title: Improved quality and more attractive work by applying EBM in disability evaluations: a qualitative survey.
abstract: BACKGROUND
  The uptake of evidence in practice by physicians, even if they are trained in the systematic method of evidence-based medicine (EBM), remains difficult to improve. The aim of this study was to explore perceptions and experiences of physicians doing disability evaluations regarding motivators and preconditions for the implementation of EBM in daily practice.
  
  
  METHODS
  This qualitative study was nested in a cluster randomized controlled trial (Trial registration NTR1767; 20-apr-2009) evaluating the effects of training in EBM. The 45 physicians that participated received a comprehensive 6-months training program in EBM of which the last course day included audio-recorded interviews in groups. During these interviews participating physicians discussed perceptions and experiences regarding EBM application in daily practice. In an iterative process we searched for common motivators or preconditions for the implementation of EBM.
  
  
  RESULTS
  Three main concepts or themes emerged after analyzing the transcriptions of the discussions: 1) improved quality of physicians' actions, such as clients benefiting from the application of EBM; 2) improved work attractiveness of physicians; and 3) preconditions that have to be met in order to work in an evidence-based manner including professional competence, facilitating material conditions and organizational support and demands.
  
  
  CONCLUSIONS
  Physicians trained in EBM are motivated to use EBM because they perceive it as a factor improving the quality of their work and making their work more attractive. In addition to personal investments and gains, organizational support should further facilitate the uptake of evidence in practice.
authors.affiliation: Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. j.l.hoving@amc.uva.nl.|Research Center for Insurance Medicine, Amsterdam, The Netherlands. j.l.hoving@amc.uva.nl.
authors.forename: Jan L
authors.initials: JL
authors.lastname: Hoving
authors.affiliation: Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.|Research Center for Insurance Medicine, Amsterdam, The Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: Kok
authors.affiliation: Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Ketelaar
authors.affiliation: Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Paul B A
authors.initials: PBA
authors.lastname: Smits
authors.affiliation: Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Frank J H
authors.initials: FJH
authors.lastname: van Dijk
authors.affiliation: Cochrane Work, Finnish Institute of Occupational Health, Kuopio, Finland.
authors.forename: Jos H
authors.initials: JH
authors.lastname: Verbeek
mesh_terms: D001291:Attitude of Health Personnel; D004185:Disability Evaluation; D019317:Evidence-Based Medicine / Q000379:methods*; D017144:Focus Groups; D006801:Humans; D007588:Job Satisfaction; D008875:Middle Aged; D010820:Physicians / Q000523:psychology; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D058996:Quality Improvement