title: The impact of an evidence-based medicine educational intervention on primary care physicians: a qualitative study.
abstract: BACKGROUND
  Attitudes and barriers to implementing EBM have been examined extensively, but scant evidence exists regarding the impact of EBM teaching on primary care physicians' point of care behavior.
  
  
  OBJECTIVE
  Gaining insight into behavioral and attitudinal changes of facilitators and participants during a multifaceted EBM educational intervention.
  
  
  METHODS
  A qualitative study on primary care physicians and facilitators from a large HMO selected from the intervention arm of a parallel controlled trial using purposeful sampling. We conducted focus groups with 13 facilitators and 17 physicians and semi-structured interviews with 10 facilitators and 11 physicians.
  
  
  RESULTS
  Both facilitators and participants believed EBM enhanced the quality of their practice. The intervention affected attitudes and knowledge, but had little impact on physicians' ability to utilize pre-appraised resources at the point of care. Using EBM resources during consultation was perceived to be a complex task and impractical in a busy setting. Conversely, a positive impact on using medication databases was noted. Medication databases were perceived as easy to use during consultations in which the benefits outweighed the barriers. The intervention prompted physicians to write down clinical questions more frequently and to search for answers at home.
  
  
  CONCLUSIONS
  This study underlines the need not only to enhance EBM skills, but also to improve the ease of use of EBM resources at the point of care. Tasks should be simplified by tailoring evidence-based information retrieval systems to the busy clinical schedule. Participants' recommendations to establish an HMO decision support service should be considered.
authors.affiliation: School of Public Health, University of Haifa, Mount Carmel Haifa, Israel. kshuval@study.haifa.ac.il
authors.forename: Kerem
authors.initials: K
authors.lastname: Shuval
authors.forename: Aviv
authors.initials: A
authors.lastname: Shachak
authors.forename: Shai
authors.initials: S
authors.lastname: Linn
authors.forename: Mayer
authors.initials: M
authors.lastname: Brezis
authors.forename: Paula
authors.initials: P
authors.lastname: Feder-Bubis
authors.forename: Shmuel
authors.initials: S
authors.lastname: Reis
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D004502:Education, Medical, Continuing / Q000379:methods; D004521:Educational Measurement / Q000379:methods; D019317:Evidence-Based Medicine / Q000193:education* / Q000379:methods; D017144:Focus Groups / Q000379:methods; D006801:Humans; D008875:Middle Aged; D010821:Physicians, Family / Q000193:education* / Q000523:psychology; D036301:Qualitative Research