Consultant doctors of the Philippine General Hospital (PGH) were invited to participate

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˜››Žœ™˜—’—ȱŠž‘˜›DZȱŽ˜—’•ŠȱǯȱŠ—œǰȱǰȱȱ

Ž™Š›–Ž—ȱ˜ȱŽ’Š›’Œœȱȱ

‘’•’™™’—Žȱ Ž—Ž›Š•ȱ˜œ™’Š•ȱ

—’ŸŽ›œ’¢ȱ˜ȱ‘Žȱ‘’•’™™’—ŽœȱŠ—’•Šȱ

ŠȱŸŽǰȱ›–’ŠǰȱŠ—’•ŠȱŗŖŖŖȱ‘’•’™™’—Žœȱ

Ž•Ž™‘˜—ŽDZȱƸŜřŘȱśŘśŚŖşŞȱ

Ȭ–Š’•DZȱȱ’Š—œȓœ”¢‹›˜Š‹Š—ǯŒ˜–ǯ™‘ȱȱȱȱȱ ȱ

ŽŸŽ•ȱ˜ȱ—Ž›œŠ—’—ȱŠ—ȱ›ŽŠœȱ˜ȱ™™•’ŒŠ’˜—ȱ˜ȱ˜Œ‘›Š—ŽȱŽŸ’Ž œȱŠ–˜—ȱ

›ŠŒ’Œ’—ȱ‘¢œ’Œ’Š—œȱ’•’ŠŽȱ ’‘ȱ‘Žȱ‘’•’™™’—Žȱ Ž—Ž›Š•ȱ˜œ™’Š•ȱ ȱ

Ž˜—’•ŠȱǯȱŠ—œǰ^ŗǰŘȱ¢—‘’Šȱǯȱ˜›Ž›˜ǰ^Řȱ’•Šȱ’Š—Šȱǯȱ•ŠŸŠ^řȱŠ—ȱ Ž›–Š—Šȱǯȱ ›Ž˜›’˜^ŗȱ

ȱ

ŗŽ™Š›–Ž—ȱ˜ȱŽ’Š›’Œœǰȱ˜••ŽŽȱ˜ȱŽ’Œ’—ŽȱŠ—ȱ‘’•’™™’—Žȱ Ž—Ž›Š•ȱ˜œ™’Š•ǰȱ—’ŸŽ›œ’¢ȱ˜ȱ‘Žȱ‘’•’™™’—ŽœȱŠ—’•Šȱ

؎™Š›–Ž—ȱ˜ȱ•’—’ŒŠ•ȱ™’Ž–’˜•˜¢ǰȱ˜••ŽŽȱ˜ȱŽ’Œ’—Žǰȱ—’ŸŽ›œ’¢ȱ˜ȱ‘Žȱ‘’•’™™’—ŽœȱŠ—’•Šȱ

ř˜••ŽŽȱ˜ȱŽ’Œ’—ŽǰȱŠ—’•ŠȱŽ—›Š•ȱ—’ŸŽ›œ’¢ȱǰȱŠ•˜˜ŒŠ—ȱ’¢ȱ

ȱ ȱ

ABSTRACT

Objective. The main objective of this study is to determine the level of understanding, accessibility and areas of application of Cochrane reviews (CR) among medical practitioners affiliated with a tertiary care medical center in Metro Manila, Philippines.

Study Design. Survey using a self-administered questionnaire was conducted.

Target Population and Setting. Consultant doctors of the Philippine General Hospital (PGH) were invited to participate.

The PGH is the national university hospital of the Philippines and is a tertiary referral center and teaching hospital of the University of the Philippines Manila.

Sampling Scheme. 101 doctors were chosen by stratified random sampling with the clinical department as the stratification variable. Strata samples were targeted according to strata size (proportional to size).

Measurement Instrument. Eight domains that are important in the understanding of the CR were included in a 25-item multiple-choice questionnaire. In addition, facilitating factors and barriers to the application of CR or systematic reviews (SR) were asked.

Data Analysis. Using a 25-point Multiple Choice Questionnaire, the knowledge of the respondents was measured and the mean score was estimated at a 95% confidence level. The percentage of CR awareness was also estimated at 95% confidence level.

Facilitating factors and barriers in the use of SR were described.

In addition, the following post-hoc analyses were done:

descriptions of the total score according to gender, age, year graduated and year of last training.

