The nexus of evidence, context, and patient preferences in primary care: postal survey of Canadian family physicians.

Full 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.

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Author information

Author/s: Tracy, C Shawn (CS); Dantas, Guilherme Coelho (GC); Moineddin, Rahim (R); Upshur, Ross E G (RE);

Affiliation: Primary Care Research Unit, Sunnybrook & Women's College Health Sciences Centre, 2075 Bayview Avenue, Room E3-49, Toronto, ON Canada M4N 3M5. shawn.tracy(-atsign-)sw.ca

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: BMC family practice (BMC Fam Pract), published in England. (Language: eng)

Reference: 2003-Sep; vol 4 (issue ) : pp 13

Dates: Created 2003/10/29; Completed 2003/10/31; Revised 2006/11/15;

PMID: 14505494, status: MEDLINE (last retrieval date: 11/6/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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