Discussion on UpToDate

Answering Clinical Questions Improves Patient Safety and Saves Money

Speed of updating online evidence based point of care summaries: prospective cohort analysis

Type of Evidence Behind Point-of-Care Clinical Information Products: A Bibliometric Analysis

Giustini Wang Read UpToDate 2011

To Compare PubMed Clinical Queries and UpToDate in Teaching Information Mastery to Clinical Residents: A Crossover Randomized Controlled Trial

An opinion:

As librarians do we provide the “best evidence” or do we provide a summary of recent evidence? I would like to think the former, but I feel it is closer to the latter unless we are sending along summaries from a point-of-care resource. If we are doing the latter, we do save the clinician some time, but they still have to read the articles and decide if they are valid and then decide if they are important enough to change their practice. Point-of-care resources are supposed to make that simpler and its why I think clinicians take the recommendations from DynaMed and UTD at face-value.


So the issue with UTD then is that if a clinician takes it at face value and the evidence isn’t current is the recommendation valid, are changes to practice warranted and are the potential changes what a clinician should do in order to best serve his/her patient.

The question of translating new research into practice is interesting as well. One would think, and I have no idea if anyone has looked at this yet, that having a new, practice changing, recommendation appear on average in a product 2 months after publication is better than 12+ months. But even the BMJ article doesn’t really get at the heart of practice changing vs current so it’s hard to say.

I also think we are discounting the role marketing plays in users’ perceptions of the quality of the product. Like pharmaceutical companies UTD can provide us with shiny reprints showing how great they are when, as Patrick pointed out this morning, compared to nothing. Even some of the studies that have come up today compare UTD to citation databases and not to other point-of-care resources.


I don’t think that’s a fair comparison and I think there are a lot of questions that somehow need to be addressed in this type of research to truly determine what products provide the best, most current evidence in the most timely manner instead of what users “prefer” because it’s what is familiar or what they see ads for.

What I think the BMJ article is getting closer to is an actual comparison of different products in a meaningful way. One of the most important parts of all the research we see is that it is objective, and not based on “knee jerk” responses from clients who want the system to stay the same. I know I can go out and survey my clients to get a feeling for what they think would be best, but those surveys don’t really get at the heart of what I want to know when spending thousands of dollars on a resource which is will this product improve patient care?

Another opinion:

UTD is preferred by physicians (at least according to studies by
UTD, DynaMed has self-funded studies which say the same thing). But is
"preference" more important to the care of patients than correct and
current information?

The BMJ article (which I give kudos to BMJ for publishing since their
own product, Clinical Evidence ranked the lowest), looked at systematic
reviews published between 2009 and 2010 so it's pretty current.

Here's one of the big findings:

Dynamed has a median citation rate of around two months, EBM Guidelines
is around 10 months but quite close to the limit of our follow-up. The
citation rate of the other three point of care summaries (UpToDate,
eMedicine, Clinical Evidence) were so slow that they exceeded the
follow-up period and we could not compute the median.

So basically you can expect current evidence to appear in DynaMed at 2
months and it might not even appear in UTD at 1 year. I believe this is
because the process of including information in DynaMed is much
different than UTD.

In addition, while these resources are designed to be Point-of-Care I am
unsure how much further clinicians go when searching either DynaMed or
UTD (i.e. Do they really go to PubMed and then critically appraise what
they find? Do they even find the most current and clinically relevant
information if they do search there?).

If a clinician doesn't go beyond UTD and the information they find there
isn't current I don't think it matters how many searches/dollar are run
or how "useful" they preceive it to be.

I'd be interesting in the citation for the study you mention though. I
just pulled one that concludes UTD is quicker at finding answers than
Essential Evidence, First Consult and ACP PIER, but I can't see the
methods to see if they evaluated the "correctness" of the answers found.

A comparison of answer retrieval through four evidence-based textbooks
(ACP PIER, Essential Evidence Plus, First Consult, and UpToDate): A
randomized controlled trial.