Rural Doctors’ Views on and Experiences with Evidence-Based Medicine: The FrEEDoM Qualitative Study

Hisham, Ranita; Liew, Su May; Ng, Chirk Jenn; Nor, Kamaliah Mohd; Osman, Iskandar Firzada; Ho, Gah Juan; Hamzah, Nurazira; Glasziou, Paul

doi:10.1371/journal.pone.0152649

Cited by 21 publications

(20 citation statements)

References 23 publications

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“…Medline and Embase include varieties of articles of different study and could be timeconsuming (16) for our sample in which the majorly reported the time factor as the primary barrier to the application of EBM. The time factors and lack of internet access reported as the principal barriers to EBM in the present study are in line with previous studies (2,17) .…”

Section: Discussionsupporting

confidence: 93%

“…It has been shown to reduce mortality and hospital stay. However, more than one-third of patients do not receive evidence-based health care, and a similar proportion receives harmful or unnecessary care (2) . Medical practitioners are continuously required to update their knowledge and skills concerning new modalities of diagnosis and management.…”

Section: Introductionmentioning

confidence: 99%

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Primary Health Care Physicians' Knowledge, Attitude and Practice towards Evidence-Based Medicine in Tabuk City, KSA

Altemani

2018

Egyptian Journal of Hospital Medicine

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Background: Evidence-based medicine (EBM) is an essential component of modern medical practice and crucial for patient safety and high-quality health care services. Objectives: This study was conducted to assess the knowledge, attitude and practice towards evidence-based medicine and the barriers against its application in daily medical practice. Subjects and Methods: This is a cross-sectional survey using a self-administered validated questionnaire among 68 primary health care physicians in Tabuk city, Kingdom of Saudi Arabia during the period from December 2016 to June 2017. Validated questionnaire was used to collect data from the respondents. The Statistical Package for Social Sciences (SPSS) was used for data analysis. P-value of <0.05 was considered as significant. Result: There are 62.2% male participants, the age of the majority were from 30 to 50 years (73.5%) and (72.1%) did not have board qualification, the primary literature review and summaries were the popular methods for EBM. The knowledge and attitude were suboptimal; some did not even access Medline. The unavailability of time and internet access were the most frequent barriers reported. Only a minority received formal EBM training. Conclusion: The knowledge and attitude regarding EBM were suboptimal among the primary health care physicians, the time factors, unavailability of the internet and the lack of letters, access to journals, and guidelines were the principal barriers to EBM incorporation in the clinical practice.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Primary Health Care Physicians' Knowledge, Attitude and Practice towards Evidence-Based Medicine in Tabuk City, KSA

Altemani

2018

Egyptian Journal of Hospital Medicine

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“…A recent qualitative study conducted in 2014 found that the unique barriers in implementing EBM among primary care physicians in Malaysia were lack of awareness and attention toward patient values. Patient values forms a key element of EBM and they still preferred obtaining information from their peers and interestingly, they used WhatsApp—a smart phone messenger [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Development and validation of the Evidence Based Medicine Questionnaire (EBMQ) to assess doctors’ knowledge, practice and barriers regarding the implementation of evidence-based medicine in primary care

