Improvements in patient safety culture: a national Taiwanese survey, 2009-16.

OBJECTIVE: To assess national trends in patient safety culture in Taiwan. DESIGN: A safety attitudes questionnaire (SAQ) was distributed to 144 hospitals from 2009 to 2016 (n = 392 341). SETTING: Taiwan's medical centers, regional hospitals and community hospitals. PARTICIPANTS: Hospital staff in Taiwan. INTERVENTIONS: None. MAIN OUTCOME MEASURES: 5-point Likert scale to assess changes in patient safety culture dimensions (teamwork, safety climate, job satisfaction, stress recognition, management and working conditions) converted to positive response rate (percentage of respondents who answered slightly agree or strongly agree on Likert scale). RESULTS: Dimensions for patient safety culture significantly increased in Taiwan over a period of 8 years, with an all-composite improvement in positive response rate of 4.6% (P < 0.001). Regional hospitals and community hospitals registered an all-composite improvement of 6.7 and 7.0%, respectively, while medical centers improved by 4.0%. Improvements for regional and community hospitals primarily occurred in teamwork (regional hospitals, 10.4% [95% confidence interval [CI], 10.2-10.6]; community hospitals, 8.5% [95% CI, 8.0-9.0]) and safety climate (regional hospitals, 11.1% [95% [CI], 10.9-11.4]; community hospitals, 11.3% [95% CI, 10.7-11.8]) (P < 0.001, all differences). Compared with nurses (5.1%) and pharmaceutical staff (10.6%), physicians improved the least (2.0%). Improvements for nurses and pharmacists were driven by increases in perceptions of teamwork (nurses, 9.8% [95% CI, 9.7-10.0]; pharmaceutical staff, 14.2% [95% CI, 13.4-14.9]) and safety climate (nurses, 9.0% [95% CI, 8.8-9.1]; pharmaceutical staff, 16.4% [95% CI, 15.7-17.2]) (P < 0.001, all differences). At study end, medical centers (55.1%) had greater all-composite measurements of safety culture than regional hospitals (52.4%) and community hospitals (52.2%) while physicians (63.7%) maintained greater measurements of safety culture than nurses (52.1%) and pharmaceutical staff (56.6%). CONCLUSION: These results suggest patient safety culture improved in Taiwan from 2009 to 2016.

Vocational rehabilitation for enhancing return-to-work in workers with traumatic upper limb injuries.

BACKGROUND: Traumatic upper limb injury is a leading cause of work-related disability. After return-to-work (RTW), many survivors of injuries are able to regain a quality of life (QoL) comparable with the normal population. Since RTW plays an important role in economic productivity and regaining health-related QoL, enhancing RTW in workers with traumatic limb injuries is the primary goal of rehabilitation. Vocational rehabilitation has been commonly employed in the field of occupational safety and health to increase the number of injured people returning to the labour market, prevent illness, increase well-being, and reduce disability. OBJECTIVES: To assess the effects of vocational rehabilitation programmes for enhancing RTW in workers with traumatic upper limb injuries. SEARCH METHODS: This is an update of a Cochrane review previously published in 2013. We updated our searches of the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 9), MEDLINE (to 30 August 2017), EMBASE (to 3 September 2017), CINAHL (to 6 September 2017), and PsycINFO (to 6 September 2017), and we handsearched the references lists of relevant review articles. SELECTION CRITERIA: We aimed to include all randomised controlled trials (RCTs) comparing vocational rehabilitation with an alternative (control) intervention such as standard rehabilitation, a limited form of the vocational rehabilitation intervention (such as advice on RTW, referral information, or liaison with employer), or waiting-list controls. DATA COLLECTION AND ANALYSIS: Two authors independently inspected abstracts, and we obtained full papers when necessary. When the two authors disagreed about the inclusion of a study, we resolved disagreements by discussion. A third author arbitrated when necessary. MAIN RESULTS: Our updated search identified 466 citations. Based on assessments of their titles and abstracts, we decided to evaluate the full texts of five records; however, none met our inclusion criteria. AUTHORS' CONCLUSIONS: There is currently no high-quality evidence to support or refute the efficacy of vocational rehabilitation for enhancing RTW in workers with traumatic upper limb injuries. Since injured people in occupational settings frequently receive vocational rehabilitation with the aim of decreasing work disability, enhancing RTW, increasing productivity, and containing the welfare cost, further high-quality RCTs assessing the efficacy of vocational rehabilitation for workers with traumatic upper limb injury are needed to fill this gap in knowledge.

