Rural Doctors' Views on and Experiences with Evidence-Based Medicine: The FrEEDoM Qualitative Study
Rural Doctors' Views on and Experiences with Evidence-Based Medicine: The FrEEDoM Qualitative Study
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DOI：
10.1371/journal.pone.0152649
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发表时间：
2016-03-31
期刊：
影响因子：
3.7
通讯作者：
Glasziou, Paul
中科院分区：
文献类型：
--
作者：
Hisham, Ranita;Liew, Su May;Glasziou, Paul
以证据为基础的医学是20多年前提出的，它是个人临床专业知识、最佳外部证据和患者价值的综合。然而，马来西亚的初级保健医生在获取科学文献并将其应用于临床实践方面面临着独特的障碍。目的本研究旨在探讨乡村医生在农村初级保健机构的日常临床实践中对循证医学的看法和经验。采访于2013年6月在马来西亚的两家乡村诊所进行。受试者是通过有目的的抽样招募的。与15名医务人员进行了四次焦点小组讨论，并与家庭医学专家进行了三次个人深入访谈。结果：(1)医生将循证医学主要视为统计、研究和指南；(2)对循证医学的反应很大程度上是负面的；(3)医生依赖专家、同行、指南和非循证互联网来源获取信息；(4)通过移动应用程序等新方法获取信息源；(5)循证实践存在几个障碍，包括医生、循证医学、患者和系统相关因素。这些问题包括在知识、态度、管理支持、时间和获取循证信息来源方面的不足。与会者建议使用在线服务来支持农村循证实践。结论农村循证实践水平较低，主要原因是认识、知识、态度和资源不足。医生使用非基于证据的来源，并通过消息传递应用程序等新方法访问它们。建议进行进一步的研究，以制定和评估克服已确定障碍的干预措施。
BackgroundEvidence-based medicine is the integration of individual clinical expertise, best external evidence and patient values which was introduced more than two decades ago. Yet, primary care physicians in Malaysia face unique barriers in accessing scientific literature and applying it to their clinical practice.AimThis study aimed to explore the views and experiences of rural doctors' about evidence-based medicine in their daily clinical practice in a rural primary care setting.MethodsQualitative methodology was used. The interviews were conducted in June 2013 in two rural health clinics in Malaysia. The participants were recruited using purposive sampling. Four focus group discussions with 15 medical officers and three individual in-depth interviews with family medicine specialists were carried out. All interviews were conducted using a topic guide and were audio-recorded, transcribed verbatim, checked and analyzed using a thematic approach.ResultsKey themes identified were: (1) doctors viewed evidence-based medicine mainly as statistics, research and guidelines, (2) reactions to evidence-based medicine were largely negative, (3) doctors relied on specialists, peers, guidelines and non-evidence based internet sources for information, (4) information sources were accessed using novel methods such as mobile applications and (5) there are several barriers to evidence-based practice, including doctor-, evidence-based medicine-, patient-and system-related factors. These included inadequacies in knowledge, attitude, management support, time and access to evidence-based information sources. Participants recommended the use of online services to support evidence-based practice in the rural settings.ConclusionThe level of evidence-based practice is low in the rural setting due to poor awareness, knowledge, attitude and resources. Doctors use non-evidence based sources and access them through new methods such as messaging applications. Further research is recommended to develop and evaluate interventions to overcome the identified barriers.