Utilization, impact and barriers to use the Cochrane Database of Systematic Reviews: survey on Chilean post graduate medical students

Tags: Poster
Capurro D, Rivera S, Larrondo F

Background: The Cochrane Database of Systematic Reviews (CDSR) contains high quality information that should impact clinical decisions regarding therapy. However it is not always incorporated to this process.


1. To determine the frequency of utilization, self perception of impact on clinical decisions regarding therapy.

2. Detect barriers to all of the above perceived by Postgraduate Medical Students at the Pontificia Universidad Catolica de Chile.

Methods: A validated e-mail based survey was distributed to Postgraduate Medical Students at the Pontificia Universidad Catalica de Chile enrolled in Internal Medicine, Surgery, Obstetrics/Gynecology, Pediatrics and Family Medicine. They answered questions concerning baseline characteristics, exposure to Evidence Based Medicine education, utilization of the CDSR, self-perception of impact of the information contained in the database and barriers for a more extended utilization. The differences in the proportions were analyzed using a two tailed Chi-squared test or a t-student test, a p<0.05 was considered significant.

Results: 96 surveys were distributed, 71 were answered (74%). Of the answered questionnaires 14 (19.72%) were from Internal Medicine, 9 (12.68%) from Surgery, 10 (14.08%) from Pediatrics, 11 (15.49%) from Obstetrics/Gynecology and 27 from Family Medicine Residents (38.03%). The average time from medical school graduation was 3.8 years and 65.71% had taken a formal course in Evidence Based Medicine. 100% had heard about the CDSR and 95.77% felt the systematic reviews it contains have excellent or very good quality information. 52.31% had searched frequently or several times in the CDSR with a significant difference between those who had taken or not formal EBM courses. Among those who had searched for information in the CDSR, 38.03% had used frequently or several times the information to take decisions concerning individual patients and 52.319% felt the information had always or almost always helped them take those decisions. The answers to the question about barriers to use the CDSR were: 'access is paid' (40%), 'information not readily accessible at the point of care' (36.92%), 'I don't know how to search in the CDSR' (20%), 'I prefer searching in other databases' (20%), 'information too lengthy' (9.23%), 'information is in English' (7.69%), 'I have no interest in the information at the CDSR' (4.62%), 'There is no/too few information on my specialty' (4.62%), 'the information is in a very technical language' (1.54%). 76.06% answered that their level of utilization of the CDSR would increase if they had immediate access through a personal digital assistant (PDA).

Conclusions: The data show a very high perception of the quality of the CDSR. Despite this, utilization drops almost by half. The second most frequent self-perceived barrier to use the CDSR is that the database is not readily accessible at the point of care. This information, together with the fact that more than 75% of participants believe that their grade of utilization will increase if they had immediate access at the point of patient care, reveal the need for a portable access to the CDSR.