Implementation of evidence-based practice in relation to a clinical nursing ladder system: a national survey in Taiwan.

BACKGROUND: Although evidence-based practice (EBP) has been widely investigated, few studies have investigated its correlation with a clinical nursing ladder system. The current national study evaluates whether EBP implementation has been incorporated into the clinical ladder system. METHODS: A cross-sectional questionnaire survey was conducted nationwide of registered nurses among regional hospitals of Taiwan in January to April 2011. Subjects were categorized into beginning nurses (N1 and N2) and advanced nurses (N3 and N4) by the clinical ladder system. Multivariate logistic regression model was used to adjust for possible confounding demographic factors. RESULTS: Valid postal questionnaires were collected from 4,206 nurses, including 2,028 N1, 1,595 N2, 412 N3, and 171 N4 nurses. Advanced nurses were more aware of EBP than beginning nurses (p < 0.001; 90.7% vs. 78.0%). In addition, advanced nurses were more likely to hold positive beliefs about and attitudes toward EBP (p < 0.001) and possessed more sufficient knowledge of and skills in EBP (p < 0.001). Furthermore, they more often implemented EBP principles (p < 0.001) and accessed online evidence-based retrieval databases (p < 0.001). The most common motivation for using online databases was self-learning for advanced nurses and positional promotion for beginning nurses. Multivariate logistic regression analyses showed advanced nurses were more aware of EBP, had higher knowledge and skills of EBP, and more often implemented EBP than beginning nurses. LINKING EVIDENCE TO ACTION: The awareness of, beliefs in, attitudes toward, knowledge of, skills in, and behaviors of EBP among advanced nurses were better than those among beginning nurses. The data indicate that a clinical ladder system can serve as a useful means to enhance EBP implementation.

Phototherapy for treating pressure ulcers.

BACKGROUND: A pressure ulcer is defined as "an area of localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear". The use of phototherapy - that is, light (or laser) used as an adjuvant, non-surgical intervention, with the aim of having a therapeutic effect on healing - has increased recently. OBJECTIVES: To determine the effects of phototherapy on the healing of pressure ulcers. SEARCH METHODS: In January 2014, we searched the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid EMBASE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); and EBSCO CINAHL. We did not restrict the search by language or publication date. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing the effects of phototherapy (in addition to standard treatment) with sham phototherapy (in addition to standard treatment), another type of phototherapy (in addition to standard treatment) or standard or conventional treatment alone. DATA COLLECTION AND ANALYSIS: Two review authors assessed studies for relevance and design according to the selection criteria, extracted data and evaluated study quality. The authors made attempts to obtain missing data by contacting study authors. Disagreement was resolved by consensus and discussion with a third review author. MAIN RESULTS: We identified seven RCTs involving 403 participants. All the trials were at unclear risk of bias. Trials compared the use of phototherapy with standard care only (six trials) or sham phototherapy (one trial). Only one of the trials included a third arm in which another type of phototherapy was applied. Overall, there was insufficient evidence to determine the relative effects of phototherapy for healing pressure ulcers. Time to complete healing was reported in three studies. Two studies showed the ultraviolet (UV) treated group had a shorter mean time to complete healing than the control group (mean difference -2.13 weeks (95% CI -3.53 to -0.72, P value 0.003)). One study reported that the laser group had a longer mean time to complete healing than the control group (mean difference 5.77 weeks; 95% CI -0.25 to 11.79). However, this result should be interpreted with caution, as these were small studies and the findings may have been due to chance. Three studies reported proportions of ulcers healed with a variety of results. One study reported a different outcome measure, and the other two studies had different treatment durations. These variations did not allow us to pool the studies and draw any conclusions as to whether phototherapy is effective or not. Adverse effects were reported in only two studies that compared phototherapy with control; the risk ratio for adverse events was imprecise. One study reported risk ratio (RR) 0.72 (95%CI 0.18 to 2.80). However, another study reported RR 0.89 (95% CI: 0.71 to 1.12) based on the number of events in each group, rather than the number of people with events. Among five studies reporting the rate of change in ulcer area, three studies found no statistically significant difference between the two groups. Pooling was not undertaken because of differences in outcome measures reported. The results were based on data from trials with unclear risk of bias for which generation of the randomisation sequence, concealment allocation and blinding of outcome assessors were unclear. No studies reported on quality of life, length of hospital stay, pain or cost. AUTHORS' CONCLUSIONS: We are very uncertain as to the effects of phototherapy in treating pressure ulcers. The quality of evidence is very low due to the unclear risk of bias and small number of trials available for analysis. The possibility of benefit or harm of this treatment cannot be ruled out. Further research is recommended.

