Evidence-based medicine in primary care: qualitative study of family physicians.

C Shawn Tracy,Ross Eg Upshur,Guilherme Coelho Dantas

doi:10.1186/1471-2296-4-6

Abstract

BackgroundThe objectives of this study were: a) to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM) in primary care; b) to investigate the influence of patient preferences on clinical decision-making; and c) to explore the role of intuition in family practice.MethodQualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians.ResultsParticipants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician.DiscussionPrimary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour.

Highlights

The objectives of this study were: a) to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM) in primary care; b) to investigate the influence of patient preferences on clinical decision-making; and c) to explore the role of intuition in family practice
In response to the critics and the admitted shortcomings of the original formulation of Evidence-based medicine (EBM), there has been a transformation within EBM itself as exemplified by the proposed distinction between evidence-based practitioners and evidence users [10] and the newly-articulated framework highlighting the interaction among clinical expertise, patient preferences and values, research evidence, and clinical state and circumstances [11]
Benefits and barriers The vast majority of respondents welcomed the promotion of EBM in family practice; participants enumerated a significant list of barriers and limitations pertaining to implementation (Table 2)

Summary

Introduction

The objectives of this study were: a) to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM) in primary care; b) to investigate the influence of patient preferences on clinical decision-making; and c) to explore the role of intuition in family practice. In response to the critics and the admitted shortcomings of the original formulation of EBM, there has been a transformation within EBM itself as exemplified by the proposed distinction between evidence-based practitioners and evidence users [10] and the newly-articulated framework highlighting the interaction among clinical expertise, patient preferences and values, research evidence, and clinical state and circumstances [11]. These significant modifications to the original model indicate that EBM is an evolving methodology currently in transition. The objective of this study was to investigate physician attitudes to and experience of the practice of EBM in primary care, with respect to the influence of patient preferences and the role of intuition in clinical decision-making

Objectives

Methods

Results

Conclusion