Hisham

Liew

et al. 2018

BMC Fam Pract

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BackgroundEvidence-Based Medicine (EBM) integrates best available evidence from literature and patients’ values, which then informs clinical decision making. However, there is a lack of validated instruments to assess the knowledge, practice and barriers of primary care physicians in the implementation of EBM. This study aimed to develop and validate an Evidence-Based Medicine Questionnaire (EBMQ) in Malaysia.MethodsThe EBMQ was developed based on a qualitative study, literature review and an expert panel. Face and content validity was verified by the expert panel and piloted among 10 participants. Primary care physicians with or without EBM training who could understand English were recruited from December 2015 to January 2016. The EBMQ was administered at baseline and two weeks later. A higher score indicates better knowledge, better practice of EBM and less barriers towards the implementation of EBM. We hypothesized that the EBMQ would have three domains: knowledge, practice and barriers.ResultsThe final version of the EBMQ consists of 80 items: 62 items were measured on a nominal scale, 22 items were measured on a 5 point Likert-scale. Flesch reading ease was 61.2. A total of 343 participants were approached; of whom 320 agreed to participate (response rate = 93.2%). Factor analysis revealed that the EBMQ had eight domains after 13 items were removed: “EBM websites”, “evidence-based journals”, “types of studies”, “terms related to EBM”, “practice”, “access”, “patient preferences” and “support”. Cronbach alpha for the overall EBMQ was 0.909, whilst the Cronbach alpha for the individual domain ranged from 0.657–0.940. The EBMQ was able to discriminate between doctors with and without EBM training for 24 out of 42 items. At test-retest, kappa values ranged from 0.155 to 0.620.ConclusionsThe EBMQ was found to be a valid and reliable instrument to assess the knowledge, practice and barriers towards the implementation of EBM among primary care physicians in Malaysia.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0779-5) contains supplementary material, which is available to authorized users.

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“…Older GPs are less likely to prescribe according to antibiotic guidelines, suggesting difficulty changing established practice in light of new evidence 24. Doctors may disagree with evidence-based guidelines, instead relying on their own clinical experience to guide them25; for example, doctors in India report using antibiotics as prevention in patients from poorer communities due to concerns about higher prevalence of bacterial infection 26. Barriers towards putting evidence into practice include time pressure, financial considerations and doctors’ perceptions of patients’ expectations 26–30…”

Section: Introductionmentioning

confidence: 99%

Reducing inappropriate antibiotic prescribing in upper respiratory tract infection in a primary care setting in Kolkata, India

Lunn

2018

BMJ Open Qual

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Inappropriate antibiotic use is a key factor in the emergence of antibiotic resistance. The majority of antibiotics are prescribed in primary care, where upper respiratory tract infection (URTI) is a common presentation. Inappropriate antibiotic prescribing in URTI is common globally and has increased markedly in developing and transitional countries. Antibiotic stewardship is crucial to prevent the emergence and spread of resistant microbes. This project aimed to reduce inappropriate antibiotic prescribing in URTI in a non-governmental organisation’s primary care outreach clinics in Kolkata, India, from 62.6% to 30% over 4 months. A multifaceted intervention to reduce inappropriate antibiotic use in non-specific URTI was implemented. This consisted of a repeated process of audit and feedback, interactive training sessions, one-to-one case-based discussion, antibiotic guideline development and coding updates. The primary outcome measure was antibiotic prescribing rates. A baseline audit of all patients presenting with non-specific URTI over 8 weeks in November and December 2016 (n=222) found that 62.6% were prescribed antibiotics. Postintervention audit over 4 weeks in April 2017 (n=69) showed a marked reduction in antibiotic prescribing to 7.2%. An increase in documentation of examination findings was also observed, from 52.7% to 95.6%. This multifaceted intervention was successful at reducing inappropriate antibiotic prescribing, with sustained reductions demonstrated over the 4 months of the project. This suggests that approaches previously used in Europe can successfully be applied to different settings.

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Rural Doctors’ Views on and Experiences with Evidence-Based Medicine: The FrEEDoM Qualitative Study

Cited by 21 publications

References 23 publications

Primary Health Care Physicians' Knowledge, Attitude and Practice towards Evidence-Based Medicine in Tabuk City, KSA

Primary Health Care Physicians' Knowledge, Attitude and Practice towards Evidence-Based Medicine in Tabuk City, KSA

Development and validation of the Evidence Based Medicine Questionnaire (EBMQ) to assess doctors’ knowledge, practice and barriers regarding the implementation of evidence-based medicine in primary care

Reducing inappropriate antibiotic prescribing in upper respiratory tract infection in a primary care setting in Kolkata, India

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