outbreaks, and humanitarian emergencies.
We continue to develop and update clinical content to address relevant issues for resource-limited settings. This content is available in our global health collection.
Throughout the pandemic, UpToDate has offered open access to clinical content and guidance for Covid-19 clinical topics. View the topic list here.
We support research conducted by Better Evidence at Ariadne Labs to better understand the impact that an evidence-based clinical resource can have on front-line care.
Additional studies are underway to evaluate the impact of UpToDate on medical education in Africa and on clinical care delivered worldwide.
Research supports use of UpToDate in resource-limited settings
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.
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.
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.
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.
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.
Featured UpToDate donation recipients
Tom Chew, MD – Iraq
Donation recipient since: July 2010
Affiliated site: Scientific Technology & Language Institute (Iraq)
Team comprised of: Two American physicians working with two local physicians and administrative staff
Patients include: Refugees in northern Iraq
Number of patients cared for per year: 12,000
Most common conditions managed: Post-traumatic stress disorder, depression, diabetes mellitus, hypertension
My wife and I have a lifelong calling to serve the poor and needy. The medical needs among the refugees in northern Iraq are so significant that the government is heavily dependent on outside groups for assistance.
The ability to access UpToDate very easily at any point of care significantly improves implementation of evidence-based guidelines…I have changed my diagnostic criteria and treatment plans countless times based on UpToDate.
Julio Paz, MD – Bolivia
Donations recipient since: November 2012
Affiliated site: Hospital Arco Iris (La Paz, Bolivia)
Team comprised of: 13 physicians, heads of departments, and internists
Patients include: Primarily vulnerable groups (such as children who work and live on the street, elderly citizens, pregnant women, young children under the age of 5), and individuals without health insurance who rely on government coverage
Number of patients care for per year: 6,000+ inpatients/year; 100,000+ outpatient consultations/year; nearly 50,000 free consultations held through four mobile clinics (aimed to reach most at-risk patients)
Most common conditions managed: Diabetes mellitus, cholecystitis, appendicitis, head trauma, pulmonary disease, urinary tract infections, and obstetrical problems
Our hospital provides medical attention primarily to vulnerable groups…we have 120 beds and provide services in intensive care, adult primary care, newborn care, radiology, and endoscopic procedures. We have radiology residency program, and we receive residents from other cities who take shifts in orthopedics, anesthesiology, and obstetrics/gynecology.
The biggest change we have seen is the ease of access to subjects that are being constantly updated and for which we receive guidance for diagnosis and treatment. A big advantage is that, besides being reviewed by an expert panel, they are very current, which makes them reliable.
Brenda Mastin, FNP – Togo
Donation recipient since: October 2014
Affiliated sites: Association of Baptists for World Evangelism (ABWE) International
Karolyn Kempton Memorial Christian Hospital (Togo)
Friend Indeed Association (HIV/AIDS ministry providing education, compassion, and support)
Team comprised of: 5 mid-level providers, 2 physicians, and 30+ in HIV/AIDS ministry
Patients include: Local residents with acute and chronic conditions
Number of patients treated per year: 15,000+
Most common conditions managed: Parasitic infections, typhoid and paratyphoid fever, amebiasis, malaria, diabetes mellitus, hypertension, and back pain
Using UpToDate has radically changed the way I practice in that I have at my fingertips literally all the tools I need to give sound, relevant, current medical care wherever I am.
There are so many stories where access to UpToDate completely changed the course of what I (or my colleagues were going to do) after we read up on it. An example: a patient presented suddenly with fever, shortness of breath, decreased oxygen saturation, and mental change after having been at the hospital for a tibia/fibula fracture and dislocated right hip. None of us knew that there is a fat embolism syndrome and that it could present with fever. We adjusted our thinking and gave correct care, because of our trusty resource, UpToDate.
Robert Chapman, MD, PhD – United States
Donations recipient since: June 2017
Affiliated site: Lakeland Volunteers in Medicine (Lakeland, Florida; US)
Team comprised of: Approximately 30 primary care physicians, subspecialists, nurse practitioners, physical therapists, chiropractors, and a dentist (most are volunteers), plus almost 250 additional volunteers who serve as receptionists, pharmacists, nurses, schedulers, medical records clerks, and administrative personnel
Patients include: Local residents with no medical insurance and income below twice the poverty level
Number of patients cared for per year: 1300+
Most conditions managed: Chronic diseases such as hypertension, diabetes, depression, and chronic lung disease
Lakeland Volunteers in Medicine (LVIM) was founded based on the Volunteers in Medicine model begun by Dr. Jack McConnell, a retired pediatrician who began the first Volunteers in Medicine in Hilton Head, South Carolina. LVIM is housed in a former elementary school which was refurbished as a medical clinic. As a non-profit charity, it is funded solely through grants and donations.
UpToDate has served as a wonderful resource for us at LVIM. Many of our volunteer physicians are retired from their active practices and use UpToDate to keep up with the many changes occurring in medicine, and to ensure that high quality of care is maintained.