The nexus of evidence, context, and patient preferences in primary care: postal survey of Canadian family physicians
- PMID: 14505494
- PMCID: PMC212556
- DOI: 10.1186/1471-2296-4-13
The nexus of evidence, context, and patient preferences in primary care: postal survey of Canadian family physicians
Abstract
Background: Evidence-based medicine is gaining prominence in primary care. This study sought to examine the relationships among family physicians' attitudes toward EBM, contextual factors, and clinical decision-making and to investigate the factors that contribute to 'contrary to evidence' clinical decisions.
Methods: A postal survey mailed to a random sample of Canadian family physicians, stratified by age, gender, and practice setting. The main outcome measures were respondents' attitudes toward evidence-based medicine and preferred treatment option in four simulated clinical scenarios with wording randomly varied.
Results: Canadian family physicians report positive attitudes toward EBM, believe that EBM improves patient care, and agree that research findings are useful in the day-to-day management of patients. The scenario study showed that physicians were strongly influenced by a patient demanding/requesting either a screening test (adjusted Odds Ratio [OR] 5.15, 95% confidence interval [CI] 2.9 to 9.2 for demand mammogram; adjusted OR 3.11, 95% CI 1.7 to 5.6 for request mammogram) or a diagnostic test (adjusted OR 3.95, 95% CI 2.1 to 7.5 for demand lumbar spine x-ray; adjusted OR 2.08, 95% CI 1.1 to 4.1 for request x-ray). This relationship did not hold for the treatment scenario (prescribing antibiotics for acute bronchitis) where hours of practice (adjusted OR 3.5, 95% CI 1.1 to 11.7 for 50+ hours practice; adjusted OR 1.79, 95% CI 1.0 to 3.2 for 20-49 hours practice) and type of practice (adjusted OR 2.22, 95% CI 1.3 to 3.7 for solo practice) were significant. 80% of respondents reported teaching breast self-examination with female physicians twice as likely as males (adjusted OR 2.11, 95% CI 1.2 to 3.8).
Conclusions: Canadian family physicians are favourably disposed to the precepts of evidence-based medicine; however, patient expectations and practice characteristics can influence physicians such that decisions are taken that are broadly contrary to evidence. Recently revised models of EBM emphasizing the importance of patient preferences and the clinical context appear to reflect more accurately the clinical reality of primary care physicians.
Similar articles
-
Evidence-based medicine in primary care: qualitative study of family physicians.BMC Fam Pract. 2003 May 9;4:6. doi: 10.1186/1471-2296-4-6. Epub 2003 May 9. BMC Fam Pract. 2003. PMID: 12740025 Free PMC article.
-
Contextual factors in clinical decision making: national survey of Canadian family physicians.Can Fam Physician. 2005 Aug;51(8):1106-7. Can Fam Physician. 2005. PMID: 16926949 Free PMC article.
-
Dental screening and referral of young children by pediatric primary care providers.Pediatrics. 2004 Nov;114(5):e642-52. doi: 10.1542/peds.2004-1269. Pediatrics. 2004. PMID: 15520094
-
Evidence-based medicine and general practice.Br J Gen Pract. 1997 Jul;47(420):449-52. Br J Gen Pract. 1997. PMID: 9281875 Free PMC article. Review.
-
Understanding why we agree on the evidence but disagree on the medicine.Respir Care. 2001 Dec;46(12):1442-9. Respir Care. 2001. PMID: 11728303 Review.
Cited by
-
The practice of palliative care from the perspective of patients and carers.BMJ Support Palliat Care. 2014 Sep;4(3):291-8. doi: 10.1136/bmjspcare-2013-000551. Epub 2014 Jan 16. BMJ Support Palliat Care. 2014. PMID: 24644204 Free PMC article.
-
Perceptions, attitudes and knowledge of evidence-based medicine in primary care in Spain: a study protocol.BMC Health Serv Res. 2009 May 15;9:80. doi: 10.1186/1472-6963-9-80. BMC Health Serv Res. 2009. PMID: 19445660 Free PMC article.
-
Pharmacists' attitudes towards an evidence-based approach for over-the-counter medication.Int J Clin Pharm. 2012 Feb;34(1):63-71. doi: 10.1007/s11096-011-9586-y. Epub 2011 Nov 23. Int J Clin Pharm. 2012. PMID: 22108790
-
How Primary Care Physicians Integrate Price Information into Clinical Decision-Making.J Gen Intern Med. 2017 Jan;32(1):81-87. doi: 10.1007/s11606-016-3805-0. Epub 2016 Aug 25. J Gen Intern Med. 2017. PMID: 27561735 Free PMC article.
-
Breast self-examination: resistance to change.Can Fam Physician. 2005 May;51(5):698-9. Can Fam Physician. 2005. PMID: 16926925 Free PMC article.
References
-
- Tonelli MR. The limits of evidence-based medicine. Respir Care. 2001;46:1435–40. - PubMed
-
- Royal Pharmaceutical Society of Great Britain From compliance to concordance: Achieving shared goals in medicine taking http://www.concordance.org
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources