Table 1 Studies addressing barriers towards EBM in general practice
From: Implementing evidence-based medicine in general practice: a focus group based study
Study Year | Olantunbosun et al, 1998 [1] | Mc Coll et al 1998 [2] | McAlister et al 1999 [3] | Mayer et al 1999 [4] | Tomlin et al 1999 [5] |
|---|---|---|---|---|---|
Population | Randomised sample of GPs and Gynaecologists in Canada | Randomised sample of GPs in Wessex, United Kingdom | Gps, members of the 'Canadian Society of Internal Medicine, Canada | Purposeful sample of GPs of educational programs, courses, supervisors of the 'Adelaide Royal Australian college of GPs', GPs from the Darwin Urban division of GPs, Australia | Purposeful sample of 8 practices of GPs in the North Tames region, members of the 'Medical Research Council General Practice Research Framework', United Kingdom |
Design | Quantitative: Questionnaire | Quantitative: Questionnaire | Cross-sectional research: Questionnaire | Qualitative: Focus groups | Qualitative: Semi-structured interviews |
Respondents | N = 154 GPs Response rate 78% | N = 452 Response rate 67% | N = 294 Response rate 60% | N = 27 | N = 24 |
Barriers | Factors -Time consuming -Decrease of the art of medicine -Lack of evidence -Experience not taken into account | Factors -no skills in critical appraisal -EBM threatens GPs -Time consuming -No access to information -Organisational Chaos -No financial profits -Gaps in evidence -Evidence does not fit general practice -Too much evidence -Evidence hard to implement | Factors -Too academic -Decrease of the art of medicine -Movement still young -Gaps in evidence -not applicable to individual patient -Decrease of importance of experience | Factors -Reduction of therapeutic freedom -Contradictions in evidence -Not applicable in daily practice -Not applicable to individual patient -Studies too quantitative | Factors -lack of time -Lack of information sources -Lack of knowledge and skills -Too much pressure, less motivation -Evidence does not count complexity of situations in practice |
| Â | Actors Patients -erosion of autonomy | Actors Patients: -expectations do not fit EBM -does not except certain advice Colleagues: -Not evidence-based minded Government: -No investments Media: -Counterproductive messages | Â | Actors Commercial organisations: -have influence on evidence Patients: -Do not count in terms of risks | Actors Patients: -No compliance -Specific cultural background -Specific values and knowledge -Behaviour GP = avoiding conflict -Clientism |
Study Year | Scott et al 2000 [6] | Freeman et al 2001 [7] | Young et al 2001 [8] | Ely et al 2002 [9] | Putnam et al 2002 [10] |
Population | Sample of members from the 'Internal Medicine Society', Australia and New Zealand, participants of an EBM-course program, doctors with a practice in 5 hospitals | Purposeful sample of GPs out of three regions concentrated around a hospital, United Kingdom | 1. GPs, participants of a research project on preventive care, selection of those willing to participate, Australia | Sample of GPs in Iowa, United States | Purposeful sample of GPs with a minimum of one year experience, patients with cardiovascular problems, working in the region Nova Scotia, Scotland |
Design | Quantitative: Questionnaire | Qualitative: 3 focus groups | 1. Quantitative: Questionnaire 2. Qualitative: semi-structured interviews | Qualitative: observations | Qualitative: 9 focus groups |
Respondents | N = 111 Response rate 20% | N = 19 | N = 60 | N = 25 | N = 50 |
Barriers | Factors -Lack of time -No access to information -Problems in organisation -Lack of knowledge and skills -GPs not motivated -Not applicable to individual patient -Inconsequence in evidence | Factors -Lack of logistic support -Too many habitudes -Decrease of importance of experience | Factors -Lack of time -High cost of information sources -Lack of skills -Not applicable in daily practice -Evidence-Based acting = less patients an hour | Factors -Lack of knowledge and skills -Too less capacities to implement EBM in practice | Factors -Lack of time -Lack of competences -Evidence = dogma, confusing -Not applicable to individual patient -Decrease of importance of experience |
| Â | Â | Actors Patients: -Does not accept certain advice -Specific characteristics -Asks for certain treatments -Do not always understand evidence-based message Colleagues: -Do not consider the patient in total -Specialist = evidence-based mafia | Actors Patients: -Asks for certain treatments -Specific expectations -Do not always understand evidence-based message | Â | Actors Patients: -Brings info from internet -Not interested in EBM -Not enough competences to understand EBM -Creates uncertainty in the patient |
Study Year | Al-Ansary et al 2002 [11] | Shawn et al 2003 [12] | Â | Â | Â |
Population | All GPs out of the region Riyadh, Saudi Arabia | GPs/participants of a national research program on the implementation of EBM, | Â | Â | Â |
Design | Quantitative: cross-sectional research, questionnaire | Qualitative: semi-structured interviews | Â | Â | Â |
Respondents | N = 559 response rate 86% | N = 15 | Â | Â | Â |
Barriers | Factors -Lack of time -No access to information sources -Limited information sources -No high quality training programs available | Factors -Lack of time -Lack of information sources -No access to information sources -Lack of competences -Scientific studies not attractive -Decrease of the art of medicine -Decrease of clinical autonomy -Too much pressure -Inconsequence in evidence -Reliability and generalisation of scientific studies? -Not applicable in general practice -GPs actions based on intuition | Â | Â | Â |
| Â | Actors Patients: -Specific attitude | Actors Patients: -Values and preferences of patients must be considered Colleagues: -Too less specialists working local Commercial organisations: -evidence sponsored by industry | Â | Â | Â |