McKenna Hugh P, Ashton Sue, Keeney Sinead
Head of School of Nursing, University of Ulster, Ulster, UK.
J Adv Nurs. 2004 Jan;45(2):178-89. doi: 10.1046/j.1365-2648.2003.02879.x.
Evidence-based practice is one of the most important underlying principles in modern health care. In the United Kingdom, successive governments have highlighted the fact that a quality health service is built upon the use of best evidence. Health professionals are becoming more accountable within clinical governance structures for the care they provide. The need to use robust research findings effectively is a critical component of their role. However, studies show that a number of barriers prevent the effective use of best available evidence.
This study aimed to identify barriers to evidence-based practice in primary care.
A specially designed questionnaire was used to gather respondents' perceptions of the barriers to evidence-based practice. Data were collected in 2000/2001.
Findings show that general practitioners (GPs) ranked barriers differently to community nurses. GPs believed that the most significant barriers to using evidence in practice were: the limited relevance of research to practice, keeping up with all the current changes in primary care, and the ability to search for evidence-based information. In contrast, the most significant barriers to the identified by community nurses were poor computer facilities, poor patient compliance and difficulties in influencing changes within primary care. This suggests that these two groups may require different strategies for barrier removal.
Identifying barriers is just the first step to addressing issues surrounding the use of evidence-based practice. Extra resources will be needed if these barriers are to be tackled. However, if the resultant change improves the health and wellbeing of people and communities, then the extra costs would be offset by more efficient use of services.
循证医学实践是现代医疗保健中最重要的基本原则之一。在英国，历届政府都强调优质医疗服务是建立在使用最佳证据的基础之上的。在临床治理结构中，医疗专业人员对其提供的护理承担着越来越多的责任。有效运用可靠的研究成果是他们职责的关键组成部分。然而，研究表明，一些障碍阻碍了最佳可用证据的有效利用。
本研究旨在确定基层医疗中循证医学实践的障碍。
使用一份专门设计的问卷来收集受访者对循证医学实践障碍的看法。数据于2000/2001年收集。
结果表明，全科医生（GPs）对障碍的排序与社区护士不同。全科医生认为，在实践中使用证据的最主要障碍是：研究与实践的相关性有限、跟上基层医疗的所有当前变化以及搜索循证信息的能力。相比之下，社区护士确定的最主要障碍是计算机设施差、患者依从性差以及在影响基层医疗变革方面存在困难。这表明这两组人员可能需要不同的消除障碍策略。
识别障碍只是解决围绕循证医学实践使用问题的第一步。如果要解决这些障碍，将需要额外的资源。然而，如果由此产生的变化改善了人们和社区的健康与福祉，那么额外的成本将被更高效地利用服务所抵消。
