Term of Award

Summer 2024

Degree Name

Doctor of Public Health (Dr.P.H.)

Document Type and Release Option

Dissertation (restricted to Georgia Southern)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

Department

Department of Health Policy and Management (COPH)

Committee Chair

Gulzar Shah

Committee Member 1

Linda Kimsey

Committee Member 2

Samuel Opoku

Abstract

Evidence-based, digital clinical decision support (CDS) tools bring the most recent scientific evidence and medical discoveries to clinicians at the point of care. They have been shown to improve diagnostic accuracy and promote quality and efficient care. Digital CDS tools are regularly used and integrated into practice in many parts of the world. However, adoption has been inconsistent. Barriers to use include cost, lack of awareness, limited understanding of utility, and lack of training on the tools.

After exposing students to such tools during their clinical training years, they tend to use them in clinical practice. In 2019, the Better Evidence for Training program began facilitating access to one CDS tool, UpToDate, in African medical schools. The program has grown to support access and uptake in 59 schools, though impact across the 59 schools has been inconsistent, without a clear explanation as to why.

This retrospective, non-experimental observational cohort study aimed to assess what drove the use and registration of UpToDate among trainees and faculty at African medical schools participating in the Better Evidence for Training program. It relied on a linear random intercept model to measure and compare the monthly usage and registration rates across the schools longitudinally. Independent variables included prior awareness of the tool, Internet connectivity, data costs, number and engagement of local Champions, urbanicity, composition of users, and student-to-faculty ratio.

Prior awareness of the tool, the number of faculty at the medical school, and the number of residents at the medical school were found to be statistically significant predictors of usage rates. There were no factors significantly associated with UpToDate registration rates.

Findings suggest that pre-marketing may be important for encouraging the use of the tool after access is enabled. Bigger schools that have more faculty and residents or post-graduate students may also see greater usage rates.

OCLC Number

1446520001

Research Data and Supplementary Material

No

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