Family physicians' experience and understanding of evidence-based practice and guideline implementation in primary care practice, Cape Town, South Africa.

Michael K Pather,Robert Mash

doi:10.4102/phcfm.v11i1.1592

Michael K Pather, Robert Mash

Open Access

https://doi.org/10.4102/phcfm.v11i1.1592

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Abstract

BackgroundIn primary care, patients present with multimorbidity and a wide spectrum of undifferentiated illnesses, which makes the application of evidence-based practice (EBP) principles more challenging than in other practice contexts.AimThe goal of this study was to explore the experiences and understanding of family physicians (FP) in primary care with regard to EBP and the implementation of evidence-based guidelines.SettingThe study was conducted in Cape Town primary care facilities and South African university departments of Family Medicine.MethodsFor this phenomenological, qualitative study, 27 purposefully selected FPs from three groups were interviewed: senior academic FPs; local FPs in public-sector practice; and local FPs in private-sector practice. Data were analysed using the framework method with the assistance of ATLAS.ti, version 6.1.ResultsGuideline development should be a more inclusive process that incorporates more evidence from primary care. Contextualisation should happen at an organisational level and may include adaptation as well as the development of practical or integrated tools. Organisations should ensure synergy between corporate and clinical governance activities. Dissemination should ensure that all practitioners are aware of and know how to access guidelines. Implementation should include training that is interactive and recognises individual practitioners’ readiness to change, as well as local barriers. Quality improvement cycles may reinforce implementation and provide feedback on the process.ConclusionEvidence-based practice is currently limited in its capacity to inform primary care. The conceptual framework provided illustrates the key steps in guideline development, contextualisation, dissemination, implementation and evaluation, as well as the interconnections between steps and barriers or enablers to progress. The framework may be useful for policymakers, health care managers and practitioners in similar settings.

Highlights

IntroductionThe principles of evidence-based practice (EBP), are not as applied in primary care as in the biomedical and more disease-centred context of hospital care, where the process of evidence-based medicine (EBM) was originally developed.[5] Primary care is characterised by undifferentiated multiple problems across a broad spectrum of reasons for encounter with a complex interplay of medical, social and psychological issues
One of the most consistent findings in health services research is the gap between evidence and practice.[1,2,3] Bridging this gap is central to ensuring that beneficial interventions are used appropriately and harmful interventions are avoided.[4]The principles of evidence-based practice (EBP), are not as applied in primary care as in the biomedical and more disease-centred context of hospital care, where the process of evidence-based medicine (EBM) was originally developed.[5]
In the public sector of the Cape Town metropole, family physicians (FPs) were appointed at community health centres where they were the senior clinicians in multidisciplinary teams that included medical officers, clinical nurse practitioners, pharmacists and other allied health professionals

Summary

Introduction

The principles of evidence-based practice (EBP), are not as applied in primary care as in the biomedical and more disease-centred context of hospital care, where the process of evidence-based medicine (EBM) was originally developed.[5] Primary care is characterised by undifferentiated multiple problems across a broad spectrum of reasons for encounter with a complex interplay of medical, social and psychological issues. Practitioners need research evidence for the whole range of diagnostic, prognostic, interventional and phenomenological questions that arise within this context.[6] Concern has been raised that research is often conducted in areas outside of primary care with limited generalisability.[7] In addition research evidence from the primary care setting is often of poor quality[8] and evidence derived from randomised controlled trials constitutes only a portion of the real knowledge that is needed.[9] http://www.phcfm.org. Patients present with multimorbidity and a wide spectrum of undifferentiated illnesses, which makes the application of evidence-based practice (EBP) principles more challenging than in other practice contexts

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