Results. Of 101 consultants invited, 59 participated (58%

response rate) within the 6-month data collection period. The mean age was 47.2 years with a standard deviation (SD) of 7.8

years. Forty-five respondents (76%) had their last formal medical-related training from 1991 onwards. The mean score was 14.7 points (SD 6.7) using the 25-item multiple choice questions on concepts and principles of systematic reviews. Of these 59 respondents, 49 (83.0%: 95% CI: 75.2 – 90.9) indicated that they were aware of the existence of CR. Of those who were aware of CR, 42 (85.7%, 95% CI: 75.9 -95.6) have actually used them. The following factors help the respondents use CR:

efficient Internet access, working knowledge of research methodology, working knowledge of how to critically appraise the medical literature, and familiarity with the terms used in the review. On the other hand, the following were considered barriers: inefficient access, poor knowledge of general research methodology, poor understanding of the principles of Evidence- based medicine (EBM) and difficulty in understanding the reviews.

Conclusion. Practicing physicians in a tertiary university hospital in the Philippines were only able to get about 60% of the principles and concepts of understanding SR. Eighty three percent of them are aware of CR. Access to internet, familiarity with terms and working knowledge of CR and evidence-based medicine are the facilitating factors for application of the results of SR and CR. Although most claimed to use the SR results in literature reviews, only about 60% are able to use them in teaching, clinical practice or health policy development.

Key Words: cochrane reviews, systematic reviews, meta-analysis, knowledge, evidence-based medicine

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—›˜žŒ’˜—ȱ

Ÿ’Ž—ŒŽȬ‹ŠœŽȱŽ’Œ’—ŽȱǻǼȱ‘ŠœȱŠ›˜žœŽȱœ’—’’ŒŠ—ȱ

’—Ž›Žœȱœ’—ŒŽȱ’œȱ’—ŒŽ™’˜—ȱ’—ȱŗşşŗǯ^ŗȱȱȱ™›˜™˜œŽȱŠȱ™Š›Š’–ȱ

œ‘’ȱ ’—ȱ ‹˜‘ȱ ‘Žȱ ™›ŠŒ’ŒŽȱ ˜ȱ –Ž’Œ’—Žȱ Š—ȱ ‘˜ ȱ ˜ȱ ŽŠŒ‘ȱ ’ǯȱȱ

‘Ž›Žȱ ’œȱ ›˜ ’—ȱ ›ŽŒ˜—’’˜—ȱ ‘Šȱ ŽŸ’Ž—ŒŽȬ‹ŠœŽȱ –Ž’Œ’—Žȱ ǻǼȱ’—ȱŽ—Ž›Š•ȱ™›ŠŒ’ŒŽȱ ’••ȱ’–™›˜ŸŽȱ‘ŽŠ•‘ȱ˜žŒ˜–Žœȱ˜›ȱ