Profile of evidence-based practice among respiratory therapists in Taiwan.

BACKGROUND: Evidence-based practice (EBP) has been proposed as a core competence to improve healthcare quality. The profile of EBP among respiratory therapists (RTs) has not been explored. We investigated how RTs in Taiwan perceive the implementation of EBP. METHODS: We surveyed RTs in Taiwan's regional hospitals during a 4-month period in 2011. RESULTS: A majority of RTs were aware of EBP (88.0%). Although most RTs held a favorable impression of EBP, their knowledge of and skill in EBP implementation were deficient. Only half of the RTs had implemented EBP. Insufficient convenient kits (59.1%), deficient designated personnel (50.0%), and lack of time (45.5%) were major barriers to implementing EBP. RTs rated MEDLINE as the most commonly used evidence-based retrieval database, followed by UpToDate, the Cochrane Library, MD Consult, ProQuest, CINAHL, DynaMed, and Micromedex. Multivariate regression analyses demonstrated sufficient skill in EBP and use of online databases as favorable factors for implementing EBP. In contrast, barriers of time constraint and insufficient knowledge were unfavorable factors for the implementation of EBP. CONCLUSIONS: EBP is not widespread among RTs in Taiwan. We have identified important factors in the implementation of EBP. The data provide valuable evidence for plotting strategies for disseminating EBP implementation.

Vocational rehabilitation for enhancing return-to-work in workers with traumatic upper limb injuries.

BACKGROUND: Traumatic upper limb injury is a leading cause of work-related disability. After return-to-work (RTW), many survivors of injuries are able to regain a quality of life (QoL) comparable with the normal population. Since RTW plays an important role in economic productivity and regaining health-related QoL, enhancing RTW in workers with traumatic limb injuries is the primary goal of rehabilitation. Vocational rehabilitation has been adapted in the field of occupational safety and health to enhance the number of injured people returning to the labour market, prevent illness, increase well-being, and reduce disability. OBJECTIVES: To assess the effects of vocational rehabilitation programs in enhancing RTW of workers with traumatic upper limb injuries. SEARCH METHODS: We searched OSH UPDATE databases (CISDOC, HSELINE, International Bibliographic, NIOSHTIC, NIOSHTIC-2, RILOSH) (up to 10 December 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 11), MEDLINE through PubMed (up to 15 November 2012), EMBASE (up to 28 November 2012), CINAHL (up to 5 May 2013), PsycINFO (up to 7 December 2012), and handsearched the reference lists of relevant review articles. SELECTION CRITERIA: We aimed to include all randomised controlled trials (RCTs) comparing vocational rehabilitation with an alternative (control) intervention such as standard rehabilitation, an incomplete form of the vocational rehabilitation intervention (such as with limited advice on RTW, referral information, or liaison with employer), or waiting-list controls. DATA COLLECTION AND ANALYSIS: Two authors independently inspected abstracts and we obtained full papers when necessary. When the two authors disagreed about the inclusion of a study, we resolved disagreements by discussion. A third author arbitrated when necessary. MAIN RESULTS: Our search identified 332 citations. Based on assessments of their titles and abstracts, we decided to evaluate the full texts of 15 citations. In the end, none of these 15 citations met our inclusion criteria. AUTHORS' CONCLUSIONS: There is currently no high-level evidence to support or refute the efficacy of vocational rehabilitation in enhancing RTW in workers with traumatic upper limb injuries. Since vocational rehabilitation has frequently been provided to injured people in occupational settings with the aim of decreasing work disability, enhancing RTW, increasing productivity, and containing the welfare cost, further high-quality RCTs assessing the efficacy of vocational rehabilitation for workers with traumatic upper limb injury are needed to fill this gap in knowledge.

