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Where do GPs get evidence-based information?


There is a plethora of sources of evidence-based information for doctors. Do they use any? How much do they use? What is the biggest influence? How is information best presented?

These questions, and more, have been answered in a thorough and thoughtful review of Wessex GPs by Alastair McColl and his colleagues from Southampton [1]. Structured questionnaires were sent to a quarter of Wessex GP principals, and 302 (67%) replied. The results obtained were the following:

Attitudes

GPs predominately welcomed evidence-based medicine, considered that it improved patient care and that research findings were useful in the day-to-day management of patients. The median value for the estimated percentage of the respondents' clinical practice that was evidence-based was 50%.

Awareness

There was a low level of awareness of evidence-based resources (Figure 1).
Over 80% were unaware of DARE or Evidence-based Purchasing (the S&W Region's own newsletter). Bandolier , Evidence-based Medicine and Effective Health Care Bulletins were the sources with the highest awareness and the highest rating for being used to help in clinical decision-making (Figure 1).

Access

Few GPs had access to searching tools in their surgeries. Only 20% had access to MEDLINE and 17% had access to the Internet. Slightly more than this (21% and 29% respectively) had access at home.

Approach

The questionnaire also asked some penetrating questions about GPs' knowledge of technical terms used in evidence-based medicine (things like odds ratios, heterogeneity and the like). They used a very high hurdle - whether respondents understood the term and could explain it to others. Of all the terms, the one which came out top of this stiff test was the number needed to treat (NNT), with 35% of GPs being able to understand it and explain it to others (Figure 2).

Acquiring more evidence

Few practitioners thought it appropriate for them to identify and appraise primary literature. Most wanted established evidence-based guidelines developed by colleagues, where good evidence and knowledge can be combined with other factors into local wisdom.

Comment

All this makes pretty good sense. General practitioners have been at the forefront of efforts to provide evidence-based education (perhaps reflecting a bias towards prophylaxis - small numbers of events in large populations - in the public health community who have been most enthused by EBM). So finding that, after four years or so, they like it and think it useful is rewarding. That is underpinned by the fact that about a third of these GPs feel able to tackle technical terms head on - not just pretend some understanding. And large numbers of GPs wanted to learn more.

But this survey also gives an idea about the way in which GPs like information presented, which is changing fast. Four years ago the NNT was largely unheard of: now it is the favoured term by Wessex GPs. That is a remarkable change in a short time.

It is clear that what GPs want is evidence presented in short, understandable packets, with recognised quality standards, using understandable descriptions (like NNTs) of useful clinical outcomes, so that evidence can be incorporated easily and quickly into local guidelines and practice.

Reference:

  1. A McColl, H Smith, P White, J Field. General practitioners' perceptions of the route to evidence based medicine: a questionnaire survey. BMJ 1998 316:361-5.



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