The use of evidence-based medicine in the practice of consultant physicians. Results of a questionnaire survey.
BACKGROUND
Information is lacking about the extent to which Australasian physicians apply methods of evidence-based medicine (EBM) in routine practice.


OBJECTIVE
To assess the frequency and predictors of use of EBM methods in a sample of consultant physicians in adult medicine.


METHODS
Self-administered questionnaires were distributed to a convenience sample of 545 physicians from October 1998 to January 1999.


RESULTS
One hundred and eleven questionnaires were returned (20% response rate). Ninety-eight (88%) respondents formulated five or less clinical questions per week; 69 (62%) undertook five or more evidence searches per week, the majority as MEDLINE searches involving therapeutic topics. Respondents identified insufficient time (74%), limited search skills (41%), and limited access to evidence (43%) as search impediments. In determining evidence quality, 37% frequently relied on global impressions, while 22% frequently applied explicit critical appraisal (p=0.008). Efficiency of literature searches was rated on average as good/very good by 18%, fair by 52% and poor by 30%. As a result of EBM, 47% frequently had confidence in pre-existing decisions increased, 39% gained improved knowledge, and 5% altered clinical decisions. Frequently encountered inhibitors to changing practice were personal conservatism (40%), organisational constraints (40%), and interdisciplinary tensions (39%). Perceived weaknesses of EBM included: limited applicability to individual patients (26%); evidence deficiencies (25%); and too time consuming (13%). In making EBM more attractive, one third requested reliable evidence sources at the point of care.


CONCLUSIONS
The application of EBM to routine practice by physicians is constrained by deficient EBM skills, limited access to evidence, lack of time, and cognitive and environmental factors. Targeted education in EBM and systems that quickly deliver high-quality evidence at the point of care are needed in realising the full potential of EBM to improve care.
Princess Alexandra Hospital, Brisbane, Qld. scotti@health.qld.gov.au
I
I
Scott
R
R
Heyworth
P
P
Fairweather
D001315:Australia; D002983:Clinical Competence; D019992:Databases as Topic; D019317:Evidence-Based Medicine; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016239:MEDLINE; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D013997:Time Factors