Implementing evidence-based medicine in general practice: a focus group based study.
BACKGROUND
Over the past years concerns are rising about the use of Evidence-Based Medicine (EBM) in health care. The calls for an increase in the practice of EBM, seem to be obstructed by many barriers preventing the implementation of evidence-based thinking and acting in general practice. This study aims to explore the barriers of Flemish GPs (General Practitioners) to the implementation of EBM in routine clinical work and to identify possible strategies for integrating EBM in daily work.


METHODS
We used a qualitative research strategy to gather and analyse data. We organised focus groups between September 2002 and April 2003. The focus group data were analysed using a combined strategy of 'between-case' analysis and 'grounded theory approach'. Thirty-one general practitioners participated in four focus groups. Purposeful sampling was used to recruit participants.


RESULTS
A basic classification model documents the influencing factors and actors on a micro-, meso- as well as macro-level. Patients, colleagues, competences, logistics and time were identified on the micro-level (the GPs' individual practice), commercial and consumer organisations on the meso-level (institutions, organisations) and health care policy, media and specific characteristics of evidence on the macro-level (policy level and international scientific community). Existing barriers and possible strategies to overcome these barriers were described.


CONCLUSIONS
In order to implement EBM in routine general practice, an integrated approach on different levels needs to be developed.
Hannes
Karin
K
Belgian Centre for Evidence-Based Medicine, Belgian Branch of the Cochrane Collaboration, Kapucijnenvoer 33 blok J, 3000 Leuven, Belgium. Karin.hannes@med.kuleuven.be
Leys
Marcus
M
Vermeire
Etienne
E
Aertgeerts
Bert
B
Buntinx
Frank
F
Depoorter
Anne-Marie
AM
D000328:Adult; D001530:Belgium; D002983:Clinical Competence; D019317:Evidence-Based Medicine / Q000193:education*; D005194:Family Practice / Q000193:education* / Q000592:standards; D005260:Female; D017144:Focus Groups; D019983:Guideline Adherence; D006284:Health Plan Implementation; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D036301:Qualitative Research; D018511:Systems Integration; D013997:Time Factors