To uptodate or not to uptodate – are you UpToDate dependent?

In der US-amerikanischen Mailingliste medlib-l wird mal wieder über UpToDate diskutiert, hier und hier. Linda Spadaccini, Waterbury Hospital, stellte dort am Montag die Frage, ob Due to the uncertainty of pricing every year, I am wondering if any library who bought UpToDate quit buying it and requested their physicians or medical staff office pay for it instead.

Die Antworten möchte ich Ihnen nicht vorenthalten (siehe unten), aber vorab der hochinteressante Hinweis von Halyna Liszczynskyj, St. Elizabeth Medical Center, Utica, was Ärzte von UpToDate halten: Here are the links to the blog entries for UpToDate dependency commentaries from physicians:

Dr. RW: Are you UpTodate dependent?:

Now I’m not here to criticize UpToDate. I love UpToDate and have my own personal subscription. It is a wonderful resource and, other than perhaps the cost, I find no fault with it. The problem is UpToDate dependence, which is symbolic of the larger problem of over reliance on “look up” resources. Although look up resources are essential to the practice of evidence based medicine, over reliance becomes a problem when their use supplants knowledge of basic science, acquisition of medical knowledge, background reading and clinical judgment. These essential skills and attributes help safeguard against an overly formulaic approach to patient care and result in fewer mistakes when patients do not follow the usual scripts.

(So auch Ves Dimov, Clinical Cases)

Maria at Intueri:

… only 10% of UpToDate is evidence-based. […] UpToDate could theoretically brainwash us all with heretical information that would absolutely impact patient care. […] A disadvantage of Dynamed is that one must already know something about the topic to make sense of the information. UpToDate is a textbook; thus, you can read general background information about progressive multifocal leukoencephalopathy (PML) before learning about appropriate management and treatment of this condition. On Dynamed, you better know what PML is or otherwise, the information doesn’t really make much sense.

Und hier die Antworten der Medizinbibliothekare:

James R.Bulger, Library Services, Minneapolis:

Two or three years ago we made the decision to have physicians buy UTD on their own, rather than purchase an institutional subscription. Our rationale was this: if UTD is a point-of-care resource, as it claims to be, then it needs to be available not only via IP recognition on our hospital(s) network, but also via handheld devices and via remote access (i.e., physician offices). The cost to provide this level of access, as you all know, is astronomical. As a bit of a compromise, we offered to handle the subscription purchases and renewals. Interestinly, in spite of the earlier hue and cry to get an institutional account, we weren’t overwhelmed by requests when it came to laying your own money down.

Wir bezahlen UpToDate nur noch zu 80%, 20% wird von acht klinischen Abteilungen übernommen (das war für mich die Nagelprobe, ob überhaupt echtes Interesse besteht).

Lori Graham, Jameson Health System Library:

I have to say from what I am reading on the listserv that I am one of the fortunate few whose hospital chose DynaMed over UpToDate. We tell the doctors that if they want UTD they can get it on their own but are still welcome to use DynaMed. They are even welcome to get double the CME’s if they choose. DynaMed has CME, PDA access, and remote access included in the institution price. Speaking of price, for our institution, we are paying $6,000 less than UTD. DynaMed is also used by our nursing staff and community education department for the patient friendly links to authoritative websites if EbscoHealth does not have one on that topic. Sure, DynaMed is differently searched but everything is evidence based.

Patti Reynolds, Sarasota Memorial Hospital, berichtet von einer Erfahrung der besonderen Art:

Last week two representatives came down from UpToDate to install a „fix“ on our network which would prevent remote access through the citrix server to the UpToDate link on our library web page. When I became aware that this would also mean that we would have to take the link for UpToDate off our library web page, the decision was made for me. I will not pay for this service. They suggested that we install it as an icon on every desk top in the hospital, which was not accepted by our IS department. We are the 4th hospital in which they have installed this „fix“.

David Rothman bespricht UpTodate ebenfalls. Sein Feed, um uptodate über UpToDate zu bleiben, funktioniert leider nicht, darum benutzen Sie lieber den hier.