How doctors practice evidence-based medicine

Evidence-based medicine (EBM) has gained worldwide attention. Many studies have used questionnaires to discuss factors obstructing the practice of EBM. However, no large-scale data analysis has focused on who has practised EBM and when they practised it. This retrospective study aims to fill the research gap by applying nationally representative data to analyse EBM practice after the provision of new evidence regarding the prescription of rosiglitazone which has been shown to increase the risk of myocardial infarction.

We used the National Health Insurance Database in Taiwan to analyse the variations in rosiglitazone prescription among physicians. The study period was from the second quarter of 2007 to the fourth quarter of 2008. A total of 2536 physicians who prescribed rosiglitazone at least once were included in this study. We applied multivariate logistic analyses to predict the probability of physicians ceasing to prescribe rosiglitazone.

We observed a significant improvement in EBM practice among specialists and experienced physicians. Endocrinologists were four times more likely to change rosiglitazone prescription habits than other specialists (odds ratio 4.129, 95% confidence interval 2.484-6.863). Doctors with more than 10 years of specialist experience performed better in EBM practice. Moreover, a prominent time lag with more than 6 months between EBM emergence and EBM practice was noticed.

Our study suggested that EBM was still not well practised, using rosiglitazone prescription as a study case. Further education and encouragement to strengthen physicians' EBM practice remain urgently needed within the medical community.