The implementation of evidence-based medicine in general practice prescribing

Background. Research on the implementation of evidence-based medicine has f ocused on how best to influence doctors through information and education s trategies. In order to understand the barriers and facilitators to implemen tation, it may also be important to study the characteristics of those doct ors and practices that successfully implement evidence-based changes. Aim. To determine the relationship between practice and doctor characterist ics and the implementation of recommended evidence-based changes in the are a of prescribing. Method. Visits were made to 39 practices in southern England. Audits of thr ee key prescribing changes were carried out and amalgamated to produce an ' implementation score' for each practice. These scores were related to a wid e range of practice and doctor variables obtained from a questionnaire surv ey of doctors and practice managers. Results. There was wide variation between the practices' implementation sco res (mean 67%, range 45% to 88%). The only factors that had a significant r elationship with implementation of these important prescribing changes were an innovative approach among the doctors (most practitioners were cautious of change), and fundholding status. Use of clinical protocols, disease reg isters, or computers was not associated with overall implementation score, nor was the doctor's age. Doctors complained of information overload. Conclusions. The emphasis on the need for evidence in medicine, and better transmission of information, needs to be balanced by a recognition that mos t general practitioners are pragmatic, averse to innovation, and already fe el overwhelmed with information. Important advances in therapy may be crowd ed out. More attention should be given to the facilitation of priority chan ges in practices.