Improved quality and more attractive work by applying EBM in disability evaluations: a qualitative survey.

Jan L Hoving,Frank J H Van Dijk,Rob Kok,Jos H Verbeek,Paul B A Smits,Sarah M Ketelaar

doi:10.1186/s12909-016-0599-z

Abstract

BackgroundThe uptake of evidence in practice by physicians, even if they are trained in the systematic method of evidence-based medicine (EBM), remains difficult to improve. The aim of this study was to explore perceptions and experiences of physicians doing disability evaluations regarding motivators and preconditions for the implementation of EBM in daily practice.MethodsThis qualitative study was nested in a cluster randomized controlled trial (Trial registration NTR1767; 20-apr-2009) evaluating the effects of training in EBM. The 45 physicians that participated received a comprehensive 6-months training program in EBM of which the last course day included audio-recorded interviews in groups. During these interviews participating physicians discussed perceptions and experiences regarding EBM application in daily practice. In an iterative process we searched for common motivators or preconditions for the implementation of EBM.ResultsThree main concepts or themes emerged after analyzing the transcriptions of the discussions: 1) improved quality of physicians’ actions, such as clients benefiting from the application of EBM; 2) improved work attractiveness of physicians; and 3) preconditions that have to be met in order to work in an evidence-based manner including professional competence, facilitating material conditions and organizational support and demands.ConclusionsPhysicians trained in EBM are motivated to use EBM because they perceive it as a factor improving the quality of their work and making their work more attractive. In addition to personal investments and gains, organizational support should further facilitate the uptake of evidence in practice.

Highlights

The uptake of evidence in practice by physicians, even if they are trained in the systematic method of evidence-based medicine (EBM), remains difficult to improve
We showed that the use of evidence in the daily practice of physicians performing disability evaluations can be improved through the application of a clinically integrated comprehensive postgraduate EBM training program [6]
In a similar educational EBM program among general practitioners developed by Shuval et al [9] physicians reported that EBM enhanced the quality of their practice with regard to justifying decisions and selecting best treatment for patients

Summary

Introduction

The uptake of evidence in practice by physicians, even if they are trained in the systematic method of evidence-based medicine (EBM), remains difficult to improve. The use of evidence is considered good clinical practice [1], the uptake of evidence in practice by physicians, even if they have been trained in the systematic method of evidence-based medicine (EBM), remains difficult to improve [2] This is a problem during and after continuous medical education programs, where the final aim is to change professional behavior [3,4,5]. General practitioners focus on diagnosis and treatment decisions, whereas physicians involved in disability evaluation mainly focus on client limitations in work or work disability resulting from a chronic disease or handicap, how these limitations will evolve and how adverse effects on work ability can be minimized [6, 7] Given these differences in tasks, we wanted to study if the themes mentioned above are similar for physicians performing disability evaluations after participating in a EBM course [6, 8]

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Methods

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Conclusion