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Table 2 Studies addressing strategies to bridge barriers towards EBM in general practice

From: Implementing evidence-based medicine in general practice: a focus group based study

Study Year Hayward et al 1999 [13] Oswald et al 1999 [14] Brassey et al 2001 [15] Markey et al 2001 [16] Alper et al 2001 [17]  
Population Stratified, randomised sample of GPs in division South of Adelaide, Australia Theoretical sample of GPs willing to participate, with patients with a non-rheumatic atrial fibrillation, 6 general practices in Cambridge, United Kingdom GPs who use the information service ATTRACT ('evidence-based summaries to clinical queries'), United Kingdom All GPs/members of the 'Monash Division of General Practice in the South-East Suburbs' of Melbourne, Australia 2 GPs 2 information-specialists, United States  
Design Action research, Telephonic interviews No control group mentioned Prospective research design: 6 months follow-up No control group mentioned Quantitative: Questionnaires, No control group mentioned Quantitative: RCT Registration of answers to questions found in medical databases  
Respondents N = 31 N = ? N = 42
response rate 84%
N = 132
response rate 48%
N = 4  
Tested interventions Set-up of an online support system through which doctors can submit a form with their question(s), being answered by an information specialist Evaluation of plans of care of patients in patients records, evaluation of current type of care in the framework of criteria of a treatment protocol the doctors made themselves. Set-up of an online support system through which doctors can submit a form with their question(s), being addressed with a summary of current scientific results 'Academic detailing': introduction in EBM and exploration of knowledge and attitudes by an educative worker in the home practice of the GP Identification of qualitative databases, being able to answer questions of GPs  
Conclusion GPs found the answers useful to support their clinical decisions. In four of twenty cases the answers had a positive effect on the management of the patient. Doctors noted their reasons to neglect the recommendations of the protocol very explicit. They pointed at the difficulties of applying the recommendations of the protocol on their individual patient. GPs appreciate clear summaries of scientific literature. The answers lead to a change in daily clinical practice. 'Academic detailing' leads to a significant improvement in knowledge and understanding of EBM, but does not affect the attitude towards EBM. It is not clear whether academic detailing can motivate practitioners to change their clinical practice. Existing databases are capable of answering most questions of practitioners. However, a lot of gaps in scientific knowledge should still be addressed.  
Study Year Del Mar et al 2001 [18] Swinglehurst et al 2001 [19] Fritsche et al 2002 [20] Greenhalgh et al 2002 [21] Al-Ansary et al 2002 [11] Schwartz et al 2003 [22]
Population GPs with an education in information programs, Australia GPs of the region Fulham and Hammersmith, United Kingdom Participants of a course program on EBM, Berlin, Germany Selection of doctors in the field of primary care All GPs out of the region Riyadh, Saudi Arabia 3 GPs from one practice, coaching junior doctors for the university of Detroit, United States
Design Action Research, Questionnaire No control group mentioned Descriptive pilot study: Questionnaire and semi-structured interviews, No control group mentioned Quantitative: pre-post design Case studies combined with qualitative research methods Quantitative: cross-sectional research with questionnaire Prospective research design: Registration of search results, 3 months follow-up
Respondents N = 71 N = 34
response rate 34%
Two Cohorts
N 1999 = 82
N 2000 = 50
N 2001 = 71
N = ? N = 559
response rate 86%
N = 3
Tested or interventions Set-up of two information desks to assist practitioners in their search for medical literature (Quest and Aqua) Set-up of a clinical information system (helpdesk) to support practitioners in taking their clinical decisions Intensive 3-day course in EBM Comparison of an academic feedback system for practitioners and a practice-oriented feedback system Suggested intervention: Training programs in searching scientific literature and critical appraisal, the use of clinical guidelines and protocols Searching for evidence during the encounter with the patient
Conclusion An information desk is useful to assist practitioners with their search. However, a cost-utility analysis should be undertaken to evaluate both information desks. The helpdesks succeeds in creating a better access to 'evidence' for practitioners. GPs are satisfied with the system, but the number of users is very low. For those who used it, it actually led to a change in their clinical practice. The course led to a significant improvement of knowledge and skills towards EBM. A good information system simultaneously provides a search engine for researchers and a search engine for practitioners. Concrete actions to implement EBM in the field of health care are very necessary. Time that must be invested in a search for answers is an important barrier to use information systems during patient encounters. It can be bridged by high quality summaries of literature. Faster internet connections are necessary.