The "evidence-based practice inventory": reliability and validity was demonstrated for a novel instrument to identify barriers and facilitators for Evidence Based Practice in health care.

OBJECTIVES: To design and validate a practical questionnaire for clinicians, to identify barriers and facilitators for evidence-based practice (EBP), that is, the use of research evidence in patient care. The inventory is ultimately intended for departments to assess local conditions for EBP, to aim and evaluate efforts at improving or maximizing EBP. STUDY DESIGN AND SETTING: We derived candidate items from existing EBP scales, psychology, and behavioral economics. In an online Delphi study, 537 international expert clinicians, researchers, teachers, and policymakers interested in EBP identified items with sufficient face and content validity. We piloted and validated the resulting draft inventory among 127 clinicians from various specialties and career stages. RESULTS: The Delphi study started with 114 items and resulted in a draft inventory with 29 items in five dimensions. During the pilot, the inventory was easy to complete within 15 minutes and the items showed sufficient response variation. In four of five dimensions, test-retest reliability was substantial to almost perfect and the power to discriminate between groups with different expertise was adequate, whereas internal consistency showed that the items generally measured the same construct. On the basis of internal consistency and factor analysis, we excluded three items. The final EBP inventory consists of 26 items in five dimensions: decision making, subjective norm, attitude, perceived behavior control, and intention and behavior. DISCUSSION AND CONCLUSION: The EBP inventory was developed with support of EBP experts and validated among various academic clinicians. It shows adequate face and content validity, internal consistency, test-retest reliability, discriminative power, and completion will take <15 minutes. We recommend further evaluation of its value in field trials.

Do general practitioners follow treatment recommendations from guidelines in their decisions on heart failure management? A cross-sectional study.

OBJECTIVE: To investigate whether general practitioners (GPs) follow treatment recommendations from clinical practice guidelines in their decisions on the management of heart failure patients, and assess whether doctors' characteristics are related to their decisions. DESIGN: Cross-sectional vignette study. SETTING: Continuing Medical Education meeting. PARTICIPANTS: 451 Dutch GPs. MAIN OUTCOME MEASURES: Answers to four multiple-choice treatment decisions in clinical vignettes of a patient with heart failure and a reduced ejection fraction. With univariable and multivariable regression analyses, respondent characteristics were related to optimal treatment decisions. RESULTS: Of the 451 GPs, none took four optimal decisions: 7% considered stopping statin treatment, 36% initiated ß-blocker treatment at a low-dose and 4% doubled the ß-blocker in the up-titration phase. Finally, for our vignette patient now also suffering from chronic obstructive pulmonary disease, 45% of the GPs continued ß-blocker therapy even when they considered prescribing a long-acting ß2-agonist. While the relation between respondent characteristics and each decision was very different, none was independently associated with all four decisions. Giving priority to evidence-based medicine was independently related to stopping statin treatment and doubling the ß-blocker in the up-titration phase. CONCLUSIONS: GPs seem not to follow treatment recommendations from clinical practice guidelines in their decisions on the management of heart failure patients. The recommendations from guidelines may appear counterintuitive when statin treatment needs to be stopped when a patient feels comfortable, or when a ß-blocker should be up-titrated in patients who experience more symptoms. Giving priority to evidence-based medicine is possibly positively related to difficult treatment decisions.

Doctors' perceptions and use of evidence-based medicine: a systematic review and thematic synthesis of qualitative studies.

PURPOSE: Many primary qualitative studies of barriers and facilitators for doctors' use of evidence-based medicine (EBM) are available, but knowledge remains fragmented. This study sought to synthesize the results of these qualitative studies, taking the variability across context (i.e., medical disciplines, career stages, practice settings, and time of study) into account. METHOD: The authors searched PubMed through April 26, 2012, and independently selected studies according to prespecified criteria for relevance and methodological quality. Additionally, they performed a thematic synthesis through line-by-line interpretation, coding, and thematic arrangement of information. RESULTS: The search resulted in 1,211 publications, of which 30 studies were included. Five major themes emerged on barriers and facilitators for doctors' use of EBM: individual mind-set, professional group norms, EBM competencies, balance between confidence and critical reflection, and managerial collaboration. The authors found particular barriers and facilitators across career stages. Although clinical experience and professional status were perceived to be helpful, they could also prevent doctors from identifying information needs and adopting new evidence. Although residents' lack of clinical experience raised awareness of information needs, residents perceived lack of clinical experience and their hierarchical dependence on staff as barriers to articulating information needs and to translating and introducing evidence to patient care. CONCLUSIONS: Encouragement of group norms for safe communication and shared learning across career stages is perceived as the most prominent facilitator for EBM.

Career stage and work setting create different barriers for evidence-based medicine.

RATIONALE, AIMS AND OBJECTIVES: Although many barriers to practising evidence-based medicine (EBM) are described, it remains poorly understood why clinicians do, and do not, incorporate high-quality evidence into their routine practice. To date, a comprehensive framework for the classification for barriers to practising EBM is lacking. This qualitative study explored the relationship between differences in career stage and work setting among doctors and their perceived barriers for practising EBM. We also explored an alternative classification of barriers. METHODS: Purposive participant sampling reflected three career stages in two different work settings: four registrars, four consultant anaesthetists and four senior anaesthetists from two departments of anaesthesiology, in an academic and a general hospital, in The Netherlands. Perceptions on practising EBM and its barriers were explored in semi-structured interviews. Using grounded theory approach, we build a framework for the classification of these barriers. RESULTS: In both departments, registrars and consultants demonstrated little sense of urgency to work on their EBM performance; registrars struggled with information overload and hierarchical dependence, and consultants practised confidence-based medicine. Senior doctors in both departments reported that combining clinical work with leadership tasks made them more reflective, and therefore more susceptible to the reasoning approach inherent within the current approach to EBM. They considered themselves willing and able to apply EBM, and were reported to act accordingly. Differences in setting that complicated practising EBM related to the general hospital. The absence of formal hierarchy among doctors resulted in a lack of medical consensus and an absence of integrated management teams hindered collaboration between doctors and non-medical managers. We identified 10 conditions that were conducive to the practice of EBM. CONCLUSIONS: Both career stage and work setting were associated with perceived barriers to practising EBM. We have included these in our theoretical framework for classification of these barriers.