Our partner UpToDate is featured in the current issue of the Global Public Health journal. The article, “Health care workers in Africa access a broad range of topics using evidence-based online medical information,” was co-authored by Dr. Margaret L. McNairy, Dr. Alysse G Wurcel, Dr. Franklin Huang and Dr. Johanna P. Daily, and investigates the relationship between access to evidence-based, online clinical resources and improvements in patient care in resource-limited settings (RLS). Clinicians in RLS can now access UpToDate, a leading evidence-based and peer-reviewed clinical information resource, by applying to the international grant subscription program on Global Health Delivery Online.

“This study shows that providers in RLS need more than just ‘turning on’ UpToDate. GHDonline is the connective tissue—a forum for our colleagues in over 150 countries to share their expertise and access crucial resources to improve clinical service,” notes Rebecca Weintraub, MD, co-founder of GHDonline and Associate Physician in the Division of Global Health Equity at Brigham and Women’s Hospital. “On the wards of Brigham, I read UpToDate 50 times a day. My mission was to provide this for our colleagues in Malawi and Mongolia,” she adds.

A total of 102 healthcare workers (HCW) were trained to use UpToDate across four hospitals in Africa. Of the 102, 64 completed a survey at the end of the program. The majority of users were doctors (63%), nurses (25%) or medical officers and/or students (12%). Ninety-six percent of users felt “very comfortable” with English. The data suggests that the provision of evidence-based medical information resources via the Internet is feasible in RLS, is used for a broad variety of topics, and could improve providers’ knowledge, clinical practice and potentially patient outcomes. The methodology also demonstrates that initial and regular training and support is needed for these resources to be fully used in RLS.

Highlights

• One hundred percent of respondents reported the tool “somewhat” or “very much” improved their clinical knowledge
• Ninety-six percent of surveyed users felt UpToDate was “much faster” or “faster” in finding information than the best available alternative
• Sixty percent responded that UpToDate led to improved quality of patient care

Study Methodology

Four hospitals were chosen for this study based on their affiliation with the authors’ sponsoring institutions: two medical centers in Rwanda, one hospital in Malawi, and one hospital in South Africa. UpToDate provided unlimited, 24 hour free access to its knowledge system via the Internet and all hospitals had satellite or cable Internet access that was free for the clinical staff. The study began in January of 2009 and lasted 6 months.

Commitment to Improving Care in RLS

In November 2009, UpToDate committed to supporting clinicians in RLS by partnering with Global Health Delivery Online (GHDonline.org) to launch an international grant subscription program. To date, more than 120 organizations access UpToDate through the program, benefitting millions of patients each year.

The Global Health Delivery Project at Harvard built GHDonline.org in 2008 to streamline the translation and dissemination of evidence-based health information into practice. It is supported in part by the Division of Global Health Equity at Brigham and Women’s Hospital and the Department of Global Health and Social Medicine at Harvard Medical School.

Johanna Daily, MD, study co-author, moderator of the GHDOnline community for grant recipients, and associate professor at Albert Einstein College of Medicine of Yeshiva University, insists that “clinicians in resource-limited settings critically need access to broad medical knowledge databases; often one health worker has to act as the internist, OB-GYN, pediatrician, surgeon and a specialist of every type. Some clinics may have single topic practice guidelines for HIV, TB or malaria, however the patient health issues are much more diverse. The fact that in Rwanda, participants researched drug information and pediatrics more often than infectious diseases is testament to this fact.”

Denise Basow, President, UpToDate, and MD, says, “UpToDate has been supporting the care of patients in resource limited settings for many years, both through our donations program and through the development of content specific to these areas. While we were confident that we were making an impact, it is nice to verify it through studies like this one. UpToDate is committed to helping clinicians around the world make evidence-based decisions when caring for patients, as we know this leads to better health outcomes.”