title: Barriers to evidence-based physician decision-making at the point of care: a narrative literature review.
abstract: We conduct a narrative literature review using four real-world cases of clinical decisions to show how barriers to the use of evidence-based medicine affect physician decision-making at the point of care, and where adjustments could be made in the healthcare system to address these barriers. Our four cases constitute decisions typical of the types physicians make on a regular basis: diagnostic testing, initial treatment and treatment monitoring. To shed light on opportunities to improve patient care while reducing costs, we focus on barriers that could be addressed through changes to policy and/or practice at a particular level of the healthcare system. We conclude by relating our findings to the passage of the Medicare Access and Children's Health Insurance Program Reauthorization Act in April 2015.
authors.affiliation: Mathematica Policy Research, Princeton, NJ, USA.
authors.forename: Kara
authors.initials: K
authors.lastname: Contreary
authors.affiliation: Mathematica Policy Research, Princeton, NJ, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Collins
authors.affiliation: Mathematica Policy Research, Princeton, NJ, USA.
authors.forename: Eugene C
authors.initials: EC
authors.lastname: Rich
mesh_terms: D000066491:Clinical Decision-Making / Q000379:methods*; D019317:Evidence-Based Medicine / Q000379:methods*; D006801:Humans; D010820:Physicians; D019095:Point-of-Care Systems
keywords: acid suppression therapy; appendicitis; cardiac imaging; claudication; coronary heart disease; deprescribing; evidence-based medicine; gastroesophageal reflux disease; physician decision-making; vascular surgery