Barriers and facilitators to use of a clinical evidence technology in the management of skin problems in primary care: insights from mixed methods.

Marianne D Burke,Benjamin Littenberg,Liliane B Savard,Alan S Rubin

doi:10.5195/jmla.2020.787

Abstract

Objective:Few studies have examined the impact of a single clinical evidence technology (CET) on provider practice or patient outcomes from the provider's perspective. A previous cluster-randomized controlled trial with patient-reported data tested the effectiveness of a CET (i.e., VisualDx) in improving skin problem outcomes but found no significant effect. The objectives of this follow-up study were to identify barriers and facilitators to the use of the CET from the perspective of primary care providers (PCPs) and to identify reasons why the CET did not affect outcomes in the trial.Methods:Using a convergent mixed methods design, the authors had PCPs complete a post-trial survey and participate in interviews about using the CET for managing patients' skin problems. Data from both methods were integrated.Results:PCPs found the CET somewhat easy to use but only occasionally useful. Less experienced PCPs used the CET more frequently. Data from interviews revealed barriers and facilitators at four steps of evidence-based practice: clinical question recognition, information acquisition, appraisal of relevance, and application with patients. Facilitators included uncertainty in dermatology, intention for use, convenience of access, diagnosis and treatment support, and patient communication. Barriers included confidence in dermatology, preference for other sources, interface difficulties, presence of irrelevant information, and lack of decision impact.Conclusion:PCPs found the CET useful for diagnosis, treatment support, and patient communication. However, the barriers of interface difficulties, irrelevant search results, and preferred use of other sources limited its positive impact on patient skin problem management.

Highlights

Clinical evidence technologies (CETs) are information sources derived from medical research literature that assist health care providers in continued learning, decision making, and patient care
Twenty-one of the 32 (66%) primary care providers (PCPs) in the original trial participated in the post-trial survey: 13 of 17 (76%) in the CET arm, and 8 of 15 (53%) in the control arm (Table 1)
When asked if VisualDx was useful for diagnosing and treating patients, 5 PCPs (38%) responded “usually,” 5 (38%) responded occasionally, and 3 (23%) responded “not at all”; none found it “always” useful. These findings indicated that the CET was perceived as easier to use than useful (Table 2)

Summary

Introduction

Clinical evidence technologies (CETs) are information sources derived from medical research literature that assist health care providers in continued learning, decision making, and patient care. Evidence-based medicine (EBM), defined as “the integration of best research evidence with clinical expertise and patient values” [1], endorses the use of research-based evidence found in CETs—including medical journals, databases, clinical guidelines, and synthesized clinical summaries—to find evidence for patient care. Clinicians report referencing CETs and using the information therein to make better diagnosis and treatment decisions [2,3,4]. They report barriers to answering their clinical questions, such as poor technology access, lack of relevant evidence sources, and time constraints [5,6,7].

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Discussion

Conclusion