Shuval Kerem, Shachak Aviv, Linn Shai, Brezis Mayer, Feder-Bubis Paula, Reis Shmuel
School of Public Health, University of Haifa, Mount Carmel Haifa, Israel.
J Gen Intern Med. 2007 Mar;22(3):327-31. doi: 10.1007/s11606-006-0055-6.
Attitudes and barriers to implementing EBM have been examined extensively, but scant evidence exists regarding the impact of EBM teaching on primary care physicians' point of care behavior.
Gaining insight into behavioral and attitudinal changes of facilitators and participants during a multifaceted EBM educational intervention.
DESIGN, SETTING, AND PARTICIPANTS: A qualitative study on primary care physicians and facilitators from a large HMO selected from the intervention arm of a parallel controlled trial using purposeful sampling. We conducted focus groups with 13 facilitators and 17 physicians and semi-structured interviews with 10 facilitators and 11 physicians.
Both facilitators and participants believed EBM enhanced the quality of their practice. The intervention affected attitudes and knowledge, but had little impact on physicians' ability to utilize pre-appraised resources at the point of care. Using EBM resources during consultation was perceived to be a complex task and impractical in a busy setting. Conversely, a positive impact on using medication databases was noted. Medication databases were perceived as easy to use during consultations in which the benefits outweighed the barriers. The intervention prompted physicians to write down clinical questions more frequently and to search for answers at home.
This study underlines the need not only to enhance EBM skills, but also to improve the ease of use of EBM resources at the point of care. Tasks should be simplified by tailoring evidence-based information retrieval systems to the busy clinical schedule. Participants' recommendations to establish an HMO decision support service should be considered.
实施循证医学（EBM）的态度和障碍已得到广泛研究，但关于循证医学教学对初级保健医生即时医疗行为影响的证据却很少。
深入了解多方面循证医学教育干预过程中促进者和参与者的行为及态度变化。
设计、地点和参与者：一项定性研究，通过目的抽样从一项平行对照试验的干预组中选取了一家大型健康维护组织（HMO）的初级保健医生和促进者。我们对13名促进者和17名医生进行了焦点小组讨论，并对10名促进者和11名医生进行了半结构化访谈。
促进者和参与者都认为循证医学提高了他们的医疗质量。该干预影响了态度和知识，但对医生在即时医疗时利用预先评估资源的能力影响不大。在会诊期间使用循证医学资源被认为是一项复杂的任务，在繁忙的环境中不切实际。相反，注意到对使用药物数据库有积极影响。在会诊期间，药物数据库被认为易于使用，其益处大于障碍。该干预促使医生更频繁地写下临床问题并在家中寻找答案。
本研究强调不仅需要提高循证医学技能，还需要提高循证医学资源在即时医疗时的易用性。应通过根据繁忙的临床日程调整循证信息检索系统来简化任务。应考虑参与者关于建立健康维护组织决策支持服务的建议。
