Learning with computerized guidelines in general practice?: A randomized controlled trial

Butzlaff, Martin; Vollmar, HC; Floer, Bettina; Koneczny, Nik; Isfort, Jana; Lange, Sandra

doi:10.1093/fampra/cmh214

Cited by 42 publications

(55 citation statements)

References 10 publications

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“…Of the 22 studies that were included, nine concerned qualitative, [13][14][15][16][17][18][19][20]24 12 concerned quantitative, [21][22][23][24][25][26][27][28][29][30][31][32]34 and one concerned both qualitative and quantitative research methods. 33 One RCT was included in the review, but the barriers regarding EBM that were described in this study -and respectively included in this article -were described for the intervention group (specific access to literature) only.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…16,27 This is caused by the idea that EBM requires them to work strictly according to the guidelines. 15,18,23,25 Furthermore, earlier 13,14,17,18,22,24,27,30,34 • Use of evidence is complicated 23 • Difficulty keeping up 13,27 • Adapting to preferences, beliefs, and• Lack of time: [13][14][15][16]20,21,25,[28][29][30][31]33 demands different from evidence 15,24,26,30,33 • to search for evidence 17,19,33 • to access evidence 19,26 • 19,[24][25][26]31 • Words of GP and presentation of experts/specialists 13,14,20 information used by GP 34 personal experiences in life or in clinical practice influence the use of evidence; 26,34 fo...…”

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confidence: 99%

“…17,18,20,[24][25][26]30,31,33,34 Patients' preferences, expectations, and beliefs have a major influence on EBM use, according to GPs. 26,30,31,33,34 When the evidence-based preferences of the GP and the wishes of the patient do not match, the GP may feel a barrier to convincing the patient, [17][18][19][20][21][22][23][24][25][26] because GPs feel pressured to fulfil patients' wishes. 15,17,24,26,34 This results from the fact that patients have strong ideas about what they want from their GP.…”

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confidence: 99%

“…15,16,18,20,23,24,27,28,30,32,34 In all the studies, barriers related to one or more of the components of the conceptual model of EBM (evidence, the GP's preferences, the patient's preferences, the GP setting) were found. These barriers are summarised in Table 3.…”

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confidence: 99%

“…Most of the 22 articles describe barriers that are related to the evidence itself. [14][15][16][17][18][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Some say that general practice lacks sound evidence, 14,24,26,30,31,33 especially for the many problems faced by GPs. 15 In one study sample, 34% of the surveyed GPs felt that there is a lack of evidence.…”

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confidence: 99%

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Barriers to GPs' use of evidence-based medicine: a systematic review

Zwolsman¹,

Pas²,

Hooft³

et al. 2012

Br J Gen Pract

161

149

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BackgroundGPs report various barriers to the use and practice of evidence-based medicine (EBM). A review of research on these barriers may help solve problems regarding the uptake of evidence in clinical outpatient practice. AimTo determine the barriers encountered by GPs in the practice of EBM and to come up with solutions to the barriers identified. DesignA systematic review of the literature. MethodThe following databases were searched: MEDLINE ® (PubMed ® ), Embase, CINAHL ® , ERIC, and the Cochrane Library, until February 2011. Primary studies (all methods, all languages) that explore the barriers that GPs encounter in the practice of EBM were included. ResultsA total of 14 700 articles were identified, of which 22 fulfilled all inclusion criteria. Of the latter, nine concerned qualitative, 12 concerned quantitative, and one concerned both qualitative and quantitative research methods. The barriers described in the articles cover the categories: evidence (including the accompanying EBM steps), the GP's preferences (experience, expertise, education), and the patient's preferences. The particular GP setting also has important barriers to the use of EBM. Barriers found in this review, among others, include lack of time, EBM skills, and available evidence; patient-related factors; and the attitude of the GP. ConclusionVarious barriers are encountered when using EBM in GP practice. Interventions that help GPs to overcome these barriers are needed, both within EBM education and in clinical practice. Keywordsdecision-making; evidence-based medicine; general practitioners; review.e511 British Journal of General Practice, July 2012 language in which an article is written was not an exclusion criterion. If needed, relevant parts of the paper were translated. In cases where more information was needed to ascertain inclusion or exclusion, the authors of the study were contacted. The search strategy was based on the search terms from an earlier systematic review of barriers faced by resident doctors. It was developed by a clinical librarian and adapted for GPs (Box 1). 8 Information sources Study selectionBefore reviewing, the researchers discussed the inclusion and exclusion criteria in order to improve inter-rater reliability. Two reviewers independently appraised the titles of the studies retrieved from the literature search, to assess which studies were clearly irrelevant to the present study. Studies were excluded only if both reviewers considered a title unsuitable for inclusion. The same two reviewers independently appraised the abstracts of the studies that had not been excluded. These studies were excluded if both reviewers thought it appropriate to do so. If only one reviewer thought the study should be included, a decision was made through discussion with a third reviewer.Two reviewers independently appraised the complete texts of the studies that had been included, based on their abstracts. If only one of the reviewers thought that the study should be included, a third reviewer determined whether ...

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Section: Study Characteristicsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Barriers to GPs' use of evidence-based medicine: a systematic review

Zwolsman¹,

Pas²,

Hooft³

et al. 2012

Br J Gen Pract

161

149

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Electronic retrieval of health information by healthcare providers to improve practice and patient care

McGowan

Grad

Pluye

et al. 2009

Cochrane Database of Systematic Reviews

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Interventions to increase the use of electronic health information by healthcare practitioners to improve clinical practice and patient outcomes

Fiander¹,

McGowan

Grad

et al. 2015

Cochrane Database of Systematic Reviews

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This review provided no evidence that the use of EHI translates into improved clinical practice or patient outcomes, though it does suggest that when practitioners are provided with EHI and education or training, the use of EHI increases. We have defined use as the activity of logging into an EHI resource, but based on our findings use does not automatically translate to the application of EHI in practice. While using EHI may be an important component of evidence-based medicine, alone it is insufficient to improve patient care or clinical practices. For EHI to be applied in patient care, it will be necessary to understand why practitioners' are reluctant to apply EHI when treating people, and to determine the most effective way(s) to reduce this reluctance.

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Learning with computerized guidelines in general practice?: A randomized controlled trial

Abstract: An efficient knowledge transfer through computerized guidelines was not achieved. Usage, individual learning and potential implementation depend on adequate incentives and pragmatic aspects of clinical practice: easy and quick access.

Cited by 42 publications

References 10 publications

Barriers to GPs' use of evidence-based medicine: a systematic review

Barriers to GPs' use of evidence-based medicine: a systematic review

Electronic retrieval of health information by healthcare providers to improve practice and patient care

Interventions to increase the use of electronic health information by healthcare practitioners to improve clinical practice and patient outcomes

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