Where do developing World clinicians obtain evidence for practice: a case study on pneumonia

Area of Science:

• Global Health
• Clinical Practice
• Medical Education

Background:

• Limited data exist on evidence-based medicine (EBM) practices in developing countries.
• Understanding clinicians' evidence sources is crucial for improving healthcare quality.
• Variation in managing hospital-acquired pneumonia (HAP) may stem from differing information access.

Purpose of the Study:

• To assess variations in HAP management among developing countries.
• To determine if evidence source influences HAP treatment decisions.
• To identify factors affecting EBM implementation in resource-limited settings.

Main Methods:

• A hypothetical case of HAP in a 60-year-old female patient was presented.
• Questionnaires collected data on diagnostic investigations, treatment choices, and information sources used by clinicians.
• Participants were doctors from primary and secondary hospitals across six International Clinical Epidemiology Network (INCLEN) centers in Asia and Africa.

Main Results:

• Chest X-ray and sputum cultures were common investigations, but treatment choices (penicillin, cephalosporin, aminoglycoside) varied significantly.
• Textbooks were the most frequent information source; access to libraries, textbooks, and journals correlated with appropriate investigation choices.
• Access to local antibiotic sensitivity data was linked to appropriate initial treatment decisions.

Conclusions:

• Significant variation exists in HAP management within and between developing countries.
• Improved access to medical literature and local antibiotic sensitivity data can enhance EBM practice.
• Interventions should focus on enhancing information accessibility to bridge the EBM gap in developing regions.