Barriers to evidence-based practice in primary care
Barriers to evidence-based practice in primary care
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DOI：
10.1046/j.1365-2648.2003.02879.x
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发表时间：
2004-01-01
影响因子：
3.8
通讯作者：
Keeney, S
中科院分区：
文献类型：
--
作者：
McKenna, HP;Ashton, S;Keeney, S
背景循证实践是现代医疗保健最重要的基本原则之一。在联合王国，历届政府都强调，高质量的卫生服务是建立在使用最佳证据的基础上的。卫生专业人员在临床治理结构中对他们提供的护理越来越负责。有效利用强有力的研究结果是其作用的一个关键组成部分。然而，研究表明，一些障碍阻碍了有效利用现有的最佳证据。本研究的目的是确定在初级保健循证实践的障碍。一个专门设计的问卷被用来收集受访者的看法的障碍，以证据为基础的做法。数据收集于2000/2001年。研究结果表明，全科医生（全科医生）排名障碍不同的社区护士。全科医生认为，在实践中使用证据的最大障碍是：研究与实践的相关性有限，跟上初级保健的所有当前变化，以及搜索循证信息的能力。相比之下，社区护士发现的最重要的障碍是计算机设施差，病人依从性差，难以影响初级保健的变化。这表明，这两个群体可能需要不同的策略来清除障碍。识别障碍只是解决使用循证实践问题的第一步。如果要克服这些障碍，就需要额外的资源。然而，如果由此产生的变化改善了人民和社区的健康和福祉，那么额外的费用将通过更有效地利用服务来抵消。
Background. 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.Aim. This study aimed to identify barriers to evidence-based practice in primary care.Method. A specially designed questionnaire was used to gather respondents' perceptions of the barriers to evidence-based practice. Data were collected in 2000/2001.Findings. 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.Conclusions. 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.