™Š’Ž—œǯȱ ȱȱ ‘Šœȱ ’—›˜žŒŽȱ —Ž ȱ Œ˜—ŒŽ™œȱ Š—ȱ ‘Šœȱ Š•œ˜ȱ

›’Ž›Žȱ Šȱ ’ŸŽ›œ’¢ȱ ˜ȱ ŽžŒŠ’˜—Š•ȱ ’—’’Š’ŸŽœȱ ˜›ȱ Œ›’’ŒŠ•ȱ

Š™™›Š’œŠ•ȱ˜ȱ‘Žȱ•’Ž›Šž›Žǯȱȱȱ

—ŽȱœžŒ‘ȱ’—’’Š’ŸŽȱ’œȱ‘Žȱ˜Œ‘›Š—Žȱ˜••Š‹˜›Š’˜—ǯȱȱ ‘Žȱ

˜Œ‘›Š—Žȱ˜••Š‹˜›Š’˜—ȱ’œȱŠ—ȱ’—Ž›—Š’˜—Š•ȱ˜›Š—’£Š’˜—ȱ‘Šȱ

‘Šœȱ ›ŽŸ˜•ž’˜—’£Žȱ ‘Žȱ œ¢—‘Žœ’œȱ ǻœ¢œŽ–Š’Œȱ ›ŽŸ’Ž Ǽȱ ˜ȱ

ŽŸ’Ž—ŒŽǯȱ ȱ ȱ Š’–œȱ ˜ȱ ‘Ž•™ȱ ™Ž˜™•Žȱ –Š”Žȱ  Ž••Ȭ’—˜›–Žȱ

ŽŒ’œ’˜—œȱ Š‹˜žȱ ‘ŽŠ•‘ȱ ŒŠ›Žȱ ‹¢ȱ ™›Ž™Š›’—ǰȱ –Š’—Š’—’—ǰȱ Š—ȱ

Ž—œž›’—ȱ‘ŽȱŠŒŒŽœœ’‹’•’¢ȱ˜ȱ›’˜›˜žœǰȱœ¢œŽ–Š’ŒǰȱŠ—ȱž™Ȭ˜Ȭ

ŠŽȱ ›ŽŸ’Ž œȱ ǻŠ—ǰȱ  ‘Ž›Žȱ ™˜œœ’‹•Žǰȱ –ŽŠȬŠ—Š•¢œŽœǼȱ ˜ȱ ‘Žȱ

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Žœ™˜—Ž—ȱž–‹Ž›ȱ ȱ

—Ž›œŠ—’—ȱŠ—ȱ™™•’ŒŠ’˜—ȱ˜ȱ˜Œ‘›Š—ŽȱŽŸ’Ž œȱŠ–˜—ȱ›ŠŒ’Œ’—ȱ‘¢œ’Œ’Š—œȱŠȱ‘Žȱ‘’•’™™’—Žȱ Ž—Ž›Š•ȱ˜œ™’Š•ȱ ȱ

ŠŠȱ˜••ŽŒ’˜—ȱ˜›–ȱ ȱ

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ŽŠ›ȱ›ǯȱȏȏȏȏȏȏȏȏȏȏȏǰȱȱ ȱ

‘Žȱ˜Œ‘›Š—Žȱ˜••Š‹˜›Š’˜—ȱ™›˜Ÿ’ŽœȱŠȱŸŽ—žŽȱ˜›ȱŸŠ•’ȱœ¢—‘Žœ’œȱ˜ȱŽŸ’Ž—ŒŽȱŠ›Žœœ’—ȱ›Ž•ŽŸŠ—ȱ™›ŽŸŽ—’˜—ǰȱ’Š—˜œ’ŒȱŠ—ȱ

‘Ž›Š™Žž’ŒȱšžŽœ’˜—œǯȱȱ—ȱŠ’’˜—ǰȱ‘ŽȱŒ˜••Š‹˜›Š’˜—ȱŠ•œ˜ȱ™›˜–˜Žœȱ’–Ž•¢ȱ’œœŽ–’—Š’˜—ȱ˜ȱ‘ŽœŽȱœ¢—‘ŽœŽœǯȱȱ’œȱŽ—Ÿ’œ’˜—Žȱ

‘Šȱ‘’œȱ’–Ž•¢ȱ’œœŽ–’—Š’˜—ȱŒŠ—ȱ’—•žŽ—ŒŽȱŒ•’—’ŒŠ•ȱ™›ŠŒ’ŒŽȱ‘Ž›Ž‹¢ȱ™›˜–˜’—ȱ˜™’–ž–ȱŠ—ȱŽšž’Š‹•Žȱ‘ŽŠ•‘ȱŒŠ›ŽȱŽ•’ŸŽ›¢ǯȱȱ

œȱ ˜ȱ œŽŒ˜—ȱ šžŠ›Ž›ȱ ˜ȱ ŘŖŖşǰȱ śŝŞśȱ ›ŽŸ’Ž œȱ ‘ŠŸŽȱ ‹ŽŽ—ȱ ™˜œŽȱ ˜—ȱ ’œȱ œ’Žȱ ǽ‘™DZȦȦ   ǯŒ˜Œ‘›Š—Žǯ˜›Ȧ’—Ž¡ǯ‘–Ǿǯȱ ȱ ’ŸŽ—ȱ ‘Žȱ

‘’‘•¢ȱ ŽŒ‘—’ŒŠ•ȱ —Šž›Žȱ ˜ȱ ‘Žȱ ›ŽŸ’Ž œǰȱ œ’–™•’’Žȱ ŽžŒŠ’˜—Š•ȱ –ŠŽ›’Š•œȱ ‘ŠŸŽȱ ‹ŽŽ—ȱ ŽŸŽ•˜™Žȱ Š—ȱ  ˜›”œ‘˜™œȱ ‘ŠŸŽȱ ‹ŽŽ—ȱ

Œ˜—žŒŽȱ˜ȱ™›˜–˜Žȱž—Ž›œŠ—’—ȱ˜ȱœžŒ‘ȱ›ŽŸ’Ž œǯȱ ȱ

ŽȱŠ›ŽȱŒ˜—žŒ’—ȱŠȱœž¢ȱ‘ŠȱŠ’–œȱ˜ȱŽŽ›–’—Žȱ’ȱ‘Žȱ˜Œ‘›Š—Žȱ›ŽŸ’Ž œȱ’—ȱ‘ŽȱŒž››Ž—ȱ˜›–ŠȱŠ—ȱ’œœŽ–’—Š’˜—ȱ–˜ŽȱŠ›Žȱ

