title: Why is there variation in the practice of evidence-based medicine in primary care? A qualitative study.
abstract: OBJECTIVE
  To explore the factors, including barriers and facilitators, influencing the practice of evidence-based medicine (EBM) across various primary care settings in Malaysia based on the doctors' views and experiences.
  
  
  METHODS
  The qualitative study was used to answer the research question. 37 primary care physicians participated in six focus group discussions and six individual in-depth interviews. A semistructured topic guide was used to facilitate both the interviews and focus groups, which were audio recorded, transcribed verbatim, checked and analysed using a thematic approach.
  
  
  METHODS
  37 primary care doctors including medical officers, family medicine specialists, primary care lecturers and general practitioners with different working experiences and in different settings.
  
  
  METHODS
  The study was conducted across three primary care settings-an academic primary care practice, private and public health clinics in Klang Valley, Malaysia.
  
  
  RESULTS
  The doctors in this study were aware of the importance of EBM but seldom practised it. Three main factors influenced the implementation of EBM in the doctors' daily practice. First, there was a lack of knowledge and skills in searching for and applying evidence. Second, workplace culture influenced doctors' practice of EBM. Third, some doctors considered EBM as a threat to good clinical practice. They were concerned that rigid application of evidence compromised personalised patient care and felt that EBM did not consider the importance of clinical experience.
  
  
  CONCLUSIONS
  Despite being aware of and having a positive attitude towards EBM, doctors in this study seldom practised EBM in their routine clinical practice. Besides commonly cited barriers such as having a heavy workload and lack of training, workplace 'EBM culture' had an important influence on the doctors' behaviour. Strategies targeting barriers at the practice level should be considered when implementing EBM in primary care.
authors.affiliation: Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Ranita
authors.initials: R
authors.lastname: Hisham
authors.affiliation: Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Chirk Jenn
authors.initials: CJ
authors.lastname: Ng
authors.affiliation: Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Su May
authors.initials: SM
authors.lastname: Liew
authors.affiliation: Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Nurazira
authors.initials: N
authors.lastname: Hamzah
authors.affiliation: Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Gah Juan
authors.initials: GJ
authors.lastname: Ho
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D019317:Evidence-Based Medicine / Q000592:standards*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D017132:Workplace
keywords: PRIMARY CARE; QUALITATIVE RESEARCH