The use of evidence-based medicine in the practice of consultant physicians - Results of a questionnaire survey

Background: Information is lacking about the extent to which Australasian p hysicians apply methods of evidence-based medicine (EBM) in routine practic e. Aims: To assess the frequency and predictors of use of EBM methods in a sample of consultant physicians in adult medicine. Methods: Self-administered questionnaires were distributed to a convenience sample of 545 physicians from October 1998 to January 1999. Results: One hundred and eleven questionnaires were returned (20% response rate). Ninety-eight (88%) respondents formulated five or less clinical ques tions per week; 69 (62%) undertook five or more evidence searches per week, the majority as MEDLINE searches involving therapeutic topics. Respondents identified insufficient time (74%), limited search skills (41%), and limit ed access to evidence (43%) as search impediments. In determining evidence quality, 37% frequently relied on global impressions, while 22% frequently applied explicit critical appraisal (p = 0.008). Efficiency of literature s earches was rated on average as good/very good by 18%, fair by 52% and poor by 30%. As a result of EBM, 47% frequently had confidence in pre-existing decisions increased, 39% gained improved knowledge, and 5% altered clinical decisions. Frequently encountered inhibitors to changing practice were per sonal conservatism (40%), organisational constraints (40%), and interdiscip linary tensions (39%). Perceived weaknesses of EBM included: limited applic ability to individual patients (26%); evidence deficiencies (25%); and too time consuming (13%). In making EBM more attractive, one third requested re liable evidence sources at the point of care. Conclusions: The application of EBM to routine practice by physicians is co nstrained by deficient EBM skills, limited access to evidence, lack of time , and cognitive and environmental factors. Targeted education in EBM and sy stems that quickly deliver high-quality evidence at the point of care are n eeded in realising the full potential of EBM to improve care.