Barriers to GPs' use of evidence-based medicine: a systematic review

Abstract

Background: GPs report various barriers to the use and practice of evidence-based medicine (EBM). A review of research on these barriers may help solve problems regarding the uptake of evidence in clinical outpatient practice.

Aim: To determine the barriers encountered by GPs in the practice of EBM and to come up with solutions to the barriers identified.

Design: A systematic review of the literature.

Method: The following databases were searched: MEDLINE (PubMed), Embase, CINAHL, ERIC, and the Cochrane Library, until February 2011. Primary studies (all methods, all languages) that explore the barriers that GPs encounter in the practice of EBM were included.

Results: A total of 14 700 articles were identified, of which 22 fulfilled all inclusion criteria. Of the latter, nine concerned qualitative, 12 concerned quantitative, and one concerned both qualitative and quantitative research methods. The barriers described in the articles cover the categories: evidence (including the accompanying EBM steps), the GP's preferences (experience, expertise, education), and the patient's preferences. The particular GP setting also has important barriers to the use of EBM. Barriers found in this review, among others, include lack of time, EBM skills, and available evidence; patient-related factors; and the attitude of the GP.

Conclusion: Various barriers are encountered when using EBM in GP practice. Interventions that help GPs to overcome these barriers are needed, both within EBM education and in clinical practice.

Figure 1

Conceptual model of evidence-based decision making in GPs, adapted from Sackett et al and Offringa et al.

Figure 2

Flow chart for the selection of studies.