Barriers to the use of evidence-based medicine: knowledge and skills, attitude, and external factors

Abstract

Although efforts are made to integrate evidence-based medicine (EBM) into clinical practice, physicians experience significant barriers to its implementation. The aim of this study is to quantify the barriers that general practice (GP) trainees experience when using EBM in practice. In September 2008, a questionnaire was administered to 140 GP trainees from three Dutch GP Speciality Training Institutes. The questionnaire focused on barriers that GP trainees meet when using EBM in practice. Factor analysis identified components in which barriers exist, and the validity and reliability of the questionnaire were established. After removing four items that did not fit the questionnaire structure, factor analysis identified three relevant components. All three components had similar mean scores, indicating a similar negative influence of these components on the practice of EBM: knowledge/skills (α = 0.72, mean score 2.9 ± 0.8), attitude (α = 0.70, mean score 2.9 ± 0.6), and external factors (α = 0.66, mean score 3.0 ± 0.5). The barrier that trainees experienced most was lack of time to practise EBM. Barriers to the use of EBM were present in three components: knowledge/skills, attitude, and external factors.

Learning results of GP trainers in a blended learning course on EBM: a cohort study

“…After all the questionnaires had been scored, a sample of 10 questionnaires from T 0 , T 1 and T 2 (a total of 30 questionnaires) were re-examined by another researcher. Scoring of both these questionnaires was compared to assess agreement in scoring.EBM attitudeAttitude towards EBM was examined using the questionnaire developed by McColl and colleagues for the assessment of EBM attitude in GPs [33], and has been used in multiple studies on EBM [2, 30, 34]. The questionnaire has been forward–backward translated into Dutch [35] and was adjusted, where necessary, for the GP trainers.…”

“…They also experience barriers related to their practice and patient population [2], such as a lack of time, patient-related factors and a lack of available evidence. All these barriers [3] are also experienced by GP trainers despite the additional education they received to become trainers.…”

Preparing Dental Students and Residents to Overcome Internal and External Barriers to Evidence‐Based Practice

“…Traditionally cited barriers to EBD include lack of time, difficulty discerning the best possible evidence, and patient factors (e.g., patient preferences, financial concerns, and medico-legal concerns). [2][3][4] However, the reality appears more complicated. Clinicians of all experience levels need to be aware of the biases that affect their decision making on a daily basis.…”

“…Commonly cited barriers to EBD include a lack of time, poor access to continually changing evidence, uncertainty regarding the applicability or quality of evidence, inadequate training, and the lack of a streamlined information system. [2][3][4] Unfortunately, this list of barriers focuses primarily on only the first aspect of the ADA's definition: the pursuit of clinically relevant scientific evidence. Thus, this list of barriers seems inadequate in the context of how oral health care practitioners actually diagnose and treat patients.…”

A New Method of Assessing the Impact of Evidence-Based Medicine on Claim Outcomes

“…Previous work investigating EBM 5,6 has focused on adoption of these guidelines in both general practice 7,8 and in workers compensation (CWCI), integration of EBM into the decision making process, 9,10 methods to evaluate the harm versus benefit of treatment choices, 11 and criticisms of EBM. 12,13 To date, there has not been a comprehensive study to evaluate the impact of adherence to EBM guidelines on medical costs and the duration of patient treatment.…”