Better Evidence

With 60,000 ways the body can break down and 2.5 million new research articles published annually, clinicians must be ready with diagnoses, treatments, or even just advice for a potentially enormous number of problems with every patient they care for. For clinicians in resource-limited settings–who are frequently geographically and professionally isolated, lack access to digital and in-person medical-education resources, and treat some of the largest, sickest patient populations in the world–the challenge is even greater. The Better Evidence Project seeks to enhance access and uptake of the latest clinical evidence among current and future health care providers serving vulnerable populations.

Evidence-Based Care for All

Many clinicians use evidence-based clinical resources, including UpToDate (a clinical support resource that synthesizes the latest evidence) to improve care, but these resources come at a cost. In countries that spend less than $150 per person per year on healthcare, that cost can be an insurmountable obstacle. Since 2009, the Better Evidence team has facilitated free UpToDate subscriptions for over twenty thousand qualified health professionals in more than one hundred twenty countries, approximately half of whom had no prior access to online resources.  

And clinicians use it: more than 60% of subscribers access UpToDate at least weekly to read about everything from infectious diseases to pulmonary medicine. According to one clinician in Mexico, “almost every day, I adjust a diagnosis, dose, or follow up of a patient based on what UTD offers me. Almost every day, I’m a better doctor for one of my patients, because I had access to UTD resources.”

Promoting Use of the Latest Evidence Among Providers 

Within our decade of work from 2009-2019, the Better Evidence for Providers program has facilitated free UpToDate subscriptions to over 20,000 providers in 145 countries. In 2016, we began to study how and why clinicians use UpToDate in resource-limited settings.  We will use what we learn to put UpToDate in as many clinical hands as possible and promote the use of evidence at the frontlines of care. As more clinicians use UpToDate, we are also beginning to understand how we can use the data generated by provider searches, for example, to detect emerging diseases such as ebola.

Promoting Use of the Latest Evidence Among Medical Students

Medical school is a critical time to habituate students to consult the evidence as they develop clinical skills. The majority of medical schools in the US provide access to EBCRs. However, in low- and middle-income countries (LMICs), access to EBCRs is limited. The cost of subscriptions is a significant barrier. 

Building on a pilot study that showed the utility of providing a free EBCR to students and faculty in Rwanda, we launched Better Evidence for Training in 2019 in sub-Saharan African medical schools and their affiliated training facilities. The Better Evidence for Training Program provides institutional access to UpToDate for five years and new schools will be added annually. Nine sub-Saharan medical schools opted to participate and 650 students and faculty were trained in 2019.


Research

Better evidence: prospective cohort study assessing the utility of an evidence-based clinical resource at the University of Rwanda (2019)

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 (2016)

An Online Medical Database Is Reducing Diagnostic Errors(2015)