Implementation of evidence-based practice across medical, nursing, pharmacological and allied healthcare professionals: a questionnaire survey in nationwide hospital settings.

BACKGROUND: Implementation of evidence-based practice (EBP) is regarded as core competence to improve healthcare quality. In the current study, we investigated the EBP of six groups of professionals: physicians, nurses, pharmacists, physical therapists, technicians, and other allied healthcare personnel. METHODS: A structured questionnaire survey of regional hospitals throughout Taiwan was conducted by post in 2011. Questionnaires were mailed to all healthcare workers of 11 randomly selected hospitals. Linear and logistic regression models were used to examine predictors for implementing EBP. RESULTS: In total, 6,160 returned questionnaires, including 645 from physicians, 4,206 from nurses, 430 from pharmacists, 179 from physical therapists, 537 from technicians, and 163 from other allied healthcare professionals, were valid for the analysis. Physicians and pharmacists were more aware of EBP than were the other professional groups (p < 0.001). Positive attitudes toward and beliefs in EBP were significantly lower among nurses than in the other groups (p < 0.001). Physicians had more sufficient knowledge and skills of EBP than did the other professionals (p < 0.001); in addition, they implemented EBP for clinical decision-making more often and perceived fewer personal barriers to EBP (p < 0.001). Multivariate logistic regression analyses showed that EBP implementation was associated with the following characteristics of participants: EBP training, having a faculty position, academic degree, one's profession, and perceptions (beliefs, attitudes, knowledge, skills and barriers). CONCLUSIONS: This study depicts various levels of EBP implementation among medical, nursing, pharmacological, and allied healthcare personnel. There were significant differences in their implementation of EBP. We observed that certain factors were associated with EBP implementation, including personal backgrounds and perceptions toward EBP. The data suggest that strategies for enhancing EBP implementation should differ for various groups of professionals.

Effectiveness of national evidence-based medicine competition in Taiwan.

BACKGROUND: Competition and education are intimately related and can be combined in many ways. The role of competition in medical education of evidence-based medicine (EBM) has not been investigated. In order to enhance the dissemination and implementation of EBM in Taiwan, EBM competitions have been established among healthcare professionals. This study was to evaluate the impact of competition in EBM learning. METHODS: The EBM competition used PICO (patient, intervention, comparison, and outcome) queries to examine participants' skills in framing an answerable question, literature search, critical appraisal and clinical application among interdisciplinary teams. A structured questionnaire survey was conducted to investigate EBM among participants in the years of 2009 and 2011. Participants completed a baseline questionnaire survey at three months prior to the competition and finished the same questionnaire right after the competition. RESULTS: Valid questionnaires were collected from 358 participants, included 162 physicians, 71 nurses, 101 pharmacists, and 24 other allied healthcare professionals. There were significant increases in participants' knowledge of and skills in EBM (p<0.001). Their barriers to literature searching and forming answerable questions significantly decreased (p<0.01). Furthermore, there were significant increases in their access to the evidence-based retrieval databases, including the Cochrane Library (p<0.001), MD Consult (p<0.001), ProQuest (p<0.001), UpToDate (p=0.001), CINAHL (p=0.001), and MicroMedex (p=0.024). CONCLUSIONS: The current study demonstrates a method that successfully enhanced the knowledge of, skills in, and behavior of EBM. The data suggest competition using PICO queries may serve as an effective way to facilitate the learning of EBM.

Increasing utilization of Internet-based resources following efforts to promote evidence-based medicine: a national study in Taiwan.

BACKGROUND: Since the beginning of 2007, the National Health Research Institutes has been promoting the dissemination of evidence-based medicine (EBM). The current study examined longitudinal trends of behaviors in how hospital-based physicians and nurses have searched for medical information during the spread of EBM. METHODS: Cross-sectional postal questionnaire surveys were conducted in nationally representative regional hospitals of Taiwan thrice in 2007, 2009, and 2011. Demographic data were gathered concerning gender, age, working experience, teaching appointment, academic degree, and administrative position. Linear and logistic regression models were used to examine predictors and changes over time. RESULTS: Data from physicians and nurses were collected in 2007 (n = 1156), 2009 (n = 2975), and 2011 (n = 3999). There were significant increases in the use of four Internet-based resources - Web portals, online databases, electronic journals, and electronic books - across the three survey years among physicians and nurses (p < 0.001). Access to textbooks and printed journals, however, did not change over the 4-year study period. In addition, there were significant relationships between the usage of Internet-based resources and users' characteristics. Age and faculty position were important predictors in relation to the usage among physicians and nurses, while academic degree served as a critical factor among nurses only. CONCLUSIONS: Physicians and nurses used a variety of sources to look for medical information. There was a steady increase in use of Internet-based resources during the diffusion period of EBM. The findings highlight the importance of the Internet as a prominent source of medical information for main healthcare professionals.

