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EBM in primary care: a qualitative multicenter study in Spain.
Carlos Calderón1, Iván Sola, Rafael Rotaeche
1Centro de Salud de Alza, Donostia-San Sebastián, Spain. ccalderong@telefonica.net
BMC Family Practice
|August 11, 2011
Summary
Spanish family physicians perceive evidence-based medicine (EBM) as a valuable but incomplete tool for primary care. They balance EBM with experience, questioning expert authority and seeking patient-centered approaches.
Area of Science:
- Primary Care Research
- Medical Sociology
- Evidence-Based Medicine
Background:
- Evidence-based medicine (EBM) has significantly impacted Spanish primary care.
- Research on family physicians' (FPs) attitudes towards EBM is limited.
- This study explores FPs' perceptions of EBM within the primary care setting.
Purpose of the Study:
- To investigate family physicians' perceptions of evidence-based medicine in Spain.
- To understand how FPs integrate EBM into their clinical practice.
- To explore the dynamic construction of EBM meaning in primary care.
Main Methods:
- Qualitative methodology utilizing 8 focus groups with 67 FPs from 47 health centers across 4 Spanish regions.
- Intentional sampling based on EBM education and experience.
- Sociological discourse analysis supported by MAXqda software, with results validated through triangulation and participant contrast.
Main Results:
- FPs experience a tension between EBM's "science" and clinical "experience."
- EBM sensemaking is influenced by contextual factors and perceived interests.
- FPs expressed doubt regarding EBM experts' authority and viewed EBM as simplified guidelines, not encompassing all aspects of good clinical practice.
Conclusions:
- Rethinking the meaning of "evidence" is crucial for aligning EBM with primary care realities.
- The reactive use of EBM may not always prioritize patient needs.
- New forms of EBM texts and experts may emerge, challenging current authority structures.
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