Background
Attitudes and barriers to implementing EBM have been examined extensively, but scant evidence exists regarding the impact of EBM teaching on primary care physicians’ point of care behavior.
Objective
Gaining insight into behavioral and attitudinal changes of facilitators and participants during a multifaceted EBM educational intervention.
Design, setting, and participants
A qualitative study on primary care physicians and facilitators from a large HMO selected from the intervention arm of a parallel controlled trial using purposeful sampling. We conducted focus groups with 13 facilitators and 17 physicians and semi-structured interviews with 10 facilitators and 11 physicians.
Results
Both facilitators and participants believed EBM enhanced the quality of their practice. The intervention affected attitudes and knowledge, but had little impact on physicians’ ability to utilize pre-appraised resources at the point of care. Using EBM resources during consultation was perceived to be a complex task and impractical in a busy setting. Conversely, a positive impact on using medication databases was noted. Medication databases were perceived as easy to use during consultations in which the benefits outweighed the barriers. The intervention prompted physicians to write down clinical questions more frequently and to search for answers at home.
Conclusions
This study underlines the need not only to enhance EBM skills, but also to improve the ease of use of EBM resources at the point of care. Tasks should be simplified by tailoring evidence-based information retrieval systems to the busy clinical schedule. Participants’ recommendations to establish an HMO decision support service should be considered.
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Acknowledgments
We would like to thank the primary care physicians and course facilitators who took part in the study. In addition, we thank The Galil Center for Medical Informatics and Telemedicine for giving administrative and logistic support. This paper was presented in The Second Israeli National Convention of Qualitative Research Methodologies on June 5th, 2006.
Financial Support
The Israel National Institute for Health Policy and Health Services Research and the Roter Fund (Maccabi Health Services).
Potential Financial Conflicts of Interest
None disclosed.
Ethical Approval
An exemption from the Helsinki Committee [Institutional Review Board (IRB)] of the Emek Medical Center, Afoula, Israel.
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Appendix
Appendix
Questions (Followed by Probes) for Focus Groups and Interviews
General Perceptions of EBM
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1.
How do you perceive EBM?
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1.1
What’s your definition of EBM?
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1.2
What’s your opinion of EBM?
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1.3
What do you think of critical appraisal and the use of pre-appraised resources?
EBM and Clinical Practice
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2.
How does EBM affect (if at all) your clinical practice?
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2.1
Are you able to incorporate EBM in your daily professional life?
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2.2
Is EBM practicable at the point of care? What’s the best way, in your opinion, to implement EBM?
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2.3
Do you utilize EBM resources in your practice? If so, do you do so at the point of care?
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2.4
If you utilize EBM resources, please elaborate on which resources you use. How long does it normally take to find an answer to a clinical question? If you aren’t able to find a clinical answer, what steps (if any) do you take to obtain an answer?
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2.5
Which factors, in your opinion, inhibit or promote the applicability of EBM?
Impact of the EBM Intervention
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3.
What impact (if any) has the EBM course had on your practice?
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3.1
How has the course affected you (if at all)? Are you able to use EBM more as a result of the course? Please elaborate.
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3.2
Do you utilize more pre-appraised resources or other facets of EBM as a result of the intervention?
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3.3
Has the course influenced your behavior when dealing with barriers to EBM practice?
Attitudes Towards the EBM Intervention
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4.
What did you think of the EBM course you participated in or facilitated?
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4.1
What’s your opinion regarding the workshop phase and one-on-one sessions? What has influenced you more (if at all)?
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4.2
What’s your opinion regarding the content taught in the course?
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4.3
Did you encounter any difficulties during the course?
Questions for Facilitators Only
Pre-intervention:
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5.
How do you perceive your role as facilitator in the intervention?
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5.1
What are your expectations of the intervention?
Post-intervention
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5.2
Have any changes (attitudes, knowledge, behavior or other) accrued in you and your course trainees as a result of the intervention?
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5.3
Which difficulties and successes have you encountered during the intervention?
Additional Information
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6.
Is there anything else you would like to add?
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Shuval, K., Shachak, A., Linn, S. et al. The Impact of an Evidence-Based Medicine Educational Intervention on Primary Care Physicians: A Qualitative Study. J GEN INTERN MED 22, 327–331 (2007). https://doi.org/10.1007/s11606-006-0055-6
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DOI: https://doi.org/10.1007/s11606-006-0055-6