Information-searching behaviors of main and allied health professionals: a nationwide survey in Taiwan.

RATIONALE, AIMS AND OBJECTIVES: There are a variety of resources to obtain health information, but few studies have examined if main and allied health professionals prefer different methods. The current study was to investigate their information-searching behaviours. METHODS: A constructed questionnaire survey was conducted from January through April 2011 in nationwide regional hospitals of Taiwan. Questionnaires were mailed to main professionals (physicians and nurses) and allied professionals (pharmacists, physical therapists, technicians and others), with 6160 valid returns collected. RESULTS: Among all professional groups, the most commonly used resource for seeking health information was a Web portal, followed by colleague consultations and continuing education. Physicians more often accessed Internet-based professional resources (online databases, electronic journals and electronic books) than the other groups (P < 0.05). In contrast, physical therapists more often accessed printed resources (printed journals and textbooks) than the other specialists (P < 0.05). And nurses, physical therapists and technicians more often asked colleagues and used continuing education than the other groups (P < 0.01). The most commonly used online database was Micromedex for pharmacists and MEDLINE for physicians, technicians and physical therapists. Nurses more often accessed Chinese-language databases rather than English-language databases (P < 0.001). CONCLUSIONS: This national survey depicts the information-searching pattern of various health professionals. There were significant differences between and within main and allied health professionals in their information searching. The data provide clinical implications for strategies to promote the accessing of evidence-based information.

Comparison of accessing online databases between physicians and nurses in Taiwan.

Online databases have been increasingly used as a key resource in the search for health information. The current study aims to compare the use patterns of online databases between physicians and nurses. A structured questionnaire was mailed to physicians and nurses of randomly selected regional hospitals in Taiwan. Valid questionnaires with complete answers were collected from 544 physicians and 1,573 nurses from November 2008 to February 2009. In general, physicians made more use of online databases than nurses (p  <  0.001). They more often accessed English-language online databases (p  <  0.001), including MEDLINE, MD Consult, UpToDate, Cochrane Library and ProQuest. On the other hand, nurses accessed Chinese-language online databases more frequently than physicians (p  <  0.001). Using a multivariate logistic regression model to adjust the personal characteristics, we found that nurses more often accessed Chinese-language online databases than physicians. Physicians used online databases to locate health information the most for clinical practice (76.6%), followed by instruction preparation (63.3%), and research (57.0%). Nevertheless, nurses used such databases more often for class assignments (66.4%) and clinical practice (55.8%). In conclusion, the behavior and motivation of access to online databases varied between physicians and nurses. Our findings provide evidence in the strategies to enhance the accessing of online databases.

Dissemination of systematic reviews in a hospital setting: a comparative survey for spreading use of the Cochrane Library.

INTRODUCTION: The Cochrane Library is the most important online evidence retrieval database of systematic reviews. Since 2007, the National Health Research Institutes has offered Taiwan's regional hospitals free access to the Cochrane Library. This study investigated how these hospitals disseminate its utilisation. METHODS: The usage rate of Cochrane reviews was measured in the participating hospitals from January 2008 to December 2009. Thereafter, a questionnaire survey was conducted for each regional hospital disseminator at the beginning of 2010 to analyse their methods of disseminating Cochrane reviews. RESULTS: The hospitals were stratified into three groups according to the relative rate of access: high (n=15), medium (n=16) and low (n=13). In comparison with the low-usage hospitals, the high-usage hospitals tended to assign a disseminator of evidence-based medicine to take charge of the dissemination of Cochrane reviews (p<0.001). In addition, the high-usage hospitals more often used the following six methods: providing relevant information via email (p<0.05), investing in early adopters (p<0.05), using assistance from designated personnel (p<0.05), highlighting the activity of early adopters (p<0.05), conducting workshops (p=0.001), and inviting experts to speak (p<0.001). There was no significant difference between high- and low-usage hospitals in organisational barriers. CONCLUSION: This study has identified several helpful strategies used by Taiwan's hospitals to enhance dissemination of the Cochrane Library, including raising of awareness, active delivery of information, mentoring relationships, and educational training. The data suggest that disseminating evidence-based medicine simultaneously is a key element.

