Evidence-based practice in primary health care

This study aims to describe primary care professionals' self-reported attitudes towards evidence-based practice (EBP), attention to information sources, perceptions of the barriers to EBP and strategies to improve insight in EBP and patient care. An e-mail invitation with link to an Internet-based survey was sent to Belgian medical doctors (MDs), nurses and paramedics. Under paramedics, we've included emergency medical technicians, firemen and medical volunteers (Red Cross). In general, respondents were supportive towards EBP and agreed that this concept improves patient care, but still, physicians claim that only 50% of their practice is evidence-based and nurses and paramedics spend respectively 59% and 54% of their time to EBP. Doctors depend mostly on clinical guidelines, the Internet and textbooks, while nurses prefer conferences and protocols and paramedics rely on courses and their own judgement. All respondents strongly rely on experimental knowledge gained through interaction with colleagues, although the majority reported that colleagues are often not supportive towards EBP. Lack of time, the overwhelming mass of literature, difficulties with implementation of evidence in to practice are the most common barriers. Nurses show lack of critical appraisal of research results and paramedics have difficulties understanding research and have limited access to computer facilities and their working environment. Communication in group and workshops are very highly valued. Nurses and paramedics are less reluctant towards the opinion of senior colleagues, audits on clinical practice and individual feedback than doctors. EBP generally enjoys a positive attitude at every level of the health care system, but still many obstacles have to be overcome to conquer 'experience-based practice'. The most appropriate method for actual implementation of evidence-based practice at all levels of health care is to provide summaries of evidence, easily understandable protocols and web-based databases accessible from the working environment. Students should not only learn the skills related to EBP, but should be able to integrate knowledge effectively in the clinical setting and routine care. Above all, their supervisors themselves need to evolve from 'experience-based' to evidence-based practice'.