Protecting generalism: moving on from evidence-based medicine?

Reeve, Joanne

doi:10.3399/bjgp10x514792

Cited by 33 publications

(32 citation statements)

References 17 publications

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“…42 Consultations in general practice are more complex than consultations in some specialties, 43 and the patients in primary care also differ significantly from patients in secondary care regarding variation in disorders and disease stages.…”

Section: Gp Settingmentioning

confidence: 99%

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: Gp Settingmentioning

confidence: 99%

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

Zwolsman¹,

Pas²,

Hooft³

et al. 2012

Br J Gen Pract

161

149

View full text Add to dashboard Cite

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“…In the terminal stage of disease with complex psychiatric comorbidity an individuallytailored model prevails and a disease oriented model according to diagnostic criteria is abandoned. [36][37][38] This also suggests that psychotropic drug prescription is not the optimal proxy indicator of psychiatric disease in patients with terminal stage cancer.…”

Section: Discuss This Articlementioning

confidence: 99%

Psychiatric comorbidity among terminally ill patients in general practice in the Netherlands: a comparison between patients with cancer and heart failure

G²,

Smeets³

et al. 2013

Br J Gen Pract

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“…Nowadays, it is equally likely to be about the epidemiology of disease and disease management, and is by nature more robust and broader in scope, but it may have the downside of encouraging both conformity, and a 'one size fits all' mentality of patient care, which has its associated problems. [16][17][18] Once again, this is merely a comment on the changes apparent in the ethos of one department and how they have affected the authors. We recognise that students and their teaching also forms the lifeblood of departments of general practice, but that the nature of the changes in perspective from the science of patient care and its evolution to management and preventive management strategies is an important change worthy of note and further discussion.…”

Section: University Departmentsmentioning

confidence: 99%

‘In my day …’: towards the utilisation of living history?

Jacobson

Cunningham²,

Francis³

et al. 2011

Br J Gen Pract

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This essay starts from the premise that the phrase 'in my day …' so beloved of our teachers may have more significance now that we are undergraduate teachers ourselves. We feel that earlier eras of medicine have something to contribute to younger generations and that recent evolutions are invaluable resources to consider the changing role of primary care in general and academic general practice in particular.We set out to show some of the changes over the last 20 years or so through the eyes of individuals with varying GP academic experience. However, it is not intended to be mere idle musings, because we mean to show that a blend of the good from the past, combined with the good from our contemporary position will improve ongoing academic primary care medicine and teaching.

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Protecting generalism: moving on from evidence-based medicine?

Cited by 33 publications

References 17 publications

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

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

Psychiatric comorbidity among terminally ill patients in general practice in the Netherlands: a comparison between patients with cancer and heart failure

‘In my day …’: towards the utilisation of living history?

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