The Impact of an Evidence-Based Medicine Educational Intervention on Primary Care Physicians: A Qualitative Study

Abstract

BACKGROUND: Attitudes and barriers to implementing EBM have been examined extensively, but scant evidence exists regarding the impact of EBM teaching on primary care physicians' point of care behavior.OBJECTIVE: Gaining insight into behavioral and attitudinal changes of facilitators and participants during a multifaceted EBM educational intervention. DESIGN, SETTING, AND PARTICIPANTS:A qualitative study on primary care physicians and facilitators from a large HMO selected from the intervention arm of a parallel controlled trial using purposeful sampling. We conducted focus groups with 13 facilitators and 17 physicians and semi-structured interviews with 10 facilitators and 11 physicians.RESULTS: Both facilitators and participants believed EBM enhanced the quality of their practice. The intervention affected attitudes and knowledge, but had little impact on physicians' ability to utilize pre-appraised resources at the point of care. Using EBM resources during consultation was perceived to be a complex task and impractical in a busy setting. Conversely, a positive impact on using medication databases was noted. Medication databases were perceived as easy to use during consultations in which the benefits outweighed the barriers. The intervention prompted physicians to write down clinical questions more frequently and to search for answers at home. CONCLUSIONS:This study underlines the need not only to enhance EBM skills, but also to improve the ease of use of EBM resources at the point of care. Tasks should be simplified by tailoring evidence-based information retrieval systems to the busy clinical schedule. Participants' recommendations to establish an HMO decision support service should be considered.

Problem-oriented drug information: physicians’ expectations and impact on clinical practice

“…The results support that EBM is a well-known concept and physicians generally have a positive attitude towards it [4,5]. Our study confirms that time constraints, lack of skills in searching and appraising the literature and limited access to EBM sources are considerable barriers to answering clinical drug questions [1,3,4,11].…”

“…The results support that EBM is a well-known concept and physicians generally have a positive attitude towards it [4,5]. Our study confirms that time constraints, lack of skills in searching and appraising the literature and limited access to EBM sources are considerable barriers to answering clinical drug questions [1,3,4,11]. A study among Danish hospital physicians found that most of them seemed to lack knowledge of the most basic aspects of evidence-based medicine, and this may represent another substantial barrier to implementing EBM into clinical practice [7].…”

“…A study among Danish hospital physicians found that most of them seemed to lack knowledge of the most basic aspects of evidence-based medicine, and this may represent another substantial barrier to implementing EBM into clinical practice [7]. Studies on the effect of training in EBM and searching the literature show contradictory results [4,[22][23][24] and GPs seem to prefer predigested, evidence-based information over developing the skills to produce the information themselves [5]. Even though the physicians have access to search in pre-appraised sources, a major portion of complex questions require an additional search in primary literature [9,10], require access to a diverse set of sources and typically take hours to be answered [9].…”

“…However, in a busy practice this may be difficult, though most physicians are enthusiastic about evidence-based medicine [4,5]. Despite the increased access to updated primary evidence (e.g.…”

“…The most prominent barrier is the lack of time to find the information. Other major barriers include difficulty formulating an appropriate search question, limited search skills and familiarity with evidence-based resources, limited access to EBM sources and the Web in clinics, uncertainty as to whether the relevant information has been found, and lack of skills to appraise the literature and transfer the many pieces of evidence into a clinically useful approach [1,3,4,11].…”