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Studies addressing barriers towards EBM in general practice |
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| 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] |
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| 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 |
| 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 |
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 |
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| 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] |
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| 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 |
| 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 |
Actors Patients: -Brings info from internet -Not interested in EBM -Not enough competences to understand EBM -Creates uncertainty in the patient |
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| Study Year |
Al-Ansary et al 2002 [11] |
Shawn et al 2003 [12] |
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| Population |
All GPs out of the region Riyadh, Saudi Arabia |
GPs/participants of a national research program on the implementation of EBM, |
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| Design |
Quantitative: cross-sectional research, questionnaire |
Qualitative: semi-structured interviews |
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| Respondents |
N = 559 response rate 86% |
N = 15 |
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| 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 |
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| 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 |
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Hannes et al. BMC Family Practice 2005 6:37 doi:10.1186/1471-2296-6-37 |
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