Evidence-based medicine in general practice : an exploratory study

Abstract

Evidence-based medicine (EBM) has emerged as an influential model for the practice of clinical medicine. In Malta, however, very little is known about general practitioners' attitude towards EBM. This qualitative work explores the experiences of Family Physicians in relation to this phenomenon. In this study, I employed a bricolage of research enquiry based on narrative and interpretive methods. I used two semi-structured focus group interviews with fourteen purposively selected GPs. These interviews were transcribed verbatim and analysed using qualitative content analysis. I also utilized field notes personally collected during the interviews. Reflexivity was viewed as an important dimension in designing and implementing the research. A literature review is also included in the study. The findings of the study suggest that the participants welcomed the promotion of external evidence in general practice. Four main themes could be identified: the applicability of evidence to individual patients; the use of EBM in the context of general practice; perceived barriers and constraints; and ways of moving from opinion-based to evidence-based practice. This work is intended to promote the use of qualitative research methods in general practice and to start an informing process on EBM amongst local GPs. I am aware that generalizability is not normally sought in qualitative research. However, certain tentative conclusions can be drawn from the study: decisions about the application of evidence in a general practice setting are highly complex and shaped by such factors as, the multidisciplinary nature of the practice and its patient-centredness. One recommendation that the participants agreed upon is that the best way to implement EBM in general practice is through the use of local guidelines.