Karin Hannes

Implementing evidence-based medicine in general practice: a focus group based study.

BackgroundOver the past years concerns are rising about the use of Evidence-Based Medicine (EBM) in health care. The calls for an increase in the practice of EBM, seem to be obstructed by many barriers preventing the implementation of evidence-based thinking and acting in general practice. This study aims to explore the barriers of Flemish GPs (General Practitioners) to the implementation of EBM in routine clinical work and to identify possible strategies for integrating EBM in daily work.MethodsWe used a qualitative research strategy to gather and analyse data. We organised focus groups between September 2002 and April 2003. The focus group data were analysed using a combined strategy of between-case analysis and grounded theory approach. Thirty-one general practitioners participated in four focus groups. Purposeful sampling was used to recruit participants.ResultsA basic classification model documents the influencing factors and actors on a micro-, meso- as well as macro-level. Patients, colleagues, competences, logistics and time were identified on the micro-level (the GPs individual practice), commercial and consumer organisations on the meso-level (institutions, organisations) and health care policy, media and specific characteristics of evidence on the macro-level (policy level and international scientific community). Existing barriers and possible strategies to overcome these barriers were described.ConclusionIn order to implement EBM in routine general practice, an integrated approach on different levels needs to be developed.

Exploring Barriers to the Implementation of Evidence-Based Practice in Psychiatry to Inform Health Policy: A Focus Group Based Study

This study aims to explore the obstacles to Evidence-Based Practice (EBP) experienced by Belgian Dutch-speaking psychiatrists. We used an inductive, qualitative research strategy. Thirty-nine psychiatrists participated in five focus groups organised between September 2004 and September 2006. Data-analysis was guided by a ‘grounded theory approach’. Three major themes emerged from the data: (1) Characteristics of evidence, including the lack of (use of) evidence and the applicability of evidence; (2) Characteristics of other partners in mental health care, including government, patients and drug companies and (3) Discipline-related barriers, including the complexity of diagnoses, the importance of the therapeutic relationship and personal experience, and the different schools of thoughts. A problem tree was developed, linking all obstacles. Although context-specific, the problem tree can assist policy makers working in health care systems with similar characteristics in formulating objectives and developing strategies that facilitate EBP in the field of psychiatric care.

Implementing and optimising an Electronic Library of Health Care in Belgium: results of a pilot study

Abstract Health care practitioners are expected to incorporate results from the best available, scientific information into their daily clinical decision-making process. Useful formats of evidence for practitioners include selected reviews, abstracts in which research results are discussed, “quick answer”, evidence-based website including for example diagnostic and therapeutic algorithms, drugs prescription and non-drug therapy. An increasing amount of practitioners has access to the World Wide Web, either at home or at the office. However, easy and cheap access to objective and high quality research results is limited. Many practitioners lack the skills to efficiently navigate complicated medical databases. In 2003 an ‘Electronic Library of Health Care’ was introduced in Belgium. The main goal of the electronic library is to provide a gateway to scientific evidence to Belgian health care practitioners from different disciplines. This paper presents the results of a pilot project to implement the library in the field. It also describes recent developments and adjustments that increased the efficacy of this gateway to evidence.