›ŽŠŒ‘’—ȱ ‘Žȱ Š›Žȱ Ž—ȬžœŽ›œǯȱ ‘Žȱ ›Žœž•œȱ ˜ȱ ‘’œȱ œž¢ȱ  ’••ȱ ‹Žȱ ˜—Žȱ ˜ȱ ‘Žȱ ‹ŠœŽœȱ ˜ȱ ’–™›˜Ÿ’—ȱ ŽžŒŠ’˜—Š•ȱ –ŠŽ›’Š•œȱ Š—ȱ

™›˜›Š–œȱ˜ȱ™›˜–˜ŽȱŠ™™•’ŒŠ’˜—ȱ˜ȱ˜Œ‘›Š—ŽȱŽŸ’Ž œǯȱ ȱ

‘ŽȱšžŽœ’˜——Š’›Žȱ’œȱŽœ’—Žȱ˜ȱ’Ž—’¢ȱ”Ž¢ȱŠ›ŽŠœȱ ‘Ž›Žȱ ŽȱŒŠ—ȱ’–™›˜ŸŽȱŒ˜–™›Ž‘Ž—œ’˜—ȱŠ—ȱžœŠŽȱ˜ȱ‘Žȱ˜Œ‘›Š—Žȱ›ŽŸ’Ž œǯȱȱ

Žœȱ Šœœž›Žȱ ‘Šȱ  Žȱ  ’••ȱ ˜—•¢ȱ žœŽȱ ‘’œȱ ˜›ȱ ™ž›™˜œŽœȱ ˜ȱ ‘Žȱ œž¢ȱ Š—ȱ ¢˜ž›ȱ ’Ž—’¢ȱ Š—ȱ Š—œ Ž›œȱ  ’••ȱ ‹Žȱ ‘Ž•ȱ ’—ȱ œ›’Œȱ

Œ˜—’Ž—ŒŽǯȱȱȱ ȱ

—ȱ‘’œȱŒ˜——ŽŒ’˜—ǰȱ–Š¢ȱ Žȱ›ŽšžŽœȱ¢˜žȱ˜ȱŒ˜–™•ŽŽȱ‘ŽȱŠŠŒ‘ŽȱšžŽœ’˜——Š’›Žȱ’—ȱ˜—Žȱœ’’—ȱ ’‘’—ȱŚśȱ–’—žŽœȱǻ˜ȱ–Š”Žȱ‘Žȱ

Žœ’—ȱŒ˜—’’˜—œȱœ’–’•Š›ȱŠ–˜—ȱ‘Žȱ›Žœ™˜—Ž—œǼǯȱ ȱȱ

˜žȱ–Š¢ȱŽ–Š’•ǰȱ–Š’•ǰȱ˜›ȱŠ¡ȱ‘’œȱ‹ŠŒ”ȱ˜ȱžœȱŠȱ‘ŽȱŒ˜—ŠŒȱŽŠ’•œȱ‹Ž•˜ ǯȱȱ˜žȱ–Š¢ȱŠ•œ˜ȱŒŠ••ȱžœȱŠ—ȱ Žȱ ’••ȱ‘ŠŸŽȱ’ȱ™’Œ”Žȱž™ȱ

›˜–ȱ¢˜ž›ȱ˜’ŒŽȱ˜›ȱŒ•’—’Œǯȱ‘Š—”ȱ¢˜žȱ˜›ȱœ‘Š›’—ȱ¢˜ž›ȱ™›ŽŒ’˜žœȱ’–Žȱ ’‘ȱžœǯȱ ȱȱȱȱ

’—ŒŽ›Ž•¢ȱ¢˜ž›œǰȱ ȱ

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ȱǯȱǰȱǯǯȱŠ—ȱȱǯȱǰȱǯŒǯȱ ȱ

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–Š’•DZȱȱ Œ˜Œ‘›Š—Žǯ›ŽŸ’Ž ȓ–Š’•ǯŒ˜–ȱȱ

›ŽœœDZȱȱ ȱ

Ž™Š›–Ž—ȱ˜ȱ•’—’ŒŠ•ȱ™’Ž–’˜•˜¢ǰ˜••ŽŽȱ˜ȱŽ’Œ’—Žȱ

—’ŸŽ›œ’¢ȱ˜ȱ‘Žȱ‘’•’™™’—ŽœȱŠ—’•Šȱ śŚŝȱŽ›˜ȱ ’•ȱǯǰ›–’ŠǰȱŠ—’•ŠȱŗŖŖŖȱ

Š¡ȱ˜DZȱȱ ŖŘȱǻśŘśŚŖşŞǼȱ ȱ

Appendix

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