Evidence-based practice in rural and remote clinical practice: where is the evidence?
OBJECTIVE
To critically review the evidence regarding barriers to implementing research findings in rural and remote settings, and the ways those barriers have been addressed.


METHODS
A systematic review that included searching several electronic databases, Internet sites and reference lists of relevant articles, assessment of methodological quality of the studies, and data extraction and analysis where possible. Eligibility for the review was not limited by study design.


METHODS
Studies that reported on: (1) barriers to the implementation of evidence by health professionals in rural and remote areas, or (2) interventions for implementing evidence-based practice or an element of evidence-based practice in rural and remote areas.


RESULTS
There were no experimental data available on the implementation of research findings in rural and remote clinical settings. The small amounts of empirical research undertaken (surveys) showed that some of the problems experienced by general practitioners were exacerbated by rural and remote location, particularly with relation to isolation, lack of time and locum cover, and poor information technology infrastructure.


CONCLUSIONS
There is a paucity of empirical literature on implementing evidence-based practice in rural and remote settings. This is in contrast to the large amount of literature available on implementing evidence in other clinical settings. A clear finding from the literature was that getting evidence into practice needs to be context-specific and yet very little research has been conducted into the rural and remote context. Research is needed into how evidence can be implemented in contextually specific ways in rural and remote areas.
Parsons
Jacqueline E
JE
Health Technology Assessment Unit, Department of Public Health, University of South Australia, Adelaide, Australia.
Merlin
Tracy L
TL
Taylor
Judy E
JE
Wilkinson
David
D
Hiller
Janet E
JE
D003627:Data Interpretation, Statistical; D016208:Databases, Factual; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine; D006801:Humans; D033181:Information Dissemination / Q000379:methods; D008507:Medically Underserved Area; D012106:Research; D012107:Research Design; D019035:Rural Health Services