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A qualitative study of evidence in primary care: what the practitioners are saying
Wayne Putnam1, Peter L Twohig, Frederick I Burge
1Department of Family Medicine, Dalhousie University, Halifax, NS. Wayne.Putnam@Dal.Ca
Background:
Little is known about the impact of evidence-based medicine in primary care. Our objective was to explore the influence of evidence on day-to-day family practice, with specific reference to cardiovascular disease.
Methods:
A total of 9 focus groups were conducted in rural, semi-urban and urban settings in Nova Scotia. The participants were 50 family physicians who had practised in their communities for more than 1 year and who were treating patients with cardiovascular disease.
Findings:
Two major themes emerged: evidence in the clinical encounter and the culture of evidence. The family physicians reported thinking about evidence during the clinical encounter but still situated that evidence within the specific context of their patients and their communities. They appreciated evidence that had been appraised, summarized and published as a guideline by an independent national organization. Evidence remained in the forefront of consciousness for a limited time frame. Local specialists, trusted because of their previous successes with shared patient care, were important sources and interpreters of evidence.
Interpretation:
Day-to-day family practice offers both obstacles and opportunities for the application of evidence. Although evidence is an important part of clinical practice, it is not absolute and is considered along with many other factors.