General practitioners' perceptions of the route to evidence based medicine: a questionnaire survey

British Medical Journal, Jan 31, 1998 by Alastair McColl, Helen Smith, Peter White, Jenny Field

Introduction

Evidence based medicine is being promoted in general practice as throughout the NHS. General practitioners can attend workshops on how to practice and teach it, research networks promote its use, the Cochrane Library has an increasing number of systematic reviews relevant to general practice, and the journal Evidence-Based Medicine regularly contains summaries of general practice topic. Books on evidence based medicine present common general practice questions, show how to critically appraise papers, and to evaluate different sorts of evidence. Critical appraisal is now part of the MRCGP exam. Recent papers have highlighted the need for evidence based general practice,[1 2] the role of evidence based guidelines in the management of conditions common to general practice,[3-5] and the estimated proportion of interventions in general practice that are based on evidence.[6] One paper has described the problems that may arise in general practice from overreliance on evidence based medicine.[7] These included the potential lack of applicability of the biomedical perspective and the role of opinion in tailoring evidence to a patient's context and preferences.

In the United Kingdom, however, very little is known about general practitioners' attitudes towards evidence based medicine, the extent of their skills to access and interpret evidence, the barriers to moving from opinion based to evidence based practice, and the additional support necessary to incorporate evidence based medicine into everyday general practice. The objectives of this study were to determine the attitude of general practitioners towards evidence based medicine and their related educational needs. Postgraduate tutors, health authorities, and the Wessex Primary Care Research Network (WReN) required this information to inform local strategies aimed at encouraging general practitioners to implement evidence based medicine. Early approaches used in Wessex included workshops on critical appraisal and evidence based medicine and training in performing literature search as part of courses on research methods. After initial local enthusiasm, however, it had become harder to recruit general practitioners to such training events.

To fulfil the objectives of the study we set out to identify general practitioners'

* Attitude towards evidence based medicine

* Awareness and perceived usefulness of relevant extracting journals, review publications, and databases

* Ability to access relevant databases and the world wide web

* Understanding of technical terms used in evidence based medicine

* Views on the perceived major barriers to practising evidence based medicine

* Views on how best to move from opinion based to evidence based medicine.

Subject and methods

In April 1997 we sent a questionnaire to 452 general practitioner principals in the former Wessex region in south England. These represented 25% of all Wessex general practitioner principals obtained from a national database,[8] who were randomly selected by means of random numbers generated by Microsoft Excel with supervision from a statistician.

The covering letter for the questionnaire included a definition of evidence based medicine as the "conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. Its practice means integrating individual clinical expertise with the best available external clinical evidence from systematic research."[9]

The questionnaire consisted of

* Visual analogue scales to determine the general practitioners' attitudes towards evidence based medicine

* Closed questions to assess their awareness of and perceived usefulness of extracting journals, review publications, and databases relevant to evidence based medicine; their ability to access Medline or other bibliographic databases and the world wide web; their understanding of technical terms; and their views on how best to move from opinion based practice to evidence based medicine

* A free text section to determine their views on the major barriers to practising evidence based medicine in general practice. These brief statements were coded and grouped by AMcC. (For details of the questionnaire, see copy included in this article on the BMJ website www.bmj.com).

We sent reminders to non-respondents in June and July 1997, and data on non-respondents were collected by AMcC from teaching and research networks and the 1997 Medical Directory.[10]

We entered the data into a spreadsheet. We initially identified 38 categories, but these were grouped into broader categories during the analysis. We analysed data from the visual analogue scales using SPSS for Windows 6.1.2 and analysed the other data using Microsoft Excel 5.0. We compared differences between respondents and non-respondents using the [chi square] test

Results

Of the 452 questionnaires we sent out, two were returned because the general practitioners had retired. We received 302 replies (67%) to the remaining 450 questionnaires. Table 1 compares the characteristics of the respondents and non-respondents.