Impact of a nationwide outreach program on the diffusion of evidence-based practice in Taiwan.

RATIONALE: To disseminate evidence-based practice (EBP) among hospital-based health professionals, since 2007 the National Health Research Institutes (NHRI) of Taiwan has run a complex outreach program that includes information resource support and promotional campaigns. OBJECTIVE: The aim is to evaluate the impact of this outreach program on the diffusion of EBP. SETTING: Sixty-one regional hospitals in Taiwan. DESIGN: A cross-sectional, pre- and post-survey of a nationally representative sample of physicians and nurses was carried out in 2007 and 2009 to examine views related to EBP including changes in beliefs, attitudes, knowledge, skills, perceived barriers and behaviors. RESULTS: Physicians and nurses in the 2009 survey tended to have more knowledge and skill of EBP than their counterparts in the 2007 survey. They were less likely, however, to believe that EBP can improve patient care quality and to support the implementation of EBP. The prevalence of perceived barriers to EBP declined during the 2-year study period. In addition, physicians and nurses were more likely to access the online evidence retrieval databases according to the 2009 survey when compared with responses to the 2007 survey. CONCLUSIONS: The knowledge of, skill in, and behavior regarding EBP have improved among physicians and nurses of regional hospitals in Taiwan after a promotion period of 2 years and they perceive fewer barriers to EBP. These data suggest that the multifaceted nationwide promotion program of the type conducted by NHRI succeeded in diffusion and implementation of EBP among professionals.

Comparison of evidence-based practice between physicians and nurses: a national survey of regional hospitals in Taiwan.

INTRODUCTION: Although evidence-based practice (EBP) has been widely investigated, few studies compare physicians and nurses on performance. METHODS: A structured questionnaire survey was used to investigate EBP among physicians and nurses in 61 regional hospitals of Taiwan. Valid postal questionnaires were collected from 605 physicians and 551 nurses during February to May 2007. RESULTS: Physicians were more aware of EBP than nurses. Although both groups had high recognition of belief in and favorable attitudes toward EBP, their knowledge of and skill in EBP were relatively low. When compared with nurses, physicians were more willing to support the promotion of EBP implementations in clinical services. Physicians' knowledge and skills regarding the application of EBP principles were greater than nurses. Furthermore, physicians more often accessed the on-line evidence-retrieval databases, including the Cochrane Library. The most commonly ranked barriers to EBP applications for both groups included lack of designated personnel, lack of convenient kits, limited basic knowledge of EBP, and time. In general, nurses generated more barriers than physicians. DISCUSSION: There were significant discrepancies between physicians and nurses in their awareness of, attitude toward, knowledge of, skill in, behavior toward, and barriers regarding EBP. In implementing EBP, strategies to overcome barriers and provide on-line evidence-retrieval systems should differ for physicians and nurses.

Physicians' characteristics in the usage of online database: a representative nationwide survey of regional hospitals in Taiwan.

Physicians have to deal with a broad range of medical problems in clinical practice, thus making the timely acquisition of relevant information is a critical skill for physicians to improve care quality. The current national study investigates how physicians search for medical information and analyses how they use online medical databases. A structured questionnaire survey was conducted, with 457 valid returns collected. Internet-based resources (Web portals, online databases, and electronic journals) were more often accessed by physicians to look for medical information than personal or paper ones. Almost universally, physicians have accessed online databases. MEDLINE was the most frequently accessed database. Furthermore, physicians under 50 years old tended to access online databases more often than their elder colleagues (OR = 5.27, 95% CI = 1.96-14.14 for age <35; OR = 4.68, 95% CI = 2.07-10.60 for ages 35-50). In addition, physicians with faculty position were more often accessing online databases (OR = 3.32; 95% CI = 1.75-6.30). Other factors - including clinical experience, administrative position, gender, academic degree, and professional specialty - carried no significant differences. These data may assist in determining how to promote the use of online evidence-based medical information for clinical services.