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

Abstract

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 ...

Relevance and Barriers to Evidence-Based Practice in Zambian Defense Force Medical Services: A Qualitative Analysis of Roundtable Group Discussion by Military Health Personnel

“…They stated lack of free time and hectic workload, consistent with other authors from Africa [6,7,10,29] and elsewhere [4,5,8,17,18]. These hurdles can deter staff from attending a journal club, searching for articles, reading or integrating research evidence into practice.…”

“…Negative attitude can negatively affect EBP and common state of affairs in many countries [17,18,21,23]. The possible reasons for pessimistic mind-set include lack of EBP skills, heavy workload, time constraint or other work-related conditions.…”

Therapy interventions for children with neurodisabilities: a qualitative scoping study

“…This very much concurs with the wider accepted view of the current situation 1,6,59 and therapists' views on the barriers to evidence-based practice. [60][61][62][63][64][65][66][67][68] These findings are not unique to the therapy professions investigated in this study, and have been reported across a wide range of health-care professions. [64][65][66] Furthermore, and as other studies report, [61][62][63] the applicability of existing, higher-quality evidence (derived from studies not conducted in routine practice or clinical settings) was questioned.…”

Research and other evidence in practice: the importance of our professional discourse and social relationships

“…Barriers to change of any sort in any environment abound and no less so in attempts to get research into practice. [7][8][9][10] It is possible that the day-to-day use of research in decision-making will eventually become more widespread as the concept itself follows the diffusion of innovations curve proposed by Everett Rogers 11 in which some clinicians adopt the concepts early, the majority join a little later and a few join very much later or not at all. Certainly there seems to be more talk about evidence-based practice, with undergraduate and postgraduate courses incorporating more or less EBD teaching.…”