The attitude of Belgian social insurance physicians towards evidence-based practice and clinical practice guidelines

Abstract

Background: Evidence-based medicine has broadened its scope and is starting to reach insurance medicine. Although still in its initial stages, physicians in the area of insurance medicine should keep up-to-date with the evidence on various diseases in order to correctly assess disability and to give appropriate advice about health care reimbursement. In order to explore future opportunities of evidence-based medicine to improve daily insurance medicine, there is a need for qualitative studies to better understand insurance physicians' perceptions of EBM. The present study was designed to identify the attitude of insurance physicians towards evidence-based medicine and clinical practice guidelines, and to determine their ability to access, retrieve and appraise the health evidence and the barriers for applying evidence to practice.

Methods: A cross-sectional survey study was carried out among all Dutch-speaking insurance physicians employed at one of the six Belgian social insurance sickness funds and at the National Institute of Disability and Health care Insurance (n = 224). Chi-square tests were used to compare nominal and ordinal variables. Student's t-tests, ANOVA, Mann-Whitney and Kruskal-Wallis were used to compare means of continuous variables for different groups.

Results: The response rate was 48.7%. The majority of respondents were positive towards evidence-based medicine and clinical practice guidelines. Their knowledge of EBM was rather poor. Perceived barriers for applying evidence to practice were mainly time and lack of EBM skills.

Conclusion: Although the majority of physicians were positive towards EBM and welcomed more guidelines, the use of evidence and clinical practice guidelines in insurance medicine is low at present. It is in the first place important to eradicate the perceived inertia which limits the use of EBM and to further investigate the EBM principles in the context of insurance medicine. Available high-quality evidence-based resources (at the moment mainly originating from other medical fields) need to be structured in a way that is useful for insurance physicians and global access to this information needs to be ensured.

Figure 1

Percentage of responses for the attitude towards EBM (N = 105). (1) My attitude towards evidence-based medicine is positive (2) The attitude of my colleagues is positive towards EBM (3) EBM is useful in daily practice (4) I try to base my medical decisions and/or advice during consultation on evidence (5) I find it difficult to base my medical advice on evidence (6) The use of EBM could lead to better medical decisions and advice (7) Practising EBM involves a decrease in costs (8) There is a lack of scientific studies in insurance medicine (9) Other things are more important than the evidence in the practice of insurance medicine (10) The use of EBM during consultation involves an extra workload (11) I have confidence in the evidence-based value of daily information sources in the field

Figure 2

Percentage of responses for the attitude towards CPG's (N = 105). (1) My attitude towards clinical practice guidelines is positive (2) I perceive guidelines as a useful information source (3) Clinical guidelines are mostly not applicable in daily practice (4) The opinion of experts is the most important element during guideline development (5) The integration of guidelines into practice restricts my therapeutic freedom (6) It is important that guidelines are based on research evidence (7) The development of more clinical practice guidelines is welcome (8) The use of guidelines could lead to better quality of care (9) Guidelines are implemented in view of a decrease in financial costs (10) I would like to have electronic recommendations available during consultation

Figure 3

Percentage of responses for perceived EBM skills (N = 105). (1) The ability to search fluently with PubMed or another search engine (2) The use of MeSH terms (3) The ability to formulate a PICO question (4) The use of methodological filters when searching for evidence (5) The ability to recognise potential bias in research designs (6) The use of checklists to evaluate the quality of study designs (7) The ability to interpret research results (e.g. NNT, relative risk reduction, odds ratio, etc)

Figure 4

Potential barriers for applying evidence to practice (N = 105). (1) Time (2) EBM skills (3) Concern about losing professional autonomy (4) Lack of support from top management (5) No control over the practice of evidence (6) The pressure to do the same as colleagues (7) Lack of resources (8) Social factors and legislation restrict the usefulness of evidence (9) Lack of financial incentives (10) Evidence different from professional value (11) Lack of evidence (12) Lack of clear presentation of evidence (13) Evidence too difficult/theoretical to apply to practice