title: EBM in primary care: a qualitative multicenter study in Spain.
abstract: BACKGROUND
  Evidence based medicine (EBM) has made a substantial impact on primary care in Spain over the last few years. However, little research has been done into family physicians (FPs)' attitudes related to EBM. The present study investigates FPs' perceptions of EBM in the primary care context.
  
  
  METHODS
  This study used qualitative methodology. Information was obtained from 8 focus groups composed of 67 FPs from 47 health centers in 4 autonomous regions in Spain. Intentional sampling considered participants' previous education in EBM, and their experience as tutors in family medicine or working groups' members of the Spanish Society of Family Practice. Sociological discourse analysis was used with the support of the MAXqda software. Results were validated by means of triangulation among researchers and contrast with participants.
  
  
  RESULTS
  Findings were grouped into three main areas: 1) The tug-of-war between the "science" of EBM and "experience" in the search for good clinical practice in primary care; 2) The development of EBM sensemaking as a reaction to contextual factors and interests; 3) The paradox of doubt and trust in the new EBM experts.The meaning of EBM was dynamically constructed within the primary care context. FPs did not consider good clinical practice was limited to the vision of science that EBM represents. Its use appeared to be conditioned by several factors that transcended the common concept of barriers. Along with concerns about its objectivity, participants showed a tendency to see EBM as the use of simplified guidelines developed by EBM experts.
  
  
  CONCLUSIONS
  The identification of science with EBM and its recognition as a useful but insufficient tool for the good clinical practice requires rethinking new meanings of evidence within the primary care reality. Beyond the barriers related to accessing and putting into practice the EBM, its reactive use can determine FPs' questions and EBM development in a direction not always centred on patients' needs. The questioning of experts' authority as a pillar of EBM could be challenged by the emergence of new kinds of EBM texts and experts to believe in.
authors.affiliation: Centro de Salud de Alza, Donostia-San Sebastián, Spain. ccalderong@telefonica.net
authors.forename: Carlos
authors.initials: C
authors.lastname: Calderón
authors.forename: Iván
authors.initials: I
authors.lastname: Sola
authors.forename: Rafael
authors.initials: R
authors.lastname: Rotaeche
authors.forename: Mèrce
authors.initials: M
authors.lastname: Marzo-Castillejo
authors.forename: Arturo
authors.initials: A
authors.lastname: Louro-González
authors.forename: Ricard
authors.initials: R
authors.lastname: Carrillo
authors.forename: Ana-Isabel
authors.initials: AI
authors.lastname: González
authors.forename: Pablo
authors.initials: P
authors.lastname: Alonso-Coello
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D019317:Evidence-Based Medicine; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000592:standards*; D036301:Qualitative Research; D013030:Spain