Original Paper: Barriers and facilitators to the implementation of evidence-based medicine in general practice: a qualitative study

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Abstract
Objectives: It is well recognised that the results of research evidence are frequently not implemented in clinical practice. Intervention studies have shown that doctors' habits are relatively resistant to change. A qualitative approach may provide new insights to understand the barriers and facilitators to change, and the role that evidence plays in the decision-making of general practitioners. We sought to understand general practitioners' perspectives on facilitators and hindrances to the implementation of evidence-based change in general practice and their attitudes towards the concept of evidence-based medicine. Method: Thematic analysis of 44 in-depth interviews with general practitioners from four health authorities. The interviews were focused on change in general practitioners' prescribing decisions in response to evidence. Results: Most general practitioners were aware of advice about recommended, evidence-based changes, but fewer were acting upon it. The main obstacles to full implementation were identified as scepticism towards evidence-based medicine, information overload coupled with a lack of time to assimilate information, and not having the appropriate resources, skills or motivation to implement change. Attitudes towards evidence-based medicine varied widely from hostility to enthusiasm. The majority of general practitioners expressed ambivalence towards evidence-based medicine, and questioned the utility of this concept in the real-world environment of the consultation room. Conclusions: Advocates for evidence-based medicine should be aware of the existence of sceptical attitudes amongst general practitioners, the low level of motivation to change and concerns about information overload. Future strategies to encourage more successful implementation of evidence-based change should focus on facilitation rather than information.